CARDIAC

CATHETERIZATION

Adult 2

CARDIAC CATHETERIZATION

❑ Description

❑ Indications

❑ Contraindications

❑ Complications and Risks

❑ Pre-procedure interventions

❑ Post-procedure interventions

CARDIAC CATHETERIZATION

1. Description

An invasive test involving insertion of a catheter into the heart and surrounding vessels

Obtains information about the structure and performance of the heart chambers and valves and the coronary circulation

The procedure involves inserting a long, flexible, catheter into a peripheral vein peripheral artery and guiding it under fluoroscopy (x-ray observation) or angiography.

Superiorvena cava

Right-sided heart catheterization. The catheter is insertedinto the femoral vein and advanced into the inferior vena

cava (or, if into an antecubital or basilic vein, through the

superior vena cava), right atrium, right ventricle, and pulmonary artery.

Pulmonaryartery

Inferiorvena cava

Rightventricle

Femoralvein

THE INDICATIONS FOR CARDIAC

CATHETERIZATION

are to:

❖ Confirm suspected heart disease, including coronary artery disease, myocardial disease, valvular disease and valvular dysfunction

❖ To determine the location and extent of the disease process.

❖ To assess the following:

➢ Stable, severe angina unresponsive to medical management

➢ Unstable angina pectoris

➢ Uncontrolled heart failure, ventricular dysrhythmias, or cardiogenic shock associated with acute myocardial infarction, papillary muscle dysfunction, ventricular aneurysm, or septal perforation.

CONTRAINDICATIONS

Active GI bleed

Renal failure

Recent stroke

Fever from infection

Electrolyte imbalance

Anemia

Short life expectancy

Digitalis intoxication

Uncontrolled

hypertension

Pregnancy

Bleeding disorders

Pulmonary edema

Uncontrolled

ventricular

arrhythmias

Allergic to contrast

Pressures

❑ Left ventricular systolic 90-140mm Hg

❑ Left ventricular end diastolic 4-12mm Hg

❑ Central venous Pressure (CVP) 2-8 mmHg

❑ Left atrium 2-12mm Hg

❑ Pulmonary artery systolic/end-diastolic 17-32/4-13mmHg

❑ Pulmonary wedge pressure 6-13 mm Hg

Cardiac Output 3-6 L/min

Ejection Fraction 60-70% (above 55%)

COMPLICATIONS AND RISKS

❖ Death

❖ Myocardial infarction

❖ CVA

❖ Arrhythmia

❖ Hemorrhage

❖ Contrast allergen

❖ Hemodynamic usability

❖ Perforation

HEMORRHAGE

PRE-PROCEDURE INTERVENTIONS

➢ Ensure that informed consent has been obtained.

➢ Assess for allergies to seafood, iodine, or radiopaquedyes; if allergic, the client may be premedicated with antihistamines and corticosteroids to prevent a reaction.

➢ Withhold solid food for 6 to 8 hours and liquids for 4 hours as prescribed to prevent vomiting and aspiration during the procedure.

➢ Document the client’s height and weight because these data will be needed to determine the amount of dye to be administered.

PREPROCEDURE INTERVENTIONS

➢ Document baseline vital signs and note the quality and presence of peripheral pulses for post-procedure comparison.

➢ Inform the client that a local anesthetic will be administered before catheter insertion.

➢ Inform the client that he or she may feel a fluttery feeling as the catheter passes through the heart, a flushed and warm feeling when the dye is injected, a desire to cough, and palpitations caused by heart irritability.

PREP-ROCEDURE INTERVENTIONS

➢ The insertion site is prepared by shaving and

cleaning with an antiseptic solution.

➢ Administer pre-procedure medications such as

sedatives if prescribed.

➢ Insert an IV line if prescribed.

CAUTION

If a client taking metformin is scheduled to

undergo a procedure requiring the

administration of iodine dye, the metformin is

withheld for 24 hours prior to the procedure

because of the risk of lactic acidosis. The

medication is not resumed until prescribed by the

HCP (usually 48 hours after the procedure or

after renal function studies are done and the

results are evaluated).

POST-PROCEDURE INTERVENTIONS

➢ Monitor vital signs and cardiac rhythm for

dysrhythmias at least every 30 minutes for 2

hours initially.

➢ Assess for chest pain and, if dysrhythmias or

chest pain occurs, notify the HCP.

➢ Monitor peripheral pulses and the color

warmth, and sensation of the extremity distal to

the insertion site at least every 30 minutes for 2

hours initially.

POST-PROCEDURE INTERVENTIONS

➢ Notify the HCP if the client complains of numbness

and tingling; if the extremity becomes cool, pale, or

cyanotic; or if loss of the peripheral pulses occurs. This

could indicate clot formation and is an emergency.

➢ Apply a sandbag or compression device (if prescribed)

to the insertion site to provide additional pressure if

required.

➢ Monitor for bleeding; if bleeding occurs, apply manual

pressure immediately and notify the HCP.

POST-PROCEDURE INTERVENTIONS

➢ Monitor for hematoma if a hematoma develops, notify the HCP.

➢ h. Keep the extremity extended for 4 to 6 hours, as prescribed, keeping the leg straight to prevent arterial occlusion.

➢ Maintain strict bed rest for 6 to 12 hours, as prescribed; however, the client may turn from side to side. Do not elevate the head of the bed more than 15 degrees.

➢ If the antecubital vessel was used, immobilize the arm with an arm board.

➢ Encourage fluid intake, if not contraindicated, to promote renal excretion of the dye and to replace fluid loss caused by the osmotic diuretic effect of the dye.

➢ Monitor for nausea, vomiting, rash, or other signs of hypersensitivity to the dye.

CARDIC CATHETERIZATION

https://www.youtube.com/watch?v=pX8VpeWLE7I