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Cardiac catheterization

This slides explain about cardiac catheterization, in detail including nursing management

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Cardiac catheterization

  1. 1. Cardiac Catheterization
  2. 2. Introduction Cardiac Catheterization is a procedure performed both for diagnostic and interventional purposes . The role of nurse is important while pre catheterization , intra and post catheterization.
  3. 3. Definition It is one of the invasive procedure used to visualize the heart chambers , valves and great vessel in order to diagnose and treat abnormalities of the coronary arteries
  4. 4. Purpose To analyze Chamber pressure O2 saturation Ventricular function Valvular insufficiency Stenosis Septal defects Congenital abnormalities Myocardial infarction
  5. 5. Indications Both diagnostics and therapeutics ❏ Unstable angina ❏ ACS ❏ Myocardial Infarction ❏ Congenital defects ❏ Abnormal stress test ❏ Planned valve surgeries ❏ Cardiogenic shock ❏ Ventricular arrhythmias
  6. 6. Therapeutic ❏ Percutaneous coronary angiogram ❏ Percutaneous transluminal coronary angioplasty ❏ Valvuloplasty ❏ Valvotomy
  7. 7. Contraindication ❏ Hypersensitivity to contrast medium ❏ Pregnancy ❏ Severe systemic infection ❏ Irreversible brain damage ❏ Severe heart failure ❏ Acute GI bleeding ❏ Severe hypokalemia ❏ INR more than 1.8 ❏ Acute renal failure ❏ Severe Anemia
  9. 9. Sites used in cardiac catheterization Right side: ● Femoral vein ● Antecubital vein Left heart: ● Brachial artery ● Radial artery ● Femoral artery
  10. 10. Catheters used
  11. 11. Swan Ganz catheter
  12. 12. Contrast agents ● Sodium diatrizoate ● Iohexol ● Ioversol ● Ioxaglate
  13. 13. Patient preparation ● Doctor’s order ● Informed consent ● Lab test CBC,ESR,Renal function, PT,INR, ECHO,X ray, Infectious markers and serology tests ● Check for allergy to iodine and seafoods ● Skin preparation ● IV cannulation ● Placement of ECG electrodes ● Check pedal pulse and mark it .( Dorsalis pedis and Posterior tibial) ● Monitor hemodynamic status ● Keep NPO for 6 to 8 Hrs
  14. 14. ● If creatinine above 1.5 IV fluid should be stated 6 hrs prior to angiogram ● ECG should be taken(12 lead ECG) ● Due per medications should be administered as per order( Aspirin, Clopidgrel, Pantoprazole, Diazepam ● Empty the bladder before sending patient to cath lab ● Instruct the patient regarding procedure time and experience of hot flush during injection of dye ● Sometime patient may have nausea and headache ● Assist the patient go wear OT dress ● Check for any implants ,dentures etc ● Handover the valuables to appropriate person ● Check and document height and weight to calculate the dose of dye or contrast media
  15. 15. Procedure ● As per the site / type of catheterization, a fluoroscopic catheter is inserted into the appropriate vessel ● Advancement of catheter is visualized in X Ray fluoroscopic image ● The images are recorded for evidence ● Once the cathternisnin position measured amount of contrast media is injected ● Nurse during this time need to monitor the hemodynamic status ● Advanced cardiac life support drugs and supplies are kept ready
  16. 16. Procedure (contn..) ● Patient should be monitored for any cardiac arrhythmias ● The size of the chambers, pressures are checked as per the need ● To visualize coronary arteries the catheter is placed in ascending aorta and the contrast is injected into coronary arteries ● If therapeutic is indicated ,it is done accordingly ● Patient’s pedal pulse is checked frequently during the procedure for signs of poor perfusion of the extremity ● Once the procedure is done the catheters are removed and pressure dressing is applied ● Patient shifted to recovery room for observation
  17. 17. Post procedure care ● Bedrest for 6 hours with affected extremity ● Observe the catheter site for bleeding or hematoma ● Record 12 lead ECG and correlate the findings ● Check peripheral pulses in the affected extremity every 15 mins for 1 hour and 30 mins for next hour and every hour ● Monitor hemodynamic status continuously ● Watch for signs of complications ● Advice the patient to keep the affected leg straight for 4 to 6 hours ● Head can be elevated to 30 Degree ● Started feeding and advice to drink more fluids ● Repeat LABS if needed
  18. 18. Complications ● Arrhythmias ● Thrombosis ● Pericardial tamponade ● Embolism ● Stroke ● Myocardial Infarction ● Bleeding/Hematoma ● Contrast reaction