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Cardiac Catheterization

Cardiac Catheterization

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Published by: jacallis on Feb 24, 2008
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01/30/2013

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CARDIAC CATHETERIZATION
More information in Pagana and PaganaClarification for catheterization and chronic stable angina patient:Main reasons a cardiac catheterization is recommended for a patient with chronic stableangina (according to American College of Cardiology Foundation and American HeartAssociation):Patients with disabling chronic stable angina despite medical therapyHigh-risk criteria on clinical assessment or noninvasive testing regardlessof anginal severityPatient who have survived sudden cardiac death or serious ventricular arrhythmiaPatients with angina and symptoms and signs of congestive heart failurePRE:1.Assess for allergies to radiopaque dye, iodine, or shellfish. Patient may be pretreated for the allergies.2.Written, informed consent by physician3.NPO for 6-8 hours prior to procedure4.Adequate hydrationa.IV insertion with fluids as ordered b.Clear liquids up to 4 hours before procedure may be allowed5.Use of N-acetylcysteine (Mycomyst) prior to and post cardiac catheterization in patients who are at risk for contrast nephropathy (for example, may treat if creatinine > 1.5, but depends on the hospital policy)6. Assessment of baseline vital signs, oxygen saturation, and peripheral pulses.Abnormal labs that may affect the catheterization should be communicated to thecath lab (information on front of chart, called to cath lab).7.Explain the procedure to the patient. Explain that they will be awake and mayexperience a flushing sensation as the dye is injected or feel fluttering as thecatheter passes through the heart.8. Medications: Hold metformin (Glucophage). Generally, hold low moleculaweight heparin (for example, Lovenox) on the day of the catheterization. Check adjusted insulin order for day of catheterization.POST:1.View post procedure orders and agency policy2.Maintain strict bedrest per physician’s orders (up to 4-6 hours) with head of  bed elevated < 15-30 degrees3.Continuous EKG monitoring4.Monitor VS, oxygen saturation per agency protocol.5.Assess peripheral pulses, color, sensation, temperature of extremity, signs of  bleeding or hematoma at insertion site with vital signs6.Maintain dressing at insertion site7.Maintain IV, encourage oral fluids, and monitor intake and output8.Report significant problems to physician: chest pain, dysrhythmias, bleeding,hematoma, significant changes in vital signs or peripheral pulses

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