CARDIAC CATHETERIZATION

More information in Pagana and Pagana Clarification for catheterization and chronic stable angina patient: Main reasons a cardiac catheterization is recommended for a patient with chronic stable angina (according to American College of Cardiology Foundation and American Heart Association): Patients with disabling chronic stable angina despite medical therapy High-risk criteria on clinical assessment or noninvasive testing regardless of anginal severity Patient who have survived sudden cardiac death or serious ventricular arrhythmia Patients with angina and symptoms and signs of congestive heart failure PRE: 1. Assess for allergies to radiopaque dye, iodine, or shellfish. Patient may be pretreated for the allergies. 2. Written, informed consent by physician 3. NPO for 6-8 hours prior to procedure 4. Adequate hydration a. IV insertion with fluids as ordered b. Clear liquids up to 4 hours before procedure may be allowed 5. 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 the cath lab (information on front of chart, called to cath lab). 7. Explain the procedure to the patient. Explain that they will be awake and may experience a flushing sensation as the dye is injected or feel fluttering as the catheter passes through the heart. 8. Medications: Hold metformin (Glucophage). Generally, hold low molecular weight 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 policy 2. Maintain strict bedrest per physician’s orders (up to 4-6 hours) with head of bed elevated < 15-30 degrees 3. Continuous EKG monitoring 4. 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 signs 6. Maintain dressing at insertion site 7. Maintain IV, encourage oral fluids, and monitor intake and output 8. Report significant problems to physician: chest pain, dysrhythmias, bleeding, hematoma, significant changes in vital signs or peripheral pulses

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