PRE CATH LAB CHECK LIST

PATIENT IDENTIFICATION

PERMIT SIGNED FOR:
RIGHT & LEFT CARDIAC CATHETERIZATION WITH POSSIBLE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY / STENT / INTRAVASCULAR ULTRASOUND. RIGHT & LEFT CARDIAC CATHETERIZATION OTHER: __________________________________________ PRE-OP TEACHING: I.D. BAND: ASSESS FOR ALLERGIES TO INCLUDE CONTRAST / IODINE / SHELLFISH ALLERGY IF "Yes" TO CONTRAST, IODINE or SHELLFISH, CONTACT PHYSICIAN FOR BENADRYL / STEROID ORDERS ANTIPLATELETS / ANTICOAGULATION MEDS: (Military) TIME & DATE LAST RECEIVED ASPIRIN PLAVIX LOVENOX HEPARIN OTHER: _________________________________________ NPO SINCE: SEDATION: IV INFUSING KVO: MED KARDEX & CRITICAL CARE FLOW SHEET ON CHART: LABEL DISTAL PULSES:
HEIGHT:

YES NO

COMMENTS

PLEASE NOTE AMOUNT, (Military) TIME & DATE of MEDICATION GIVEN

Date __________

Milit. Time __________ PLEASE SPECIFY MANDATORY MANDATORY (Military) TIME & DATE

(R) Posterior Tibial _______ (L) Posterior Tibial _______
WEIGHT: B / P:

(R) Dorsalis Pedis _______ (L) Dorsalis Pedis _______
H R:

0 = Absent +2 = Weak

D = Doppler +3 = Strong

+1 = Intermittent

LAB VALUES:
K: CR:

DATE:

Milit. TIME:

RN Signature / Title
BUN: PLT:

HGB:

HCT:

PT:

INR:

DATE

Military TIME

8850363 Rev. 06/04

Cath Lab Check Off List_NURSING-CATH LAB

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