Angiography 1 | Angiography | Angina Pectoris

NURSING CARE

BEFORE THE PROCEDURE

OF THE CLIENT HAVING CORONARY ANGIOGRAPHY
15 minutes for first hour, every 30 minutes for the next hour, then hourly for 4 hours or until discharge. The data provide vital information about the client’s status and potential complications such as bleeding, hematoma, or thrombus formation. Maintain bed rest as ordered, usually for 6 hours if the femoral artery is used, or 2 to 3 hours if the brachial site is used. The head of the bed may be raised to 30 degrees. Bed rest reduces movement of and pressure in the affected artery, reducing the risk of bleeding or hematoma. Keep a pressure dressing, sandbag, or ice pack in place over the arterial access site. Check frequently for bleeding (if the access site is in the groin, check for bleeding under the buttocks). Arteries are high-pressure systems. The risk for significant bleeding after an invasive procedure is high. Instruct to avoid flexing or hyperextending the affected extremity for 12 to 24 hours. Minimizing movement of the affected joint allows the artery to effectively seal and promotes blood flow, reducing the risk of bleeding, hematoma, or thrombus formation. Unless contraindicated, encourage liberal fluid intake. An increased fluid intake promotes excretion of the contrast medium, reducing the risk of toxicity (particularly to the kidneys). Promptly report diminished peripheral pulses, formation of a new hematoma or enlargement of an existing one, severe pain at the insertion site or in the affected extremity, chest pain, or dyspnea. While the risk of complications is low, myocardial infarction or insertion site complications may occur. These necessitate prompt intervention. Provide instructions about dressing changes, follow-up appointments, and potential complications prior to discharge.

• Assess the client’s and family’s knowledge and understanding of the procedure. Provide additional information as needed. Explain that the client will be awake during the procedure, which takes 1 to 2 hours to complete. A sensation of warmth (a “hot flash”) and a metallic taste may occur as the dye is injected. A rapid pulse or a few “skipped beats,” also are common and expected during the procedure. A good understanding of the procedure and expected sensations reduces anxiety and improves cooperation during the procedure. • Provide routine preoperative care as ordered (see Chapter 7). Although the client remains awake, sedation may be given. Signed consent is required, and preprocedure fasting may be ordered. • Administer ordered cardiac medications with a small sip of water unless contraindicated. Regularly ordered medications are continued to prevent cardiac compromise or dysrhythmias during the procedure. • Assess for hypersensitivity to iodine, radiologic contrast media, or seafood. An iodine-based radiologic contrast dye is typically used for an angiogram. Iodine or seafood allergy increases the risk for anaphylaxis and requires an alternative dye or special precautions. • Record baseline assessment data, including vital signs, height, and weight. Mark the locations of peripheral pulses; document their equality and amplitude. The data provide a baseline for evaluating changes after the procedure. • Instruct to void prior to going to the cardiac catheterization laboratory, to promote comfort.

AFTER THE PROCEDURE
• Assess vital signs, catheterization site for bleeding or hematoma, peripheral pulses, and neurovascular status every

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