Safe and effective care environment: List, prioritize, discuss care for patients undergoing invasive cardiac diagnostic

testing.  Create a quick concept map

Angiography (cardiac catherization) Patient teaching/preparation

 Assess patients physical and

 An invasive coronary procedure to evaluate blood
psychosocial readiness.
vessels and flow.
 MD will explain risk of procedure.
 Also used to determine areas of blood vessel
 Inform client that he/she is awake and
occlusions and/or narrowing's.
Pre-procedure sedated during procedure. In addition,
 A catheter is inserted into femoral or brachial a local anesthetic will be used before
artery and threaded into right or left side of heart.  NPO status for at least 8hrs. MD makes a small incision in groin
 Standard preoperative tests: chest x-ray, CBC, PTT, area to insert catheter.
PT, INR, and 12 lead ECG.  Instruct client to:
 Get vital signs, heart and lung sounds, and  Keep affected leg straight.
Indications: peripheral pulses.  Dressing must be kept in
 Check consent form for signature. place for the first 24 hours
 Unstable angina
 Ensure patient and family understand procedure. after discharge.
 ECG changes
 Check for iodine or shellfish allergies  Avoid strenuous exercise for
 Diagnostic confirmation of heart
disease (location and extent) prescribed period.
 Report bleeding, chest pain,
Intra-procedure (patient will be taken to cardiac SOB, color or temperature
Complications: changes on legs immediately.
catherization lab or cath lab)
 Clients with stent placement will be
 Cardiac tamponade (fluid buildup in pericardial sac)
 Give prescribed sedatives and analgesia prescribed anticoagulation therapy for
 Check for hypotension, JVD, muffled heart
 Place patient in supine position on x-ray table. 6-8 weeks.
sounds, paradoxical pulse.
 Monitor vitals and heart rhythm continuously  Need to take meds same time
 Hematoma
 Be prepared for dysrhythmias and have resuscitation everyday
 Restenosis (might occur immediately or after several
equipment and emergency meds available.  Regular lab test needed to
weeks)
check therapeutic levels
 Retroperitoneal bleeding
 Avoid bleeding.
 Myocardial Infarction (MI)
 Encourage lifestyle changes:
 Stroke
Post-procedure  Weight management
 Thromboembolism
 Low fat and sodium diet
 Dysrhythmias  Assess vital signs. Follow facility protocol for times  Regular exercise
 Arterial dissection 
 Death
Assess incision for signs of bleeding, hematoma, and  No smoking and reduced
thrombosis (check pedal pulses, color and alcohol intake.
temperature).
 Allow patient to rest in supine position with
straightened extremities.
 Monitor for dysrhythmias.
 Prevent clot formation and restenosis by
administering antiplatelet and thrombolytic agents.
 Check urine output and give IV fluids
Real world example:
My uncle “Joe” was in his late 50’s when he got heart angiography years ago after suffering from a heart attack. I have no medical knowledge that time but I
still remembered how he explained the procedure with the whole family. He mentioned that he underwent a lot of lab test in preparation and was asked if he
was allergic to iodine or shellfish which he found interesting. He then was taken into some sort of lab room then was given an injection on his thigh; this is
where a small cut was made, and a long wire was pushed up through his artery. He said that he felt a strange pushing feeling when the wire was inserted.
When I asked if the whole procedure was painful or uncomfortable, he just said that the most uncomfortable thing he felt was the dye injection. He mentioned
that the dye gave him a weird warm feeling in his head that only lasted a few seconds. Afterwards, an x-ray was taken, and the wire was pulled out. For my
uncle, the overall angiography experience was not too bad and easy in fact. No complications were found but he was told that his arteries were mostly
blocked and needed to have a heart bypass at later date.