Place : College of Nursing, MMC, Madurai

Name of the Subject : Medical Surgical Nursing

Group of student s :
Name of Topic : Cardiac Catheterization
Date :
Time :
Venue : Male Medical Ward
Methods of teaching : Lecture cum demonstration
Teaching Aids : Roller board, Charts, Handout
Name of the student teacher : Raj Kumar.K
Placement : M.Sc., Nursing I year
Name of the Guide / Evaluator : Mrs. S.MUNIAMMAL, M.Sc (N)
Lecturer, College of Nursing,
Madurai Medical College,
Madurai - 20

INTRODUCTION:

It is the insertion of a catheter into a chamber or vessel of the heart. This is done both for
diagnostic and interventional purposes. Subsets of this technique are mainly , involving the catheterization of the
coronary arteries, and catheterization of chambers and valves of the heart.
 Yes, that is the Cardiac Catheterization topic, we are going to discuss in detail.

CENTRAL OBJECTIVE

Enable the student should be able to obtain or acquire knowledge and skills regarding

the Cardiac Catheterization and develop desirable attitudes and skills towards Cardiac Catheterization.
 CONTRIBUTORY OBJECTIVES:

At the end of the demonstration the students will be able to,

 define the “Cardiac Catheterization’

 list out the indications and purposes of Cardiac Catheterization

 what are all the contraindication of Cardiac Catheterization

 explain the procedure for Cardiac Catheterization

 enumerate the nursing management of Cardiac Catheterization

 enlist the complications of Cardiac Catheterization

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1 min eefine the DEFINITION Explaining Roll Listening What is

cardiac Cardiac catheterization (heart cath) er and taking mean by

 catheterizati is the insertion of a catheter into a chamber or boar notes cardiac

on vessel of the heart. This is done both for d catheterizati

diagnostic and interventional purposes. Subsets of on?

this technique are mainly coronary catheterization,

involving the catheterization of the coronary

arteries, and catheterization of cardiac chambers

and valves of the cardiac system

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2 min list out the Indications & Purpose Explaining Char Listening What are all

indications Indications for cardiac catheterization include the t and taking the
following:
an d notes indications
 purposes of of cardiac
 To confirm the presence of suspected
Cardiac coronary artery disease (CAD) and define catherization
its anatomical location and severity
catheterizati  To perform angioplasty or stenting in a
patient with symptoms of CAD
on  To determine the presence and severity of
valvular heart disease
 To assess the presence of CAD in patients
who are referred for cardiac surgery so that
concomitant bypass surgery can be
performed, if indicated
 To provide anatomic and hemodynamic
information on the various heart chambers
and great vessels
 To assess the presence of pulmonary
embolism and/or efficacy of treatment with
thrombolytic therapy
 To help confirm angiographic and
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 hemodynamics before initiating therapy in
patients with suspected hypertrophic
cardiomyopathy
 To provide details about potential
 responsiveness of the vessel to vasodilators
in patients with pulmonary hypertension
 To assess the presence of CAD in patients
with chest pain of uncertain origin in whom
there is confusion about the presence of
CAD (ie, who are unable to undergo
noninvasive testing or who have
indeterminate nondiagnostic stress test
results)

3 min what are all Asking Han Answering Name the

CONTRAINDICATION
contraindicat questions dout and contraindicat

ion of  Severe uncontrolled hypertension and/or and listening ion of

pulmonary edema; these should be
cardiac controlled prior to the procedure explaining catheterizati
 Decompensated left-sided heart failure
catheterizati  Severe ventricular irritability that may on
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 complicate interpretation of left-sided heart
catheterization
 Reversible anemia, which should be
corrected with blood transfusions
  Hypokalemia
 Digitalis toxicity
 Allergy to contrast dye
 Acute or ongoing renal failure, without
dialysis
 Bleeding disorder, including warfarin
4 min explain the therapy explaining Dem Listening How to

procedure PROCEDURE onstr perform

for cardiac ation cardiac

 " Cardiac catheterization" is a general term
catheterizati for a group of procedures that are performed catheterizati
using this method, such as coronary
on angiography and left ventricle angiography. on?

 Once the catheter is in place, it can be used

to perform a number of procedures

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including, coronary angioplastyballoon
septostomy, electrophysiology study or catheter
ablation.

 Procedures can be diagnostic or therapeutic.

 For example, coronary angiography is a
diagnostic procedure that allows the
interventional cardiologist to visualize the
coronary vessels.

 Percutaneous coronary intervention,

however, involves the use of mechanical
stents to increase blood flow to previously
blocked (or occluded) vessels. Other
common diagnostic procedures include
measuring pressures throughout the four
chambers of the heart and evaluating
pressure differences across the major heart
valves.

 Interventional cardiologists can also use

cardiac catheterization to estimate the
cardiac output, the amount of blood pumped
by the heart per minute.
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 Cardiac catheterization requires the use of
fluoroscopy to visualize the path of the
catheter as it enters the heart or as it enters
the coronary arteries.
  The coronary arteries are known as
"epicardial vessels" as they are located in
the epicardium, the outermost layer of the
heart.[2] Fluoroscopy can be conceptually
described as continuous x-rays. The use of
fluoroscopy requires radiopaque contrast,
which in rare cases can lead to contrast-
induced kidney injury (see Contrast-induced
nephropathy).

There are two major categories of cardiac

catheterization

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 Left heart catheterization allows for direct
intervention in cases of coronary artery
occlusion.

 This technique is also used to assess the

 amount of occlusion (or blockage) in a
coronary artery, often described as a
percentage of occlusion.

 A thin, flexible wire is inserted into either

the femoral artery or the radial artery and
threaded toward the heart until it is in the
ascending aorta. At this point, the wire can
be maneuvered into the coronary ostia and
into the coronary arteries.

 A catheter is guided over the wire and

enters either the left or right coronary artery.
In this position, the interventional
cardiologist can inject contrast and visualize
the flow through the vessel.

 If necessary, the physician can utilize

percutaneous coronary intervention
techniques, including the use of a stent
(either bare-metal or drug-eluting) to open
the blocked vessel and restore appropriate
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blood flow. In general, occlusions greater
 than 70% of the width of the vessel lumen are
thought to require intervention.

 However, in cases where multiple vessels

are blocked (so called "three vessel
disease"), the interventional cardiologist
may opt instead to refer the patient to a
cardiothoracic surgeon for coronary artery
bypass graft (CABG; see Coronary artery
bypass surgery) surgery.
 Right heart catheterization allows the
physician to determine the pressures within
the heart (intracardiac pressures). In this
case, the heart is most often accessed via
the femoral vein; neither the femoral artery
nor the radial artery are used.
 Values are commonly obtained for the right
atrium, right ventricle, pulmonary arteries,
and for the pulmonary capillary "wedge"
pressures, which approximate the pressure
values of the left-sided heart chamber
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 Right heart catheterizations also allow the
physician to estimate the cardiac output, the
amount of blood that flows from the heart
 each minute, and the cardiac index, a
hemodynamic parameter that relates the
cardiac output to a patient's body surface
area.
 Determination of cardiac output can be
done by releasing a small amount of normal
saline in one area of the heart and
measuring temperature changes over time
in another area of the heart. It is important
to note that the coronary arteries are not
accessed during a right heart
catheterization.

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Catheterization of chambers and
 valves
 Catheterization of cardiac chambers and
valves may be performed at the same time
as a coronary catheterization, and may also
involve nearby major vessels, such as the
aorta. It is the main method of cardiac
ventriculography (another being
radionuclide ventriculography, whose use
has largely been replaced by
echocardiography)

 It has the ability to measure the pressure

gradient across a valve and derive valve
area from it. Thereby, it can assist in
diagnosis of, for example, aortic stenosis.

 This is also the procedure used in balloon

septostomy, which is the widening of a
foramen ovale, patent foramen ovale (PFO),
or atrial septal defect (ASD) using a balloon
catheter.
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5 min enumerate NURSING MANAGEMENT Explaining leafl Listening Discuss the
 the nursing  Record the blood pressure measurements, et nursing

management apical pulse every 15 minutes for more management

of cardiac frequentlyuntil vital signs are stable. of cardiac

catheterizati  Check peripheral pulse in affecteextremities catheterizati

on exvaluate the extremities temperature, color on?

and complaints of pain, numbness or

tingling sensation to determine the arterial

insufficiency.

 Watch the cutdown sites for hematoma

formations.question the patient of pain or.

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 Assess the complaints of chest pain and

inform immediately to physician.MI may

 occurs as a serious complication.

 Evaluate the complaints of back, thigh,

groin pain it may indicates retroperitoneal

bleeding.

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6 Enlist the Vascular complications of catheterization Explaining Listening List out the

min complication These may include the following: and taking complication

of cardiac  Accelerated atherosclerosis notes s of cardiac

 Arteriovenous fistula
catheterizati  Avulsion of artery catheterizati
 Bleeding
 on  Compartment syndrome on?
 Cutaneous infection
 Delayed reflex sympathetic dystrophy
 Digital ischemia
 Hematoma
 Perforation, laceration, dissection
 Pseudoaneurysm
 Vessel spasm
 Subcutaneous granulomatous reaction
(hydrophilic coating)
 Subacute and delayed occlusion
 Transient vocal cord paralysis

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 EVALUATION

CONTENT
Summary :-
So for we discussed about the definition of the cardiac catheterization, indications and purpose,
contra indication ,procedure, nursing management and complications of cardiac catheterization

EVALAUATION:-
ASSIGNMENT:-
Explain the cardiac catheterization
TEST TOTAL MARKS-25
TIME : 1 HOUR

1. ESSAY:- 15 marks
Define cardiac catheterization? Explain the procedure?
 2. SHORT NOTES:
A) Discuss the nursing management of cardiac catheterization? 10 marks
B) Enlist the purpose, contraindications and complication of cardiac catheterization?

BIBLIOGRAPHY:

Book reference
1. Brunner and suddharth, 2010, a textbook of medical surgical nursing, 11 th edition published by lippincot at
New Delhi
2. Lewis, 2015, A textbook of medical surgical nursing, 2nd south asian edition, elesiver publishers at New
Delhi
3. Black, J.M. & Hawks, J.H. (2009). Medical-Surgical Nursing: Clinical Management for Positive Outcomes
(8th ed.). Philadelphia: Elsevier/Saunders.
4. Hinkle, J.L., & Cheever, K.H. (2014). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th
ed.). Philadelphia: Lippincott Williams & Wilkins.

Student reference:-
1. Brunner and suddharth, 2010, a textbook of medical surgical nursing, 11 th edition published by lippincot at
New Delhi
2. Lewis, 2015, A textbook of medical surgical nursing, 2nd south asian edition, elesiver publishers at New
Delhi
3. Black, J.M. & Hawks, J.H. (2009). Medical-Surgical Nursing: Clinical Management for Positive Outcomes
(8th ed.). Philadelphia: Elsevier/Saunders.
4. Hinkle, J.L., & Cheever, K.H. (2014). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th
ed.). Philadelphia: Lippincott Williams & Wilkins.