SANAANI, Nur-hathi M.

BSN-IVA
RLE NURSING
Definition
Angioplasty, alternatively referred to as percutaneous transluminal coronary angioplasty,
is a minimally invasive procedure that typically involves inserting a balloon-tipped catheter into
the vessels to open blocked coronary vessels and alleviate ischemia. It is used to treat angina and
as a treatment for ACS. It is also possible to use catheter-based interventions to open blocked
CABGs.
Purposes
Percutaneous coronary stent, also known as percutaneous transluminal coronary
angioplasty, is a non - invasive procedure that is utilized to open blocked coronary arteries and
improve blood flow to the heart muscle by compressing and "cracking" the atheroma that has
formed within the coronary artery walls.
Objectives
 improvement in blood flow with a residual stenosis of less than 20%, in order to obtain a
maximum MAP and enhance perfusion in patients suffering from Atherosclerosis, ACS,
CAD, and MI.
 In addition, the client will no longer complain of chest pain, and the ECG may show
signs of improved myocardial perfusion, as seen by ST-segment alterations.

Equipments
Tool Purpose Illustration
Catheter A catheter is a thin,
flexible plastic tube
that can be threaded
into a blood vessel in
order to provide
treatments to the inside
of the blood channel
while in the vessel. At
the time of the
procedure, radioactive
dye is introduced
through the catheter
into the blood vessels
so that the
 cardiologists may see
images of any
blockages in the
arteries being
examined.
Angioplasty is a
procedure in which a
balloon or another
device is installed on
the tip of a catheter
and guided to the
constricted segment of
the artery with the use
of a guidewire. The
gadget attached to the
catheter is then used to
reopen the artery and
allow blood to flow
through it.
Guidewires A guidewire is a fine
metal wire that is long
and flexible, and it is
used to guide the
placement of balloons
or stents. To give
treatment, the
guidewire is inserted
through a blood vessel
to the location where it
will be used as a
guide. A balloon or
stent is then inserted
over the guidewire
until it reaches the
proper position, at
which point it is
removed.
Balloons In order to perform
angioplasty, a specific
balloon catheter with a
balloon attached at one
end and a balloon that
may be inflated at the
other end outside the
body must first be
placed within the
body. It is the
interventional
cardiologist's job to
thread the balloon
catheter over a
guidewire to the
portion of the artery
that has gotten blocked
with a fatty material
known as plaque; the
plaque is the source of
the problem that is
stopping your blood
from flowing properly.

Stents A stent is a tiny,

metal-mesh tube that is
transported to the site
of a blocked artery
using a catheter and
then permanently
lodged within the
artery after it has been
placed there.
A stent is a small
scaffold that is used to
keep an artery open
and prevent it from
collapsing or being
reblocked with plaque
after it has been
opened. The HCP can
select between three
types of stents: bare
metal, drug-eluting, or
 bioabsorbable, if the
patient is taking part in
a clinical trial (also
known as
bioresorbable).
The type of stent that
your doctor
recommends will be
determined by the size
of the artery, the
location of the
blockage, and other
considerations
particular to your
situation, such as
whether or not you
have diabetic
complications.
Vascular Closure In the following of an
Devices interventional
procedure, the health-
care provider must
ensure that the
puncture site in the
patient's skin, through
which the catheters
were introduced, is
completely closed.
A collagen plug or a
stitch may be used to
close an artery that has
been reached through
the upper leg by the
HCP. It is common for
closure devices to be
made of bands that are
wrapped around your
elbow or wrist if the
treatment was
conducted through an
access point in your
 arm or leg. They can
be filled with air or
with substances that
are designed to prevent
bleeding.
Atherectomy Devices When the fatty
substance that builds
up in arteries (plaque)
contains calcium, it
might make the
blockage more
difficult to pass
through. Because of
the severity of the
calcium buildup in the
plaque, it may not be
possible to pass the
balloon through the
obstruction and push it
to the sides of the
vessel. In order to drill
through difficult
blockages, rotational
atherectomy is a
surgery that can be
performed.
Fractional Flow The fractional flow
Reserve (FFR) rate (FFR) is a test that
is used to determine
how much blood flow
is being reduced by an
arterial blockage. A
catheter is used to
deliver a pressure-
sensing guidewire to
the site of the blockage
in the artery, which is
Intravascular Sound waves are used
Ultrasound (IVUS) to create images in all
ultrasound procedures,
including IVUS.

IVUS is a technique
that is used to obtain
images of the inside of
arteries in order to
determine whether or
not a blockage is
present, and if so, how
bad the blockage is.

During an IVUS test, a

catheter with an
ultrasound probe
attached to the end is
passed through an
artery and into the area
to be checked using an
ultrasound probe.
A sound wave is
transmitted by the
ultrasound catheter
and received as echoes
from the sound waves
when they bounce
back from the body's
tissues by the receiver.
This information is
converted into images
of the artery by a
computer.
Optical Coherence OCT is an imaging
Tomography (OCT) tool used to take high-
Imaging resolution pictures of
blood vessel walls.
OCT provides
interventional
cardiologists with
detailed images of
plaque (cholesterol
and other materials
that have accumulated
in the walls of the
artery and can rupture,
causing a blood clot to
form at the site and
block off critical blood
flow). Like IVUS, this
detailed information
about plaque build-up
in arteries can help
interventional
cardiologists
determine where best
to place stents.
Near-Infrared NIRS is a new
Spectoscopy (NIRS) imaging method that
offers interventional
cardiologists more
information to
determine where
angioplasty and
stenting would be most
effective.
NIRS does something
different: It provides
real-time information
about the chemical
composition of the
blockage, which may
help interventional
cardiologists pinpoint
areas that could cause
 a problem in the near
future.

Pre-procedure:
• Go over the chart, the history, and the indications for the procedure.
o Systemic review, including cardiovascular, respiratory, gastrointestinal,
genitourinary, and reproductive/sexual health
o The ability to remain completely still for the duration of the procedure, including
the pre-, intra-, and post-operative periods.
o Claustrophobia
• Pre-procedure laboratory testing: Blood tests are required prior to a number of IR
procedures. Instructing patients on whether or not pre-procedure blood testing is required,
as well as the reasoning for the need for the blood work, is essential.
• Allergies: known allergies with a description of the types of reactions; past reactions
involving contrast, severity, and interventions; and future reactions involving contrast,
severity, and interventions. Steroids, antihistamines, and H2 antagonists may be used to
prevent contrast reactions in patients who have previously experienced them.
 When using anticoagulants, there is a higher risk of bleeding during the IR operation.
Patients should be notified well in advance that they will be need to "hold" drugs in
order to undergo a procedure.
Procedures (WITH RATIONALE)
 PTCA is carried out in the cardiac catheterization laboratory.
 Hollow catheters called sheaths are inserted, usually in the femoral artery and sometimes
femoral vein, providing a conduit for other catheters.
o Catheters are then threaded through the femoral artery, up through the aorta, and
into the coronary arteries.
 Angiography is performed using injected radiopaque contrast agents (commonly called
dye) to identify the location and extent of the blockage.
o To facilitate the procedure and removal of atheroma
 A balloon-tipped dilation catheter is passed through the sheath and positioned over the
lesion.
o To treat plaque that has proven resistant to treatment with a standard balloon,
small blades are used to create slits in the plaque, after which a balloon is used to
compress the fatty substance into the arterial wall.
 The physician determines the catheter position by examining markers on the balloon that
can be seen with fluoroscopy. When the catheter is properly positioned, the balloon is
inflated with high pressure for several seconds and then deflated.
 The pressure compresses and often “cracks” the atheroma. The media and adventitia of
the coronary artery are also stretched. Several inflations and several balloon sizes may be
required to achieve the goal.
 o to compress the fatty substance into the arterial wall & to improve blood flow
 Intracoronary stents are usually positioned in the intima of the vessel to maintain patency
after the balloon is withdrawn.
Post procedure
 Assess affected extremity, noting its color, temperature, and capillary refill; Palpate distal
pulses; Use doppler every 15 minutes for 4 times, every 30 minutes for 3 hours, then
every 4 hours.
o Rationale: Formation of a clot at the puncture site and the child is at risk of the
clots severely obstructing distal blood and resulting in tissue damage. Frequently
assessment of the extremity for adequate perfusion enables for prompt
intervention as needed.
 Encourage bed rest and keep affected extremity straight or slight bend in the knee (10
degrees) for 6 hours.
o Rationale: Bed rest and slight, or no flexion, provides improve circulation and
minimizes the risk of further trauma which could promote the formation of a clot.
 Provide warmth to the opposite extremity.
o Rationale: Enhances blood flow without causing risk of increased bleeding at the
site.
 Inform parents and child of a need for frequent vital signs monitoring and importance of
bed rest with an extension of the extremity.
o Rationale: Promotes understanding and cooperation.
Nursing Responsibilities
 During the PCI, patients receive IV heparin or a thrombin inhibitor (eg, bivalirudin
[Angiomax]) and nurse are expected yo monitored closely for signs of bleeding.
 Patients may also receive a GP IIb/IIIa agent (eg, eptifibatide) for several hours following
the PCI to prevent platelet aggregation and thrombus formation in the coronary artery so
nurse must perform a close monitoring for signs of bleeding.
 If hemostasis is achieved, sheath is removed and direct manual pressure, and mechanical
compression device (eg, C-shaped clamp), or a pneumatic compression device are placed
as a splint to prevent massive bleeding.
 Instruct patient that they must remain flat in bed and keep the affected leg straight until
the sheaths are removed and then for a few hours afterward to maintain hemostasis.
o Because immobility and bed rest may cause discomfort, treatment may include
analgesics and sedation.
 The patient is instructed to monitor the site for bleeding or development of a hard mass
indicative of hematoma.
 Illustration:

Reference:
Brunner, & Suddarth. (2018, November 30). Brunner & Suddarth’s Textbook of Medical-Surgical

Nursing. South Asian Edition. Retrieved from ResearchGate website:

https://www.researchgate.net/publication/336144894_Brunner_Suddarth

Martin, P. (2018, June 20). 4 Cardiac Catheterization Nursing Care Plans. Retrieved from Nurseslabs

website: https://nurseslabs.com/cardiac-catheterization-nursing-care-plans/

SecondsCount. (2011, March 23). Tools and Devices Your Healthcare Team May Use in the Cath Lab.

Retrieved from The Society for Cardiovascular Angiography and Interventions website:

http://www.secondscount.org/treatments/treatments-detail-2/tools-devices-your-interventional-

cardiologist-may-3

Rowina R. Abellon, RN,

MN
Clinical Instructor
Clinical Instructo