Details of procedure

What happens during a cardiac catheterization?

A cardiac cath can be done on an outpatient basis or as part of your stay
in a hospital. Procedures may vary depending on your condition and
your doctor's practices.

Generally, a cardiac cath follows this process:

1. You'll remove any jewelry or other objects that may interfere with the procedure. You
may wear your dentures or hearing aids if you use either of these

2. Before the procedure, you should empty your bladder then change into a hospital
gown.
3. A healthcare professional may shave the area where the catheter will be put in. The
catheter is most often put in at the groin area, but other places used are the wrist, inside
the elbow, or the neck.

4. A healthcare professional will start an intravenous (IV) line in your hand or arm before
the procedure to inject the dye and to give you IV fluids, if needed.

5. You will be connected to an ECG monitor that records the electrical activity of your
heart and monitors your heart during the procedure using small electrodes that stick to
your skin.

6. You will get a sedative in your IV before the procedure to help you relax. But you will
likely be awake during the procedure.
7. Your pulses below the catheter insertion site will be checked and marked so that the
circulation to the limb can be checked after the procedure.

8. Your doctor will inject a local anesthetic (numbing medicine) into the skin where the
catheter will be put in. You may feel some stinging at the site for a few seconds after the
local anesthetic is injected.

9. Once the local anesthetic has taken effect, your doctor inserts a sheath, or
introducer into the blood vessel. This is a plastic tube through which the catheter is
thread into the blood vessel and advanced into the heart. If the arm is used, your doctor
may make a small incision (cut) to expose the blood vessel and put in the sheath.

10. Your doctor will advance the catheter through the aorta to the left side of the heart.
He or she may ask you to hold your breath, cough, or move your head a bit to get clear
views and advance the catheter. You may be able to watch this process on a computer
screen.

11. Once the catheter is in place, your doctor will inject contrast dye to visualize the
heart and the coronary arteries. You may feel some effects when the contrast dye is
injected into the catheter.
12. Tell the doctor if you feel any breathing difficulties, sweating, numbness, nausea or
vomiting, chills, itching, or heart palpitations.

13. After the contrast dye is injected, a series of rapid X-ray images of the heart and
coronary arteries will be made.

14. Once the procedure is done, your doctor will remove the catheter and close the
insertion site. He or she may close it using either collagen to seal the opening in the
artery, sutures, a clip to bind the artery together, or by holding pressure over the area to
keep the blood vessel from bleeding.

15. If a closure device is used, a sterile dressing will be out over the site. If manual
pressure is used, the doctor (or an assistant) will hold pressure on the site so that a clot
will form. Once the bleeding has stopped, a very tight bandage will be placed on the
site.

16. The staff will help you slide from the table onto a stretcher so that you can be taken
to the recovery area.

NOTE: If the catheter was placed in your groin, you will not be allowed to bend your leg
for several hours. If the insertion site was in your arm, your arm will be elevated on
pillows and kept straight by placing it in an arm guard (a plastic arm board designed to
immobilize the elbow joint). In addition, a tight plastic band may be put around your arm
near the insertion site. The band will be loosened over time and removed before you go
home.

Common side or adverse effects

What happens after cardiac catheterization?
In the hospital

 A nurse will monitor your vital signs, the insertion site, and circulation/sensation
in the affected leg or arm.

 In some cases, the sheath or introducer may be left in the insertion site. If so, you
will be on bedrest until your doctor removes the sheath. After the sheath is
removed, you may be given a light meal.

 You may feel the urge to urinate often because of the effects of the contrast dye
and increased fluids.

 You may be given pain medicine for pain or discomfort related to the insertion
site or having to lie flat and still for a prolonged period.
  Drink plenty of water and other fluids to help flush the contrast dye from your
body.

 You may go back to your usual diet after the procedure, unless your doctor tells
you otherwise.

 After the recovery period, you may be discharged home unless your doctor
decides otherwise. In many cases, you may spend the night in the hospital for
careful observation. If the cardiac cath was done on an outpatient basis and a
sedative was used, you must have another person drive you home.

At home

 Once at home, you should check the insertion site for bleeding, unusual pain,
swelling, and abnormal discoloration or temperature change. A small bruise is
normal. If you notice a constant or large amount of blood at the site that cannot
be contained with a small dressing, contact your doctor.

 Your doctor may advise you not to participate in any strenuous activities for a few
days after the procedure. He or she will tell you when it's OK to return to work
and resume normal activities.

Contact your doctor if you have any of the following:

 Fever or chills
 Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
 Coolness, numbness or tingling, or other changes in the affected arm or leg
 Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting

Your doctor may give you other instructions after the procedure, depending on your
particular situation.