Preparing a patient for
cardiac catheterization
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By Denise M. McEnroe-Petitte, MSN, RN
COMMONLY PERFORMED AND HIGHLY accurate,
diagnostic cardiac catheterization reveals defects in the
heart chambers, the valves, and coronary arteries. Using
fluoroscopy, the cardiologist inserts catheters into one
or both sides of the heart and measures pressures and
cardiac output. The cardiologist also may obtain blood
specimens for oxygen saturation testing. By injecting con-
trast media, the cardiologist can further define cardiac
structures, including the coronary arteries, and assess
cardiac wall motion. Depending on the facility and the
patient’s condition, cardiac catheterization may be per-
formed as either an inpatient or an outpatient procedure.
Indications for cardiac catheterization include
definitive or suspected myocardial ischemia, syncope, val-
vular heart disease, and acute myocardial infarction (MI).
It also may be indicated after an MI, coronary artery by-
pass graft surgery, or percutaneous transluminal coronary
angioplasty in patients having recurring symptoms, and
after a heart transplant to monitor for rejection.
Getting ready
To prepare the patient, teach him about the procedure
and answer his questions. Provide booklets, videos, or
other educational tools to reinforce learning. The cardi-
ologist will discuss benefits and risks, such as dysrhyth-
mias, bleeding, stroke, or MI. Make sure the patient has
provided informed consent.
Assess for allergies, especially significant allergies
such as a previous anaphylactic reaction to one or
more allergens, including contrast media. Ask if he has
a history of asthma, which is associated with an in-
creased likelihood of a contrast reaction. Also note if
he’s allergic to medications—including lidocaine, the
local anesthetic commonly used for vascular access.
The patient may be instructed to fast for 3 to 8 hours
before the procedure and withhold or decrease the
dosages of scheduled medications (including insulin, an-
tihypertensive drugs, and diuretics). The physician may
prescribe pretreatment prophylaxis for the patient with a
Cardiac Insider
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
history of contrast media allergy. Establish two peripheral
venous access sites and infuse I.V. fluids as ordered to
prevent dehydration. Obtain specimens for lab tests
(complete blood cell count, electrolytes, blood urea nitro-
gen, creatinine, coagulation studies, cardiac biomarkers,
and urinalysis). Also obtain a chest X-ray and an ECG.
The femoral and brachial arteries are common
catheter insertion sites, although the radial artery also
is an option. Assess and mark pulses on the extremity
that will be used. Have the patient void. (He may wear
his dentures and eyeglasses during the test.) Administer
analgesics and sedatives as directed.
During the procedure
The test itself lasts 30 minutes to 1 hour, but the entire
procedure, including precatheterization and postcathe-
terization care, may take up to 4 hours. Tell the patient
what to expect, including the following points:
• He’ll receive I.V. medication for anxiety and pain as
needed throughout the procedure.
• The testing takes place in a cool, darkened room. He’ll
lie on a special procedure table where X-rays can be
taken, either by repositioning the table or by moving
the X-ray machine around him. He’ll be attached to
equipment for continuous cardiac, BP, and pulse
oximetry monitoring.
• He’ll be awake throughout the procedure and may be
asked to cough or take a deep breath at certain times. Tell
him to immediately report any unusual symptoms, such
as chest discomfort or trouble breathing.
• When contrast media is injected into the left ventricle,
he may feel warm or flushed for up to a minute.
• After the test, the catheters are removed and bleeding is
controlled with direct pressure or with a vascular closure
device. He’ll be continuously assessed and monitored in
a postcardiac catheterization recovery area. Depending
on his condition and the method used to stop bleeding,
he’ll spend some time on bed rest with the affected
extremity immobilized.
14 Fall 2011