CARDIAC

CATHETERIZATION
AND MONITORING
(Right and left sides)
 The Reporters

who ?

AHIYAS A B L.
, CHAY R
RHID
EY V. I,
TUT

AE A
.
AM
,S HA L
IALAM
SAL

PALACIO, LESLIE ANN S.

ASIM, M
ARISSA
K.
  Cardiac catheterization is one of
the invasive procedures used to
visualize the heart’s chambers,
valves and great vessels in order
to diagnose and treat disease
related to abnormalities of the

Introduction 
coronary arteries.

The procedures involves

inserting a long, flexible,
radiopaque catheter into a
peripheral vein, peripheral
artery and guiding it under
fluoroscopy (x-ray observation)
or angiography.
 Right heart
catheterization
usually precedes left heart
catheterization. It involves the passage of
a catheter from an antecubital or femoral
vein into the right atrium, right ventricle,
pulmonary artery, and pulmonary
arterioles.
 Left heart
catheterization
is performed to evaluate the patency of the
coronary arteries and the function of the
left ventricle and the mitral and aortic
valves. Potential complications include
dysrhythmias, MI, perforation of the heart
or great vessels, and systemic
embolization.
Angiography Coronary arteriography Aortography
Indication
And purpose of
Procedure
 To confirm or establish the diagnosis.
 To measure cardiac output.
 To measure pressure and oxygen saturations.
 To calculate intra cardiac shunting and pulmonary
and systemic vascular resistance.
 To visualize coronary arteries.t
 To assess for myocarditis or rejection following
heart transplantation.
 To intervene in congenital heart disease
Contraindications
Uncontrolled Renal failure
hypertension

Severe anemia Uncompensated

congestive failure
Ventricular
fibrillations Active infection
or febrile illness
Acute stroke Electrolyte
abnormalities
Gl bleeds Severe
coagulopathy
Allergy to
contrast
 Equipment and materials needed
 Noninvasive hemodynamic
monitoring that includes BP and
multiple ECG tracings is necessary
to continuously observe for
dysrhythmias or hemodynamic
instability.
 The use of smaller (4 or 6 Fr)
catheters, which are more
amenable to shorter recovery
times, is common in diagnostic
cardiac catheterizations.
 Cardiac catheterization Various
instruments are available for arterial
access for cardiac catheterization. The
basic components include a needle,
wire, and sheath.
 There are several methods available to
achieve arterial hemostasis after
catheter removal, including manual
pressure, mechanical compression
devices such as the FemoStop (placed
over puncture site for 30 minutes), and
percutaneously deployed devices. The
latter devices are positioned at the
femoral arterial puncture site after
completion of the procedure. They
deploy collagen (VasoSeal), sutures
(Perclose, Techstar), or a combination
of both (AngioSeal).
.
 Patient
preparation
Cardiac catheterization is usually performed in
the hospital. The test requires some
preparations. Before your test

•Instruct the patient to fast, usually for 8 to 12

hours, before the procedure

•If you have diabetes, ask for instructions

about diabetes medications and insulin.

•Your doctor may recommend you stop

medications that may thin your blood. 
 Patient
preparation
• Prepare the patient for the expected duration
of the procedure.

• Reassure the patient that mild sedatives or

moderate sedation will be given
intravenously.

• Prepare the patient to experience certain

sensations during the catheterization.

• Encourage the patient to express fears and

anxieties. Provide teaching and reassurance
to reduce apprehension
 Preparatory Drugs (with or without anaesthesia)
 During cardiac catheterization, the patient has an intravenous line in
place for the administration of sedatives, fluids, heparin, and other
medications.
 If the patient has a suspected or known allergy to the substance,

antihistamines or methylprednisolone (Solu-Medrol) may be administered
before the procedure.
Details of procedure (step, with picture)

Catheter insertion site include femoral vein or artery,

umbilical vein or artery brachial vein or internal
jugular vein. Under fluoroscopy.

Catheter are guided through the heart

Collecting pressure measurements and oxygen

saturation.

Contrast dye is injected through the Catheter to

visualize blood flow patterns an structural
abnormalities
 Details of procedure (step, with picture)
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.
Details of procedure (step, with picture)

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.
Details of procedure (step, with picture)
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.
Details of procedure (step, with picture)

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.
 Common side or adverse effects

 Pain where the

catheter is put
into the body.

 Blood clot or damage

 Bleeding to the blood vessels
or
that the catheter is
bruising where the
put into.
catheter is put
into the body (the
groin, arm, neck,
or wrist)
Post procedural care ( for patient, for the equipment)
• Maintain the patient on hourly
intake and output.
• If the patient starts to bleed
at the puncture site, hold
pressure above the insertion
site until the bleeding is
stopped. Do not hold
pressure directly on the
departure site. Notify the
physician.
• first 12 hours post cardiac cath, if his condition
• Before the patient returns to the unit, the nurse
should ensure that all equipment is available to
evaluate and maintain the patient once he arrives.
These are things such as, intravenous pole with
plump, blood pressure cuff. pulse oximetry,
telemetry if ordered, and sand bag.
•
• When the patient returns he may be placed on
bed rest with the head of the bed no higher than
 
30 degrees. The patients affected extremity must
be kept straight
•
• Insure the patient is fully awake, encourage the
patient to drink at least two liters of fluid during the
warrants and if it is not contraindicated.
•
 Post procedural care ( for patient, for the equipment)
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 bed rest 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.
 Nursing Responsibilities
1. Observe the catheter access site for 6. Instruct the patient to report chest pain and
bleeding or hematoma formation, and bleeding or sudden discomfort from the
assess the peripheral pulses in the affected catheter insertion sites immediately.
extremity 7. Encourage fluids to increase urinary output
2. Evaluate temperature and color of the and flush out the dye.
affected extremity and any patient 8. Ensure safety by instructing the patient to
complaints of pain, numbness, or tingling ask for help when getting out of bed the first
sensations to determine signs of arterial time after the procedure.
insufficiency.
3. Monitor for dysrhythmias by observing the
cardiac monitor or by assessing the apical
and peripheral pulses for changes in rate
and rhythm.
4. Instruct patient to remain on bed rest for 2
to 6 hours with the affected leg straight and
the head elevated to 30 degrees.
5. Analgesic medication is administered as
prescribed for discomfort.
 Nursing Responsibilities
PATIENT EDUCATION Self-Management
After Cardiac Catheterization
After discharge from the hospital for cardiac
catheterization, guidelines for self-care include
the following:
1. For the next 24 hours, do not bend at the
waist (to lift anything), strain, or lift heavy
objects.
2. Avoid tub baths, but shower as desired.
3. Talk with your physician about when you
may return to work, drive, or resume
strenuous activities.
4. Call your physician if any of the following
occur: bleeding, swelling, new bruising or pain
from your procedure puncture site,
temperature of 101.5°F (38.6°C) or more.
5. If test results show that you have coronary
artery disease, talk with your physician about
options for treatment, including cardiac
rehabilitation programs in your community.
6. Talk with your physician and nurse about
lifestyle changes to reduce your risk for further
or future heart problems, such as quitting
smoking, lowering your cholesterol level,
initiating dietary change
THANK YOU ！