Angioplasty

Ace Khiel R. Peralta

Group 2
 DEFINITION
• Angioplasty is a procedure used to open
blocked coronary arteries caused by
coronary artery disease. It restores blood
flow to the heart muscle without open-heart
surgery. Angioplasty can be done in an
emergency setting. Or it can be done as
elective surgery if your healthcare provider
strongly suspects you have heart disease.
 Angioplasty is also called percutaneous
coronary intervention (PCI)/coronary
angioplasty
For angioplasty, a long, thin tube (catheter)
is put into a blood vessel and guided to the
blocked coronary artery. The catheter has a
tiny balloon at its tip. Once the catheter is in
place, the balloon is inflated at the narrowed
area of the heart artery. This presses the
plaque or blood clot against the sides of the
artery, making more room for blood flow.
The healthcare provider uses fluoroscopy
during the surgery. Fluoroscopy is a special
type of X-ray that’s like an X-ray "movie." It
helps the doctor find the blockages in the
heart arteries as a contrast dye moves
through the arteries. This is called coronary
angiography.
 Types of Angioplasty
1. Balloon angioplasty, which involves using
the pressure of an inflating balloon to clear
plaque that is blocking an artery. This is
rarely done alone except in cases when
doctors are unable to place a stent in the
required position.
2. Stent placement in the artery, which
involves a tube, or stent, made out of wire
mesh. Stents help to prevent an artery
narrowing again after angioplasty.
-Coronary stents are now used in nearly all
angioplasty procedures.
--Stents may be made of bare metal or have
a coating of medication. When they include
medication, they are called drug eluting
stents (DES) and are less likely to plug up
again.
What are the risks and complications of angioplasty?

• Anaphylactic reactions (if allergic to dye)

• Contrast agent nephropathy (kidney damage usually reversible due to dye)
• Arterial thrombosis and pseudoaneurysms (ballooning of the artery)
• Stent restenosis (re-narrowing of the stented segment)
• Vascular site complication (infection, hematoma, thrombosis or embolism)
• Myocardial infarction during the procedure
• Rise of cardiac enzymes of more than 3 times the normal range
• Arteriovenous fistula
 HOW TO PREPARE
1. Angioplasty is a minimally invasive procedure, but it is still surgery, and
people must follow their doctor’s instructions carefully beforehand.
2. People need to inform their doctor about any medications and
supplements they are taking. In some cases, they may need to stop
taking these drugs, especially blood thinners, before the procedure.
3. Also, an individual may need to avoid food or drinks for several hours
before the angioplasty procedure as doctors will need to sedate them.
4. Kidney tests may be needed beforehand, too, as the contrast dye that the
surgeons use can affect kidney function.
 PROCEDURE
1. Before beginning angioplasty, a healthcare professional will clean and
numb the area where the catheter enters the body, usually the groin but
sometimes the wrist.
2. Next, a doctor inserts the catheter into the artery and directs it towards
the coronary artery, watching its progress on an X-ray feed.
3. Once the catheter is in position, the doctor injects a contrast dye through
the artery, which helps identify blockages around the heart. Once they
locate the blockages, the doctor inserts a second catheter and a
guidewire, usually with a balloon at the tip.
 PROCEDURE
4. When the second catheter is in position,
the doctor inflates the balloon, which
pushes the plaque buildup away and
opens up the artery. The surgeon may
insert a stent to keep the artery propped
open.
5. According to the American Heart
Association, angioplasty can take
anywhere from 30 minutes to a few
hours. The person may need to stay in
hospital overnight.
 NURSING RESPONSIBILITIES
PREPARING FOR THE PROCEDURE

 Tell patient that he/she should have someone to take him/her home.
Anesthesia and pain medicine will make it unsafe to drive or get home on
their own.
 Make sure that the patient understand exactly what procedure is planned,
along with the risks, benefits, and other options.
 If the patient is taking aspirin or some other blood thinner, ask the doctor if
it patient should stop taking it before the procedure. These medicines
increase the risk of bleeding.
 Tell your doctor ALL the medicines and natural health products you take.
Some may increase the risk of problems during your procedure. Your
doctor will tell you if you should stop taking any of them before the
procedure and how soon to do it.
 Make sure your doctor and the hospital have a copy of your advance care
plan. If you don't have one, you may want to prepare one. It lets others
know your health care wishes. It's a good thing to have before any type of
surgery or procedure.
 NURSING RESPONSIBILITIES
During the Procedure
 Instruct the patient to follow the instructions exactly about when to stop
eating and drinking. Tell the patient that if the doctor told to take
medicines on the day of the procedure, tell to take them with only a sip of
water.
 Take a bath or shower before you come in for your procedure. Do not apply
lotions, perfumes, deodorants, or nail polish.
 Take off all jewellery and piercings. And take out contact lenses, if you
wear them.
 Instruct patient he/she will be kept comfortable and safe by the anesthesia
provider. Tell that he/she may get medicine that relaxes or puts him/her in
a light sleep. The area being worked on will be numb.
 Tell the patient that the procedure will take 30 to 90 minutes.
 Nurses will check your heart rate and blood pressure. The nurse also will
check the catheter site for bleeding.
 If the catheter was put in your groin, you will need to lie still and keep your
leg straight for several hours. The nurse may put a weighted bag on your
leg.
 If the catheter was put in your arm, you may be able to sit up right away.
But you may need to keep your arm still for at least 2 hours.
 NURSING RESPONSIBILITIES
After the procedure
1. Monitor patient’s vital signs especially the cardiac rate and rhythm using a cardiac
monitor every 15 to 30 minutes for two hours.
2. Apply a sandbag on the site for 6-8 hours or as ordered by the physician.
3. Monitor for bleeding. Inspect the pressure dressing if soak. Notify the physician if
heavy bleeding occurs.
4. Instruct the patient to keep the extremity straight for 4-6 hours or as indicated by the
physician.
5. Maintain head of bed not more than 15 degrees. Implement complete bed rest for 6-
12 hours.
6. Enforce fluids to promote the excretion of dye in the system.
7. Do not resume administration of metformin not less than 48 hours or as indicated by
the physician after the angiogram or angioplasty procedure.
 References

•
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/angioplasty-and-stent-pl
acement-for-the-heart#:~:text=For%20angioplasty%2C%20a%20long%2C%20thin,area%20of%20th
e%20heart%20artery
.
•https://www.medicalnewstoday.com/articles/327154#types

•https://rnspeak.com/angiogram-and-angioplasty-patient-care/
 Thank
you!
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