KAHER INSTITTUTE OF NURSING

SCIENCES
PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY (PTCA)

Presented by: Arya

Gaunker
M.S.c N 1st yr
PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY (PTCA)
DEFINITION

 Percutaneous transluminal coronary angioplasty (PTCA) a

procedure intended to enlarge the lumen of a stenosed
coronary artery by using a ballon tipped catheter that is guided
under the fluoroscopy to the site of a atheromatous lesion .
ballon inflation compresses the plaque against the arterial wall
and recanalization is accomplished .
INDICATIONS
 Stable angina (less than one year ) or unstable angina
(less than 6 months), despite optical medical therapy.
 Single Vessel or multivessel disease
 Proximal , accessible noncalcified lesions, midvessel
lesions
 Evolving myocardial infarction
 Obstructed coronary bypass grafts.
CONTRAINDICATIONS

 Total occlusion of coronary arteries

 Coronary spasm without underlying cause.
PRE PROCEDURE
 Explain the procedure to the client and the family members.
 History collection (including medications)
 Physical examination.
 Take consent form.
 Some routine tests such as blood test (cardiac
enzymes,PT,PTT,electrolytes(k+)creatinine and BUN
 ECG.
 Monitor vital signs.
 Preoperative medications should be given.
 Withhold anticoagulant drugs
 Tab Metformin should be discontinued.
 Food and fluids are restricted 6 to 8 hours before
INTRAOPERATIVE
 Patient should be prepared for cardiac catheterization .

 The patient is anticoagulated with 5000-10000 U of heparin

bolus to prevent clot formation on the catheter system.

 Angioplasty is performed in a facility where cardiac surgery

team is on standby.

 The coronary arteries are examined by angiography ,as they are

during the diagnostic cardiac catheterization , and the
location ,extent, and calcification of the atheroma are verified.
 After the presence of atheroma is verified, a ballon tipped
dilation catheter is passed through the sheath along a guide
catheter and positioned over the lesion
 The interventional cardiologist determines the catheter
position by examining markers on the ballon that can be
seen with fluoroscopy .
 Under local anesthesia Hollow catheters, called sheaths are
inserted usually in the femoral vein or artery (or both),
providing a conduit for other catheters.
 When the catheter is properly positioned , the ballon is
inflated with a radio opaque contrast agent to visualize the
blood vessel and to provide a steady or oscillating pressure
within the ballon .
 The ballon is inserted to certain pressure for4-5 seconds and
then deflated .
 Repeated inflations are performed ,if necessary , to reduce or
eliminate the occluding lesion .
 The pressure” cracks “ and possibly compresses the
atheroma and the coronary artery’s tunica media and tunica
adventitia layers are also stretched .
 Then the ballon catheter is pulled back and the contrast media
is injected to confirm that the atherosclerotic lesion has been
sufficiently compressed to permit significant improvement in
coronary blood flow.
POST PROCEDURE CARE

 Many patients are admitted to the hospital the day of the

percutaneous transluminal coronary angioplasty. Those with
no complications go home the next day.
 During Percutaneous transluminal coronary angioplasty
patients receive large amounts of heparin and are monitored
closely for signs of bleeding.
 Most patients also receive intravenous nitroglycerine for a
period after the procedure to prevent arterial spasm .
 Hemostasis is usually achived and sheath are pulled out
immediately at the end of the procedure by using a vascular
closure device or a device that sutures the vessels .
 Hemostasis after sheath removal may be also achieved by direct
manual pressure, a mechanical compression device (c shaped
clamp) or a pneumatic compression device .
 The patient may return to the nursing unit with the large
peripheral vascular access sheaths in place.
 The sheaths are removed after blood studies clotting indicate
that the clotting time is within an acceptable range.
 This usually takes a few hours, depending on the amount of
heparin given during procedure
 The patient must remain flat in bed and keep the affected leg
straight until the sheath are removed and there for few hours
after to maintain hemostasis.
 Sheath removal and the application of the pressure on the
vessel insertion site may cause the heart rate to slow ad the
blood pressure to decrease (vasovagal response).
 An intravenous bolus of atropine is usually used to treat side
effects.
 Some patients with unstable lesions are at high risk for abrupt
vessel closure are restarted on heparin after sheath removal, or
they receive an intravenous infusion of a GPIIb/IIIa
inhibitor.hese patients are monitored closely and progressed
more slowly.
 After hemostasis is achieved patients usually can be weaned
from the intravenous medications, resume self care and ambulate
unassisted within 1 To 12 hours of the procedure.
 The immobilization depends on The sheath inserted, the amount
of anticoagulant administered, the method of hemostasis, the
patients underlying condition.
COMPLICATIONS
 Prolonged angina pectoris
 Acute /abrupt coronary occlusion.
 Coronary dissection
 Arrhythmias
 Hypotension
 Cardiogenic shock.
REFERENCES

 Brunner and suddarths textbook of Medical surgical nursing

volume I wolters kluwer 13th edition page no 750-751.
 Deepak sethi, capt Kirti rani textbook of medical surgical
nursing I and II Jaypee publications page no 43-45.
 P hariprasath textbook of cardiovascular and thoracic nursing
jaypee publications page no 265-269.
 Sister nancy a reference manual for nurses on coronary care
nursing page no 131-132