Percutaneous

Coronary Intervention
Pre and Post-
operative care
By : Nor Masita Esa
UKM Medical Centre

13/07/2022 NME 1
 Definition
A non surgery method (Invasive
procedure)

Open narrowed arteries to increase blood

supply to myocardium

performed by inserting a catheter through

the skin in the groin or arm into an artery
(femoral or radial).

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 Definition (cont)
A balloon tipped catheter inserted into
narrowed coronary arteries and is inflated
at narrowed areas in order to widen the
artery and remove the plaque.

Stent – A stent (bare-metal or drug eluting

stent) may be placed to keep the coronary
arteries open.

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 Percutaneous Coronary Intervention include :

1. Balloon angioplasty

2. Stent placement

3. Directional and rotational atherectomy

4. Laser angioplasty

5. Graft study and Right Heart study

6. FFR and IVUS

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 Role of PCI
Primary PCI – patient contraindicated with thrombolytic
agent and directly sent for PCI

Rescue PCI – patient failed for thrombolytic agent with

persistent chest pain or St elevation not reduced, sent for
PCI

Facilitated PCI – patient plan for PCI inpatient after

treatment for ACS
Stage PCI
~Delayed Routine angiography and PCI
~Delayed selective angiography and PCI
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 Indication
Acute ST elevation myocardial Infarction

Acute coronary syndrome

(NSTEMI,USA)

Stable Angina

Anginal equivalent
(dyspnea,arrhythmia,dizziness or
syncope)
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 Indication (cont)
Patient with evidence of ischemia on
noninvasive testing.

Persistent chest pain.

Blockage one ore more arteries and lesion >50%

Recurrent stenosis and graft.

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 Contraindication
Left main stenosis in a patient who is
surgical candidate

Diffusely diseased small-caliber or vein

graft

Other coronary anatomy not amenable to

percutaneous intervention

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 Complication
Acute renal failure post intervention

Contrast induced nephropathy

Stent thrombosis

Coronary aneurysm and cardiac

tamponade

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 Complication (cont)
Another heart attack or arrhythmias such
as VT and VF

Stroke

Infection

Risk of bleeding (Retro-peritoneal

haematoma, Pseudo-anuerysm, Arterio-
venous fistula)
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 Peri-operative care
Assess the client’s and family’s knowledge
and understanding of the procedure:

1. Explain that the client will be awake during

the procedure, which takes 1 to 2 hours to
complete.

2. A sensation of warmth(a “hot flash”) and a

metallic taste may occur as the dye is injected.

4. A rapid pulse or a few “skipped beats,” also

are common and expected during the procedure.
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 Provide peri-operative care as needed :

1. IV branula if possible left hand

2. Consent – obtained by doctor and signed

by the patient or family members.

3. Fasting – at least 4 - 6 hours prior to

procedure except for medications

4. Shaving

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 Record baseline assessment data
including :
1. Vital signs
2. Height and weight
3. ECG
Assist doctor for routine blood taking as
pre-operative baseline :
1. Renal profile
2. Pt aptt inr
3. FBC
4. CE,Trop-T

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 Inform doctor if any result abnormalities
for further management such as :

1. Hydration and medication will start

for renal impairment patient.

2. The procedure will postpone if any

risk of bleeding occur such as prolong INR
result.

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 Administer ordered cardiac medications with
a small sip of water unless contraindicated.

Drug should be withold :

~LMWH and OHA morning dose on the day
of procedure
~warfarin 3 days before procedure.

Assess for hypersensitivity to iodine,

radiologic contrast, or seafood.

Patient should wear an OT gown and send to

cath lab once they are ready.
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 Post operative care
CRIB. Provide rest 4 – 6 hours.
Put patient on :
1. Supine with head bed not elevated
more than 30° for patient with femoral
approach

2. Semi-fowlers with patient with

radial approach

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 Immobilize effected leg or hand. Do not
band and keep the leg straight while sheath
intact to decrease risk of haematoma and
bleeding.

If patient with sheath intact connect to

transpac and clamp on iv flushing should be
open. And assure pressure is maintained at
300 mmHg.

Perform 12-leads ECG for comparison with

baseline ECG.

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 Vigilant continuously cardiac monitoring.

Monitor vital signs continuously.

Asses catheterization site for bleeding or

hematoma, circulation status and neurovascular
status every15 minutes for first hour, every 30
minutes for the next hour, then hourly for 4
hours or up to 8hours after sheath removal.

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 Instruct patient to report any of following :

1. Warm or wet feeling in the groin

area.

2. Leg pain or numbness of the affected

leg or arm.

3. any lower back pain or scrotum or

labial pain.

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 Give plenty of water or IVD for
hydration unless contraindication.
Monitor intake and output chart.

Assist patient in 14 ADL because patient

cannot mobilize for 6-8 hours.

Promptly report diminished peripheral

pulses, formation of a new hematoma or
enlargement of an existing one, severe
pain at the insertion site or in the affected
extremity, chest pain, or dyspnea.
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 Assist for sheath removal. Check
coagulation status. ACT < 150 sec.

Observe cardiac monitoring continuously

first hours after sheath removal.

Monitor for any complications :

1. Restenosis
2. Stent thrombosis
3. MI or dissection
4. Bleeding, haematoma or infection.
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 After 24 hours
Perform 12 leads ECG

Assist doctor for blood taking :

1. Renal profile
2. FBC
3. CK, Troponin T

Provide instructions about dressing changes,

follow-up appointments, and potential
complications prior to discharge.
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 Nursing Process
1. Anxiety due to Look and See or PCI procedure

Objective : Patient about the procedure and less

anxiety.

Nursing intervention :
1. Assess patient and family members knowledge
about the procedure.

2. Explain to patient and family members about

the procedure.
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 2. Promote patient to ask more question
about the procedure and answer all the
question.

3. Ask doctor to explain about the procedure.

4. Introduce patient with patient who has

success undergo the procedure.

5. Give emotional support to patient and

family members.

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 2. Risk of bleeding after procedure Look and
see or PCI.

Objective : No haematoma or bleeding seen at

puncture site.

Nursing Intervention :
1. Monitor puncture site such as bleeding or
haematoma.

2. Monitor vital signs continuously.

Hypotension and tachycardia is sign of
bleeding.
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 3. Advice patient to straight the affected limb
at least 4-6 hours after the procedure.

4. Record circulation chart every 15min for

first hour, 30min after second hour and hourly
until patient can bend the affected limbs.

5. Advice patient to report any wet and warm

feeling at the groin area, numbness at the
affected leg or arm.

5. Send for blood investigation such as FBC .

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 Health Education
1. Diet
Low cholesterol, low sodium and diabetic diet
if indication.

Change to white meat such as chicken and fish

Change cooking style from frying to grill or

steam.

Stop and limit the alcohol and cafein intake.

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 2. Smoking cessation
Advice patient benefit to stop smoking

~reduce cathecholamine and cardiac workload.

Inform patient nicotine in the cigaratte

cause plaque formation.

Introduce about stop smoking clinic

Introduce about nicotine replacement such

as nicotine gum and nicotine patch.
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 3. Exercise
Advice patient to start exercise gradually.

Start exercise after get advice from the

doctor.

Minimum exercise 5 times, 20 minutes

per session every week.

Sex intercouse after 6weeks of heart

attack or patient able to flight staircase

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 4. Medication

Dual antiplatelet (e.g : Plavix 75mg and

Aspirin 150mg)
~to prevent platelet aggregation
~Advice patient to observe any sign and
symptom of bleeding

Beta blocker (e.g : T. Metoprolol 25mg BD)

~to increase contractility but reduce cardiac
workload. Side effect of bradycardia and
hypotension
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 4. Medication

Statin (e.g : T. Lovastatin 40mg ON)

~to reduce cholesterol level and stabilize the
plaque.

Nitrate (S/L GTN 0.5mg)

~ to reduce chest pain. As vasodilator to increase
perfusion to myocardium and decrease afterload.
~advice patient to take 1tab every 15min. Max 3
tab. Go to emergency immediately if chest pain
not relief.

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 4. Medication (cont)

Statin (e.g : T. Lovastatin 40mg ON)

~to reduce cholesterol level and stabilize the
plaque.

Nitrate (S/L GTN 0.5mg)

~ to reduce chest pain. As vasodilator to increase
perfusion to myocardium and decrease afterload.
~advice patient to take 1tab every 15min. Max 3
tab. Go to emergency immediately if chest pain
not relief.

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 4. Medication (cont)

Ace-Inhibitor (e.g : T. Perindopril 2mg

OD)
~ to remodeling cardiac function. Side
effect of renal impairment.

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 5. Follow up

Advice patient about the important of

follow up which is to know progress of
patient condition.

On follow up also doctor will discuss

about possible treatment, management
and investigation.

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 THANK YOU
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