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Cardiac Catheterization Procedure, Risks and the Nursing Role

Jennifer Holman, Sara Neubauer, Denise Ortega

Prairie State College

 

There
are numerous tests and procedures that can be utilized to determine the health
of the heart.  Many of these diagnostic
tests are non-invasive, while others are not. One of the benefits of some
invasive tests is that they possess the ability to repair the heart simultaneously.
This means that during this procedure damage or a disease can be diagnosed and
then repaired at that moment in some cases. 
The cardiac catheterization is a great example of this. I will discuss
what this procedure is, and the nursing implications associated with it.

 So, what exactly is a cardiac
catheterization?  It is defined as, “An
invasive procedure that examines the inside of the heart’s blood vessels using
angiograms.” (Priscilla Lemone, 2011). This test is
performed using a long catheter that is inserted into an artery or vein in the
patient’s arm or leg.  The catheter is
threaded into the chambers of the heart and/or the coronary arteries depending
on the purpose of the test.  Contrast dye
is used to visualize the heart and its activity using fluoroscopy depending
upon which side of the heart needs to be visualized.  There are two types of cardiac catherization
procedures.  First, I will discuss the
Left Cardiac Catheterization.  In this
procedure the catheter is inserted into the radial, brachial, or femoral artery
and advanced retrograde.  It is advanced
through the aorta and into the coronary arteries.  It may also be introduced into the left
ventricle.  The left cardiac
catheterization allows for patency of the coronary arteries to be determined.
This procedure also determines the functionality of the aortic and bicuspid
valves as well as the left ventricle itself. 
The right cardiac catheterization is the second type.  During this procedure a catheter is inserted
into the brachial, subclavian, or femoral vein. 
It is then advanced through the inferior vena cava into the right atrium
of the heart.  The catheter is then
threaded into the pulmonary artery. 
Pressures within the heart can be measured at any of these sites and
blood samples may be obtained. 
Functionality of the tricuspid and pulmonic valve can be determined as
well. (Priscilla Lemone, 2011)

There
are many indications for a Cardiac Catheterization in addition to what I
discussed previously.  This test can be
used to identify Coronary Artery Disease and cardiac valvular disease.  Evaluation of chest pain is another reason
for this test especially because it may be caused by plaque that has narrowed
or blocked on or more of the coronary arteries. 
If narrowing or blockages are discovered the doctor may perform an
angioplasty with or without stenting. However, in approximately 70% of the time
stenting is utilized. The purpose of the stents is to hold open the walls of
the blood vessel and allow blood to flow within.  The doctor may complete other Percutaneous
Coronary Interventions during a cardiac catheterization such as correction of
heart defects or a balloon valvuloplasty. 
The purpose of this procedure may to obtain a myocardial biopsy or even
just to determine the best treatment options for the patient. (Priscilla Lemone, 2011)

            As with any procedure there are many
risks associated with a cardiac catherization. 
Infection is a risk with any invasive procedure. There will most likely
be some bruising and bleeding at the site of catheter insertion.  Damage to the artery utilized during the
procedure and to the heart itself is also possible.  The patient may also experience and allergic
reaction to the contrast dye used and possible kidney damage too.  The development of arrhythmias is possible
following this procedure.  These patients
may develop blood clots that can lead to a heart attack or stroke. (Cardiac Catheterization, 2018). As with any procedure
the patient must be aware of all the risks and make an informed decision. (Priscilla Lemone, 2011)

            The patient must be assessed before
any procedure.  However, there are
certain assessments specific to a cardiac catheterization.  A thorough history must be obtained
especially relating to any previously diagnosed heart problems.  The nurse must also be sure to assess the
patient’s kidney function as contrast dye will be administered. Contrast dye
can be toxic to patients with kidney disease. It is also important to assess
for allergies to seafood, iodine, or iodine contrast because of the contrast
medium used for this procedure.  If an
allergy is in the patient’s history or a reaction to the dye is at all possible
the doctor may continue with the procedure by pre-medicating the patient with
an antihistamine or steroid.  Medication
use, over-the-counter and prescription, by the patient must be assessed
thoroughly as well.  Many medications can
indicate medical problems that the patient may not remember or understand that
he or she has.  For example, if a patient
takes Viagra or any other blood pressure medications he or she may have or be
at a risk for cardiac problems. It is also crucial to assess the use of
Aspirin, NSAIDs, or any other medications that thin the blood as they put the
patient at significant risk for bleeding. 
As with any procedure the patient’s vital signs must be obtained and
monitored including peripheral pulses. (Priscilla Lemone, 2011)

            Nursing care pre-operatively,
intra-operatively, and post-operatively is crucial.  The patient must be educated and prepared for
the cardiac catheterization so that it can go as smoothly as possible.  Educating the patient is an essential
intervention that must be provided by the nurse.  Let’s begin with pre-operative teaching. The
patient must know to expect before, during, and after the cardiac
catheterization. The patient must be taught that during the procedure he or she
will be positioned supine and that the table will tilt.  He or she will receive a local anesthetic at
the site where the catheter will be inserted. 
Electrocardiogram leads will be applied, and vital signs will be
continuously monitored.  The doctor will
ask the patient to cough and deep breathe during the catheterization.  This procedure may take as little as 30
minutes and up to three hours.  The nurse
must also ensure that informed consent is signed.  The patient must be instructed not to eat or
drink anything for six to eight hours prior to the catheterization.  He or she must also be instructed to wear
hearing aids and/or glasses to the test. 
Other nursing interventions at this time are to insert and intravenous
catheter if not done so already and ensure patency. As always, the nurse should
always be a source of emotional support to the patient. (Priscilla
Lemone, 2011)

            After the procedure is concluded the
nurse has numerous responsibilities to ensure the health and safety of the
patient.  Vital signs should be monitored
every 15 minutes for the first hour, then every 30 minutes until the patient is
stable.  Cardiac rhythm and rate should
be assessed as well as peripheral pulses distal to the catheter insertion
site.  The site used for the procedure
must be monitored for bleeding and/or hematoma. 
Pain should be assessed especially abdominal and groin pain. Analgesics
should be administered as ordered. The nurse should also asses the patient for
any dyspnea or chest heaviness.  The
patient will remain supine with the affected leg kept straight for around six
hours if the femoral vessels were used. The head of the bed should only be at
about 15 degrees.   Recovery time is much
shorter if other vessels are used. The patient should also be instructed to
increase fluid intake to flush the contrast dye out of the body. (Priscilla
Lemone, 2011)

            Lastly, education must be provided
about caring for one’s self at home after the catheterization.  Activity must be restricted per the doctor’s
orders. However, most patients may resume normal activity the next day.  The patient must be reminded to talk all
medications as directed by the provider. The patient must be instructed to
follow up with his or her doctor as directed. 
Education on what is normal post-operatively for the catheterization
site must be provided as well as what to do if adverse events occur. (Priscilla Lemone, 2011).  The patient should be taught that small
bruising at the insertion site is to be expected.  He or she will also be taught that if
bleeding is to occur to lie flat and apply firm pressure to the site for
several minutes then check to ensure that the bleeding has ceased.  Education must also include that if the
bleeding does not stop or the site begins to rapidly swell to call 9-1-1.  Lastly, the patient must be aware that there
are several signs of complications that must be reported to the doctor.  These signs are: numbness and tingling at or
below the insertion site, the extremity distal to the site becomes blue or cold
in comparison to the opposite extremity, the site becomes more bruised, or the
site begins to swell or drain.  The for
mentioned signs can may indicate internal bleeding, impaired blood flow, or
infection. (American Heart Association, 2018).

In
summation, cardiac catheterization is an invasive, diagnostic test with a wide
range of uses.  This procedure can be
utilized to diagnose a wide array of cardiac problems as well as repair many of
them as well.

 

 

References

Cardiac Catheterization. (2018, January 8). Retrieved from American Heart
Association: http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Cardiac-Catheterization_UCM_451486_Article.jsp#.Wmea-6inHIV
Cardiac Catheterization. (2018, January 8). Retrieved from Mayo Clinic:
https://www.mayoclinic.org/tests-procedures/cardiac-catheterization/about/pac-20384695
Priscilla Lemone, K.
B. (2011). Medical-Surgical Nursing Critical Thinking in Patient Care.
New Jersey: Julie Levin Alexander.