Cardiac Catheterization Procedure, Risks and the Nursing RoleJennifer Holman, Sara Neubauer, Denise OrtegaPrairie State College Thereare numerous tests and procedures that can be utilized to determine the healthof the heart. Many of these diagnostictests are non-invasive, while others are not. One of the benefits of someinvasive 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 andthen repaired at that moment in some cases. The cardiac catheterization is a great example of this. I will discusswhat this procedure is, and the nursing implications associated with it. So, what exactly is a cardiaccatheterization? It is defined as, “Aninvasive procedure that examines the inside of the heart’s blood vessels usingangiograms.” (Priscilla Lemone, 2011).
This test isperformed using a long catheter that is inserted into an artery or vein in thepatient’s arm or leg. The catheter isthreaded into the chambers of the heart and/or the coronary arteries dependingon the purpose of the test. Contrast dyeis used to visualize the heart and its activity using fluoroscopy dependingupon which side of the heart needs to be visualized. There are two types of cardiac catherizationprocedures.
First, I will discuss theLeft Cardiac Catheterization. In thisprocedure the catheter is inserted into the radial, brachial, or femoral arteryand advanced retrograde. It is advancedthrough the aorta and into the coronary arteries. It may also be introduced into the leftventricle. The left cardiaccatheterization allows for patency of the coronary arteries to be determined.This procedure also determines the functionality of the aortic and bicuspidvalves as well as the left ventricle itself. The right cardiac catheterization is the second type.
During this procedure a catheter is insertedinto the brachial, subclavian, or femoral vein. It is then advanced through the inferior vena cava into the right atriumof the heart. The catheter is thenthreaded into the pulmonary artery.
Pressures within the heart can be measured at any of these sites andblood samples may be obtained. Functionality of the tricuspid and pulmonic valve can be determined aswell. (Priscilla Lemone, 2011)Thereare many indications for a Cardiac Catheterization in addition to what Idiscussed previously.
This test can beused to identify Coronary Artery Disease and cardiac valvular disease. Evaluation of chest pain is another reasonfor this test especially because it may be caused by plaque that has narrowedor blocked on or more of the coronary arteries. If narrowing or blockages are discovered the doctor may perform anangioplasty with or without stenting. However, in approximately 70% of the timestenting is utilized. The purpose of the stents is to hold open the walls ofthe blood vessel and allow blood to flow within.
The doctor may complete other PercutaneousCoronary Interventions during a cardiac catheterization such as correction ofheart defects or a balloon valvuloplasty. The purpose of this procedure may to obtain a myocardial biopsy or evenjust to determine the best treatment options for the patient. (Priscilla Lemone, 2011) As with any procedure there are manyrisks associated with a cardiac catherization. Infection is a risk with any invasive procedure. There will most likelybe some bruising and bleeding at the site of catheter insertion. Damage to the artery utilized during theprocedure and to the heart itself is also possible.
The patient may also experience and allergicreaction to the contrast dye used and possible kidney damage too. The development of arrhythmias is possiblefollowing this procedure. These patientsmay develop blood clots that can lead to a heart attack or stroke. (Cardiac Catheterization, 2018). As with any procedurethe patient must be aware of all the risks and make an informed decision. (Priscilla Lemone, 2011) The patient must be assessed beforeany procedure. However, there arecertain assessments specific to a cardiac catheterization.
A thorough history must be obtainedespecially relating to any previously diagnosed heart problems. The nurse must also be sure to assess thepatient’s kidney function as contrast dye will be administered. Contrast dyecan be toxic to patients with kidney disease. It is also important to assessfor allergies to seafood, iodine, or iodine contrast because of the contrastmedium used for this procedure. If anallergy is in the patient’s history or a reaction to the dye is at all possiblethe doctor may continue with the procedure by pre-medicating the patient withan antihistamine or steroid. Medicationuse, over-the-counter and prescription, by the patient must be assessedthoroughly as well.
Many medications canindicate medical problems that the patient may not remember or understand thathe or she has. For example, if a patienttakes Viagra or any other blood pressure medications he or she may have or beat a risk for cardiac problems. It is also crucial to assess the use ofAspirin, NSAIDs, or any other medications that thin the blood as they put thepatient at significant risk for bleeding. As with any procedure the patient’s vital signs must be obtained andmonitored including peripheral pulses. (Priscilla Lemone, 2011) Nursing care pre-operatively,intra-operatively, and post-operatively is crucial.
The patient must be educated and prepared forthe cardiac catheterization so that it can go as smoothly as possible. Educating the patient is an essentialintervention that must be provided by the nurse. Let’s begin with pre-operative teaching. Thepatient must know to expect before, during, and after the cardiaccatheterization. The patient must be taught that during the procedure he or shewill be positioned supine and that the table will tilt.
He or she will receive a local anesthetic atthe site where the catheter will be inserted. Electrocardiogram leads will be applied, and vital signs will becontinuously monitored. The doctor willask the patient to cough and deep breathe during the catheterization. This procedure may take as little as 30minutes and up to three hours. The nursemust also ensure that informed consent is signed. The patient must be instructed not to eat ordrink anything for six to eight hours prior to the catheterization.
He or she must also be instructed to wearhearing aids and/or glasses to the test. Other nursing interventions at this time are to insert and intravenouscatheter if not done so already and ensure patency. As always, the nurse shouldalways be a source of emotional support to the patient. (Priscilla Lemone, 2011) After the procedure is concluded thenurse has numerous responsibilities to ensure the health and safety of thepatient. Vital signs should be monitoredevery 15 minutes for the first hour, then every 30 minutes until the patient isstable. Cardiac rhythm and rate shouldbe assessed as well as peripheral pulses distal to the catheter insertionsite.
The site used for the proceduremust be monitored for bleeding and/or hematoma. Pain should be assessed especially abdominal and groin pain. Analgesicsshould be administered as ordered.
The nurse should also asses the patient forany dyspnea or chest heaviness. Thepatient will remain supine with the affected leg kept straight for around sixhours if the femoral vessels were used. The head of the bed should only be atabout 15 degrees. Recovery time is muchshorter if other vessels are used.
The patient should also be instructed toincrease fluid intake to flush the contrast dye out of the body. (Priscilla Lemone, 2011) Lastly, education must be providedabout caring for one’s self at home after the catheterization. Activity must be restricted per the doctor’sorders. However, most patients may resume normal activity the next day. The patient must be reminded to talk allmedications as directed by the provider. The patient must be instructed tofollow up with his or her doctor as directed.
Education on what is normal post-operatively for the catheterizationsite must be provided as well as what to do if adverse events occur. (Priscilla Lemone, 2011). The patient should be taught that smallbruising at the insertion site is to be expected. He or she will also be taught that ifbleeding is to occur to lie flat and apply firm pressure to the site forseveral minutes then check to ensure that the bleeding has ceased. Education must also include that if thebleeding does not stop or the site begins to rapidly swell to call 9-1-1. Lastly, the patient must be aware that thereare several signs of complications that must be reported to the doctor. These signs are: numbness and tingling at orbelow the insertion site, the extremity distal to the site becomes blue or coldin comparison to the opposite extremity, the site becomes more bruised, or thesite begins to swell or drain.
The formentioned signs can may indicate internal bleeding, impaired blood flow, orinfection. (American Heart Association, 2018).Insummation, cardiac catheterization is an invasive, diagnostic test with a widerange of uses. This procedure can beutilized to diagnose a wide array of cardiac problems as well as repair many ofthem 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.