CARDIAC CATHETERIZATION AT A GLIMPSE
By Ayinla Daniel.
Cardiac catheterization is a very important critical care procedure. In this article, I tried to bring out the most vital things to know about this procedure.
Cardiac catheterization is an invasive diagnostic procedure, which is done to evaluate cardiac function; pressures and oxygen saturation levels in the four heart chambers are measured. [Note: Pressures and oxygen saturation levels in the heart chambers differ] and it can also be used for treatment of certain heart conditions [coronary angioplasty and coronary stenting are interventions that can be carried out using cardiac catheterization].
In cardiac catheterization, a specialized catheter is used, that is threaded through an artery or a vein, commonly situated in the groin, neck or arm [sites for cardiac catheterization: femoral artery, radial artery, brachial artery], into the heart chamber, the procedure is done under the guidance of a fluoroscope. Traditionally, clients are not under general anaesthesia, except local anaesthesia used to gain per cutaneous access.
• The radial artery is the most preferred site for cardiac catheterization due to the following reasons:
- It is readily accessible
- It is the preferred site of access by many patients
- It is associated with a lower incidence of haemorrhage
- Allows earlier ambulation, compared to femoral catheterization
Though the choice of site to be used for cardiac catheterization can be influenced by a number of factors, which may include; practitioner preference and/or patients request.
Here are some of the major uses of cardiac catheterization:
- Diagnosing CAD (coronary artery disease).
- Assess coronary artery patency
- Determining the extent of artheriosclerosis
- Determine whether revascularization procedures, including PCI or coronary artery bypass graft may be of benefit to the patient.
- Diagnosing of pulmonary arterial hypertension
- Treatment of stenotic heart valves via percutaneous balloon valvuloplasty
- Samples can be taken for biopsy during a cardiac catheterization
RESPONSIBILITIES OF THE NURSE DURING CARDIAC CATHETERIZATION
The responsibilities of the nurse during cardiac catheterization is carefully divided into interventions before, during and after the procedure.
The interventions before the procedure will include;
Making sure client/patient has been properly accessed. Assessment is the most vital part of the nursing intervention. Assessment is done to understand the background of a situation, giving you fore knowledge.
With the help of assessment, the nurse is able to know what to expect, while giving care to client/patients.
Important things to note during assessment include;
- General assessment; Blood pressure, Electrocardiograph monitoring and other haemodynamic parameters e.g. SPO2,
- Availability of resuscitative equipments and expertise
During assessment, a proper history taking is done (herein lies the importance of the nursing process), to ascertain if patient is allergic to contrast die or iodine containing substances, with confirmation or suspect of patients allergy to contrast die or iodine containing foods or substances, an antihistamine or methylprednisolone is administered before the procedure.
- Routine blood tests should be ensured, which include; Blood Urea Nitrogen (BUN), creatinine levels, International normalise ratio (INR), prothrombin time (PT), activated thromboplastin time (aPPT), hematocrit and haemoglobin values, platelet count and electrolyte levels. These blood tests are important in detecting anomalies that might affect the recovery of the patient/client.
- Medical history, which includes the presence of comorbidities that may interfere with recovery and will require attention.
- EXPLAIN THE PROCEDURE TO THE PATIENT. Duration of the procedure, it lasts for about 2 hours, inform patient about the use of IV medications, which will require cannulation. Explain to the patient what they may experience during the procedure; it makes them cope with the experience. Coughing during the procedure helps disrupts disarrhythmias
The Interventions After Cardiac Catheterization
- Assess the catheter site for bleeding or hematoma formation.
- Monitor vitals signs closely; pulse is monitored closely – 15 minutes, 1 hour, 2 hours, until stable.
- Assess affected extremity closely, observe for abnormalities which will include; change in temperature, colour, numbness, ; pain, tingling sensations, also watch out for arterial insufficiency.
- Bed rest maintained for 2 – 6 hours after the procedure.
- Regular assessment of the site, give prescribed pain relief, follow proper standards in care administration.
- Instruct the patient to report any form of abnormality or discomfort at insertion site i.e chest pain.
- Monitor for contrast agent-induced nephropathy; observe elevations in blood serum creatinine levels.
- Oral and IV hydration helps flush out contrast from the system.
- Follow up and discharge planning must be ensured.
What have you got to say? Your contributions are highly welcomed as we all learn and get better together.
– Hinkle, J.L. & Cheever, K.H. (2012). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Wolters Kluwer.