cardiac catheterizatio n 2.pdf

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1. ءاعىص هعماج
ةيحصلا مولعلاو بطلا هيلك
يلاعلا ضيرمتلا هبعش
Cardiac catheterization
فارشا تحت:
د\ شاجب نادمغ
د\ ةيقفلا ىسوم
د\ يسومخ دارم
دادعا :
رصاو يلع همحرلادبع

2. oINTRODUCTION :
Cardiac catheterization is a
procedure performed both for
diagnostic and interventional
purposes . The role of nurse is
important while pre
catheterisation, intra and post
catheterization.

3. oDEFINITION :
Cardiac catheterization is an invasive diagnostic
procedure in which radiopaque arterial and
venous catheters are introduced into selected
blood vessels of the right and left sides of the
heart. Catheter advancement is guided by
fluoroscopy.

4. oINDICATION :
1- CAD
2- Assess coronary artery patency,
3-Determine the extent of atherosclerosis based on the
percentage of coronary artery obstruction.




4-To diagnose pulmonary arterial hypertension.
5- To treat stenotic heart valves via percutaneous balloon
valvuloplasty.

5. During cardiac catheterization, the patient has an IV line in place
for the administration of sedatives, fluids, heparin, and other
medications.
Noninvasive hemodynamic monitoring that includes BP and
multiple ECG tracings are necessary to continuously observe for
dysrhythmias or hemodynamic instability.
 The myocardium can become ischemic and trigger dysrhythmias
as catheters are positioned in the coronary arteries or during
injection of contrast agents.
Resuscitation equipment must be readily available during the
procedure.
Staff must be prepared to provide advanced cardiac life support
measures as necessary.

6. oIMPORTANT INVESTIGATION BEFORE PROCEDURE :
Blood urea nitrogen (BUN).
 creatinine levels.
International Normalized Ratio(INR)
prothrombin time (PT).
Activated thromboplastin time (PTT).
Hematocrit and hemoglobin values.
Platelet count and electrolyte levels.

7. oTYPES :
Right heart catheterization


Left heart catheterization.

8. oSITES USED IN CARDIAC CATHETERIZATION :
Right side :
1- Femoral vein.
2- Antecubital vein
Left side :
1- Brachial artery.
2- Radial artery.
3. Femoral artery.

9. oPATIENT PREPRATION:
Doctor’s order.
Informed consent.
Lab test CBC, ESR , RFT, PT, INR, ECHO, serology test.
Check for allergy.
Skin preparation.
I.V cannulation.
Placement of ECG electrodes.
Monitor hemodynamic status.
Keep NPO for 6 to 8 hours.
ECG should be taken (12 leads).
Due per medication should be administered as
( aspirin, clopidgrel, diazepam, pantoprazole ) .
oEmpty the bladder before sending the pt to cath lab.
oCheck and document height and weight to calculate the
dose of contrast.

10. oPROCEDURE:
As per the site / type of catheterization fluoroscopic catheter is
inserted into the appropriate vessels.
Advancement of catheter is visualized in x-ray fluoroscopic
image.
The images are recorded for evidence.
Once the cathternisnin position measured amount of contrast
media is injected.
Nurse during this time need to monitor hemodynamic status.
Advanced cardiac life support drugs and supplies are kept ready.
Patient should be monitored for any cardiac arrhythmias.
The size of the champers, pressures, are checked as per the need.
To visualized coronary arteries the catheter is placed in ascending
aorta and the contrast is injected into coronary arteries.
patient’s pulse is checked frequently during the procedure for
signs of poor perfusion of the extremity .
Once the procedure is done the catheter is removed and pressure
dressing is applied.
Patient shifted to recovery room for observation.

11. POST PROCEDURE CARE:
Bed rest for 6 hours with affected extremity.
Observe the catheter site for bleeding and hematoma.
Record 12 leads ECG.
Check peripheral pulse in the affected extremities
every 15 mints for 1 hour and 30 mints for next hour
and every hour.
Monitor hemodynamic status continuously.
Watch for signs of complication.
Advice the patient to keep the affected leg straight for
4 to 6 hours.
Started feeding and advice to drink more fluids.

12. oCOMPLICATION:
Arrhythmia.
Thrombosis .
Pericardial tamponade.
Embolism.
Stroke.
Myocardial infraction.
Bleeding / hematoma.
Contrast reaction.