Cardiac catheterization and procedures.pdf

Heart catheterization

1. CARDIACCATHETERIZATIONNURSINGCARE

2. 2
PRE PROCEDURE

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NURSINGCARE
ARegisterNursewillprovidepre/postprocedurecaretothepatientsubmittocardiaccatheterization.
ItistheresponsibilityoftheNurseinchargeofthepatientcaretopreparethepatientforthe
procedure.AllthisinformationshouldbedocumentedonTHOMandshouldhandovertotheCathLab
nursethatreceivethepatient.
The Interventional Cardiologist or designate obtains informed, written consent from the client, family
or legal guardian
Patient should be NPO for four hours prior to procedure or as ordered by the Cath Lab.

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NURSINGCARE
AFTER ADMISSION A REGISTER NURSE WILL
Afterthepatienthasbeenreceivedontheunit,instructtowearahospitalgownandensurethatisone
one,openatfront.
Dopre-procedureteachingandexplaintheprocedureandallthestepsofhispreparationpreparation,
beingavailabletoclarifyalldoubtsofthepatientandfamily
Obtainbaselinevitalsignsandaphysicalassessment-includingassessmentofperipheralpulse.
Andagoodassessmentalwaysbeginswiththesamequestions.Askthepatientwhytheyareinthe
hospitalandwhat,specifically,istheirchiefcomplain

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NURSINGCARE
Taking a complete patient history and assessment is important and the base of our
nurses care, so obtain:
The patient history and his chief complain
If any allergies
Medication
Medical history
Family history
Social history

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NURSINGCARE
During the preparation of the patient, should be assessed and confirmed the following patient’s data
and Vital Signs.
Height.
Weight.
Temperature.
Heart Rate.
Blood Pressure.
Pain.
SPO2 level.
Glucose levels.
Peripheral pulses
Pregnancy test if female patient in reproductive age.
Blood Products availability, if applicable.
Allergies to Food, Medication and Others

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NURSINGCARE
Review if any recent ECG done.
Review the BLOOD TEST results regarding CBC, White cells, PTT and INR (if applicable) and inform
Cath lab team if any abnormal result
Pre procedure the INR must be less than 2
CURRENT MEDICATION –Patient’s should be checked for medication that might interfere with their
hemodynamic state during the procedure like Anti-hypertensive, anti-coagulants, anti-diabetics and
insulin.
If patient preview taken warfarin check when the last dose, review results of INR test.

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NURSINGCARE
If patient is on IV heparin, check the order regarding the need or not the discontinued.
IfpatientisonLow-molecular-weightheparin(LMWH),Dabigatran,Rivaroxabanorother
oralanticoagulantcheckwhenthelastdoseandconfirmwithPhysicianwhatwasthecorrect
datetobeholdingthedosepriortotheprocedure
ReviewtheorderreferredtoholdMetforminandMetformin-containingmedicationspriorto
procedureandfor48hoursfollowingunlessdirectedotherwisebythecardiologist.
CheckwiththePhysician,whattheorder,regardingdiuretics,insulinandotheroraldiabetic
agents.

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NURSINGCARE
PRE PROCEDURE LOADING DOSE:
If patient already on daily dose of Aspirin 81 mg for a week, no need loading dose
If patient is not on daily dose of Aspirin 81 mg for a week, or any dose, administered 300
mg of aspirin as loading dose
If patient already on daily dose of clopidogrel 75 mg for a week, no need loading dose
If patient is not on daily dose of clopidogrel 75mg for a week, or any dose, administered
600 mg of clopidogrel as loading dose

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NURSINGCARE
PRE-MEDICATION.
If prescribed should be administered and documented on patient’s notes. If not should also be
documented the reason why they were not administered
if any dough regarding medication
Contact patient physician or Cath lab

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NURSINGCARE
SPECIAL ATTENTION –any alterations
vital signs,
Hight level of creatinine,
Hight or low Potassium level ,
Alterations on INR level , CBC and white cells
ECG alterations ,
any king of allergy specially allergy to fish or seafood
MUST BE COMMUNICATE IMMEDIATELY TO THE PATIENT PHYSICIANS

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NURSINGCARE
Remove all of patient’s jewellery and contact lenses. eyeglasses, hearing aids and
dentures may be worn by patient.
Clip the hair at the anticipated access site with surgical clippers.
-Right radial
-Both groins ( the shaving must be from umbilicus till above the knee as physicians
preference )
Ensure the patient has patent IV access, preferably 20G in the left arm and started
normal saline at 50 ml /m
ENSURE THAT PATIENT GO TO BATHROOM BEFORE SENT TO CATH LAB (empty bladder)

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NURSINGCARE
Fill the Safety checklist for cardiac
interventional procedure, Pre
Cath-assessment-Nursing
Transfer patient to Cath Lab via
stretcher with the current and old
charts.

14. 14
POS PROCEDURE

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NURSINGCARE
The patient will be returned to the unit via stretcher, and should be transferred from stretcher
to bed with a Register Nurse assistance.
The Cath lab nurse will hand over the patient regarding the procedure done , artery access
used , any complications resisted , medication on going , medication administrate during
procedure , any special concern with patient and the posprocedure order following the Post
Cab/ PciManagement Sheet

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NURSINGCARE

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NURSINGCARE
Cath lab nurse must ensure that the patient file contains

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NURSINGCARE
Upon patient return to the unit, immediately obtain and documented a post-procedure
assessment which includes vital signs, condition of puncture site, intactness of dressing
and circulation (peripheral pulse assessment), sensation and movement on the limb
distal to the access site.
If not done already at Cath lab obtain ECG posprocedure or if patient present chest
pain (see Guidelines Obtain a ECG)
Ensure that the Trbandis in the correct position and adequate pressure is applied and
no bleeding noted –it will be removed as the physicians orders and follow the usual
protocol

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NURSINGCARE
POS PROCEDURE ASSESSMENT OF VITAL SIGNS
.
Perform minimum vital signs (heart rate, blood pressure, respirations) and also access site
and distal circulation
Every 15 minutes at first hour
Every 30 minutes at second hour
Every hour for the next two hours
And every 4-hours until patient discharge
If case of radial access used , resume client’s pre-procedure diet upon return to the
unit if radial access used
If femoral sheath still in situ, patient must keep NPO until sheath removed

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NURSINGCARE
TRBAND
To be removed as protocol /physicians order

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NURSINGCARE
During the observation of the patent after a cardiac catheterization of diagnostioc/therapeutic the
nurse must to maintain surveillance and action against possible complications such as:
Myocardial infarction
Stroke
Local vascular complication
Cardiac tamponade
Arrhythmias
Vasovagal reaction
Allergic reactions/Anaphylaxis
Nephrotoxicity induced by contrast
Infection
Hypotension
Volume overload

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NURSINGCARE
IF PATIENT PRESENT ANY OF THESES SIGNALS AND SYNTOM:
Tachycardia
Hypotension
Tachypnea
Restlessness, lethargy or confusion
Weak pulses
Damp and cold skin
Decrease in urinary output
Nausea/vomit
ECG changes
Palpitations INFORM IMMEDIATELY THE PHYSICIAN
S yncope

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NURSINGCARE
IF ANY BLEEDING NOTED FROM THE ACCESS PUNCTURE
Immediately apply pressure
Inform the physician
IF ANY HEMATOMA NOTED FROM THE ACCESS PUNCTURE
Immediately apply pressure ( use cold gauze during the pressure )
Inform the physician

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NURSINGCARE
The time of patient admission will depend on the procedure to which the patient was
subjected but almost the times he will be discharge in the next day
During the discharge process reinforce all the information needed by the patient
regarding the post procedure cares
Advice the patient If he live out of town and have been discharged the same day as the
procedure, it is recommended that stay in the city overnight.

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NURSINGCARE
Give to patient/family the brochure
regarding the post procedure instructions.
Give time to patient /family read the
brochure.
Be available to escalate any doubts and
concerns
GOOD WORK

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NURSINGCARE

27. THANK YOU
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27
ISABEL PAULO