CARDIAC CATHETERIZATION NURSING CARE

CARDIAC CATHETRIZATION NURSING CARE

1. Cardiac catheterization nursing care

2. 2 PRE PROCEDURE

3. 3 Nursing care A Register Nurse will provide pre/post procedure care to the patient submit to cardiac catheterization. It is the responsibility of the Nurse in charge of the patient care to prepare the patient for the procedure. All this information should be documented on THOM and should handover to the Cath Lab nurse that receive the patient. 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.

4. 4 Nursing care AFTER ADMISSION A REGISTER NURSE WILL After the patient has been received on the unit , instruct to wear a hospital gown and ensure that is one , open at front . Do pre-procedure teaching and explain the procedure and all the steps of his preparation preparation , being available to clarify all doubts of the patient and family Obtain baseline vital signs and a physical assessment - including assessment of peripheral pulse. And a good assessment always begins with the same questions . Ask the patient why they are in the hospital and what, specifically , is their chief complain

5. 5 Nursing care 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

6. 6 Nursing care 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

7. 7 Nursing care 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.

8. 8 Nursing care If patient is on IV heparin, check the order regarding the need or not the discontinued. If patient is on Low-molecular-weight heparin (LMWH), Dabigatran, Rivaroxaban or other oral anticoagulant check when the last dose and confirm with Physician what was the correct date to be holding the dose prior to the procedure Review the order referred to hold Metformin and Metformin-containing medications prior to procedure and for 48 hours following unless directed otherwise by the cardiologist. Check with the Physician, what the order, regarding diuretics, insulin and other oral diabetic agents.

9. 9 Nursing care 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

10. 10 Nursing care 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

11. 11 Nursing care 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

12. 12 Nursing care 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)

13. 13 Nursing care 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

15. 15 Nursing care 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 pos procedure order following the Post Cab/ Pci Management Sheet

16. 16 Nursing care

17. 17 Nursing care Cath lab nurse must ensure that the patient file contains

18. 18 Nursing care 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 pos procedure or if patient present chest pain (see Guidelines Obtain a ECG) Ensure that the Trband is 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

19. 19 Nursing care 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

20. 20 Nursing care TRBAND To be removed as protocol /physicians order

21. 21 Nursing care 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

22. 22 Nursing care 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

23. 23 Nursing care 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

24. 24 Nursing care 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.

25. 25 Nursing care 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

26. 26 Nursing care

27. THANK YOU شكراً 27 ISABEL PAULO