Newer advancements in interventional cardiology by DEEPAK ARJUN, RN,RM

NEWER ADVANCES IN
INTERVENTIONAL
CARDIOLOGY
ROLE OF A NURSE
Mr. DEEPAK ARJUN, RN
CARDIOTHORACIC & TRANSPLANT UNIT
GLOBAL HEALTH CITY
www.globalhospitalsindia.com Frost & Sullivan Healthcare Service Provider Company of the Year | India’s Most Admired Promising Hospital Chain

Define Interventional cardiology
Interventional cardiology
Branch of Cardiology that deals with catheter based diagnosis
and treatment of structural heart diseases.
 Its minimally invasive & Painless.
 It include Paediatric and Adult Intervention.

Perfusion of the Heart

ASD CLOSURE - Atrial Septal Defect :

Types of Closure Devises
(1) Amplatzer - Septal Occluder System - Nickel-titanium Metal Alloy.
(2) HELEX - Septal Occluder -

PROCEDURE-ASD Closure

ASD - CLOSURE

Ventricular Septal Defect
.

Types of VSD

Device Closure Of VSD
Car
dioSEAL Device
Amplatzer Muscular VSD Occluder
Size - 18,25,30,35 mm
Cardio SEAL Device- INLET VSD Closure
Size - 23, 28, 33,40 mm
Perimembranous VSD Occluder
Size – 15 – 35 mm

Sollysaffe
TwoFolldabllePollyestter
pattches
 Occlluttech
Contain Polyethylene (PET) patch,

VSD - CLOSURE INSERTION

PATENT DUCTUS ARTERIOSUS
Patent ductus arteriosus (PDA), in which there is a persistent
communication between the descending thoracic aorta and the
pulmonary artery that results from failure of normal
physiologic closure of the fetal ductus

PDA CLOSURE

Nurses Responsibility
Preoperative :
 Stop oral anticoagulants 3-5 days before the procedure
 Soluble aspirin, 325 mg , before the procedure
 Diabetic Management – Not OHA but Insulin
 Doctor’s written order for the test.
 NPO – 6 hours
 Secure IV – Line

Intraoperative:
Haemo dynamic Management
Arrythymia Management
Postoperative:
 Bed rest for at least 4 to 8 hours & keep the affected leg straight at all times
 Maintain Vital parameters
 Check for Groin site(s) for bleeding or swelling
Monitor for the COMPLICATIONS
 ASD “unsuitable” for device closure
 Air Embolism (via long sheath)-
 Device Embolization
 Arrhythmias
 Atrial wall erosion with pericardial tamponade
 SIRS –Systemic Inflamatory Response syndrome

Discharge Education
 After the procedure, to take anticoagulants - for 6 months.
 Diabetics Mgt - metformin 48 hours after the procedure
 On the day of discharge, limit the activities
 Check for redness & drainage around the Puncture site.
Warning Alerts for the patient on Discharge
 Pain at the puncture site that makes walking difficult.
 Numbness or tingling in the thigh or leg.
 Calf tenderness or pain, Swelling of the ankle or foot.
 Discoloration or coolness of the leg or foot

TYPES OF INTERVENTIONAL PROCEDURES
1. Fractional Flow Reserve ( FFR ) – Assessment
2. Thrombectomy
3. Stents – Drug eluting & Biogradable
4. Mitra clip
5. Percutaneous valve Repair
6. Balloon Valvuloplasty
7. Atherectomy – Directional / Rotational / Transluminal / Laser
8. Radiation therapy / Brachytherapy
9. Embolization Prevention Devices

Fractional Flow Reserve - Assessment
FFR = Maximum flow in the presence of a Stenosis
Normal Maximum flow
Normal FFR- 1.0
Myocardial Ischemia- 0.75-0.80
FFR = Pd/Pa
Pd = pressure distal to the lesion,
Pa = pressure proximal to the lesion

FFR - ASSESSMENT

THROMBECTOMY
Angiojet
Transluminal Extraction Catheter (TEC)
Indications:
Thrombus-containing blockages in blood vessels
Blockages in saphenous vein grafts
Blockages in aged, degenerated bypass grafts
Contraindications:
 Severe eccentricity / angulation of the targeted lesions (due to risk of perforation by deep cuts)
 Major sidebranch involvement (due to risk of occlusion)
 Heavily calcified lesions (as they prevent the device from crossing the lesion)
 Lesions with major dissections
due to risk of perforation caused by the poor integrity of the vessel wall

TYPES OF STENTS
REVA Tyrosine–Polycarbonate
Slide and Lock Polymer Stents
Everolimus-eluting PLLA/PDLLA
Polymer Stent
Absorbable Magnesium Metallic Stent

MITRA CLIP
• Contraindications
Active inflammation of the heart (endocarditis)
1) Rheumatic mitral valve disease
3) Blood clots present at the intended site of implant or blood clots
in vessels through which access to the defect is gained
4) Patients who cannot tolerate blood thinners (anti-coagulation
and anti-platelet medications).

PERCUTANEOUS VALVE REPAIR – Mitral Regurgitation

PERCUTANEOUS VALVE REPAIR - TAVI

BALLOON VALVULOPLASTY

BALLOON VALVULOPLASTY - Procedure

ATHERECTOMY - Types

DIRECTIONAL ATHERECTOMY

ROTATIONAL ATHERECTOMY

TRANSLUMINAL EXTRACTION

LASER ATHERECTOMY

RADIATION THERAPY / BRACHYTHERAPY
 Brachytherapy - Direct application of radiation to an artery
 Treating restenosis
 Radiation source is applied to the blocked stent for a period of
several minutes and then removed.
 Low-dose rate (LDR) implants
 High-dose rate (HDR) implants
 Permanent implants
 Low-dose rate (LDR) implants
“ Radioactive seeds “

EMBOLIZATION PREVENTION DEVICES

Embolization Prevention Devices

Risks For Percutaneous Coronary Intervention
 Bleeding at the catheter insertion site
 Blood clot - insertion site / Device
 SIRS – Infection
 Cardiac dysrhythmias or arrhythmias
 Chest pain or discomfort
 Rupture of the coronary artery - requiring open-heart surgery
 Risk for allergic reaction to the dye - CKD

Complications:
Major Complications
 Acute Re-occlusion
 Rhythm and conduction disorders
 Bleeding
 Accidental dissection of the valvular ring (PVI)
 Cardiac tamponade
 Acute heart failure - Valve Implantation
 Death

Complications
Minor Complications
 Side branch occlusion
 Ventricular/atrial arrhythmias
 Bradycardia
 Left-to-right shunt
 Hypotension
 Blood loss
 Arterial thrombus
 Coronary embolism
 Emergency recatheterization
 Ischemia - cannulated extremity
 Decrease in renal functions - Contrast medium
 Systemic embolism
 Hematoma in the groin, retroperitoneal hematoma, pseudoaneurysm, A-V
fistula

Goal Of RN
 Prevention and early diagnosis of potential complications,
 Education of the patient and the family,
 Rehabilitation
 Continuous Nursing education.
The nurse to follow recent advances and published literature
and join nursing seminars for the improvement of her knowledge about
individualized and structured patient care and education of the patient
and the family

NURSES RESPONSIBILITY - PCI
Pre Operatively:
 Explain the procedure & sign a consent
 Allergic to any medications /contrast dye / latex and anesthetic agents
 Npo & prepration
 History of bleeding disorders
 Remove any jewelry
 Remove clothing and will be given a gown to wear.
 Empty the bladder prior to the procedure.
 Secure IV-Line
Intra Operatively:
 Placed in a supine position
 Haemodynamic Monitoring
 sedative medication

 Check Peripheral Pulses
 Check for any breathing difficulties, sweating, numbness, itching,
nausea / vomiting, chills, or heart palpitations.
 Arrythmia Management -
Post Opeatively :
 Apply manual pressure / sutures / closure device that uses collagen
 Check for bleeding
 Tight bandage will be placed / sandbag
 Chest pain or tightness, any feelings of warmth, pain at the insertion site
 Bedrest for two to six hours
 Maintain Strict I/O Chart - contrast dye and increased fluids
 Check for Orthostatic hypotension
 Encourage oral liquids

Home Care Teaching:
 Monitor the insertion site - bleeding,unusual pain,swelling & abnormal
discoloration or temperature change
 Regular aerobic exercises such as walking, swimming, jogging &
bicycling
 Advised not to participate in any strenuous activities
 Diabetic Mgt - Changes in glucose and fat metabolism enhances
atherosclerosis
 Follow up tread mill test performed to determine success of procedure

Chest Pain
Etiology:
 Decresed coronory perfusion
 Severe Ischemia
Goal :
 Alleviation of pain
 Supporting the circulation

Arrhythmia
Etiology :
 Inability to deliver sufficient O2to the myocardium
 Type of contrast medium
 Electrolyte imbalance
Goal :
 Preventing the development of arrhythmia,
 Eliminating arrhythmia
 Stabilization of cardiac rhythm

Decreased Cardiac Output
Etiology :
 Decrease in circulating volume,
 Blood loss,
 Cardiac tamponade,
 Arrhythmia,
 Myocardial ischemia / MI
 Necrosis
 Increase in pulmonary arterial pressure
Goal :
 Early diagnosis of symptoms and signs showing a decrease in CO
 Prevention of complications,
 Increasing cardiac output to the normal level

Decrease In Peripheral Tissue Perfusion
Etiology
 Mechanical obstruction in the arterial or venous cannula
 Arterial vasospasm,
 Thrombus formation
 Embolization / immobility / Bleeding or hematoma
Goal :
 Providing adequate peripheral tissue perfusion
 To reduce ischemic pain, Presence of senses, warm and pink skin
at the extremity

Risk of Thrombo embolism
Etiology :
 Decrease in peripheral perfusion
Goal :
 Prevention of thromboembolism
 Prevent Numbness & edema
 Normal sensory & motor function

Newer advancements in interventional cardiology by DEEPAK ARJUN, RN,RM

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