Mr. Husain Nadaf, Tutor

1. PROCEDURE ON
CARDIAC
CATHERTIZATION
GUIDED BY:
MRS. MANISHA SAMUDRE
ASSISTANT PROFESSOR
HOD OF MEDICAL- SURGICAL
NURSING

2. • A medical procedure in which a thin, flexible catheter is
inserted through an artery or vein (as of the arm or leg) and
passed into the heart for the diagnosis and treatment of heart
conditions
• During cardiac catheterization, a long thin tube called a
catheter is inserted in an artery or vein in your groin, neck or
arm and threaded through your blood vessels and guide the
physician as a road map to your heart, to do diagnostic tests as
part of a cardiac catheterization.

3. • Cardiac catheterization helps provide not only intra-cardiac
pressure measurements, but also measurements of oxygen
saturation and cardiac output and helps provide a qualitative
assessment of coronary blood flow and helps identify
collateral vessels.

4. INDICATIONS
Cardiac catheterization is a procedure undertaken for the diagnosis of
a variety of cardiac diseases. As with any invasive procedure that
is associated with important complications, the decision to
recommend cardiac catheterization must be based on a careful
evaluation of the risks and benefits to the patient.
• Locate narrowing or blockages in your blood vessels
• Find out the amount of oxygen in your heart
• Test the pressure inside your heart
• Take a sample of tissue from your heart (biopsy)
• Heart defects present from birth (congenital heart defects)

5. • Look for problems with your heart valves
• Identification of the extent and severity of coronary artery
disease and evaluation of left ventricular function
• Assessment of the severity of valvular or myocardial disorders
such as aortic stenosis and/or insufficiency, mitral stenosis and/or
insufficiency, and various cardiomyopathies to determine the
need for surgical correction
• Determination of the presence of coronary artery disease in
patients with confusing clinical presentations or chest pain of
uncertain origin

6. CONTRAINDICATIONS
With the exception of patient refusal, cardiac catheterization has
no absolute contraindications. Clearly, the risk-to-benefit ratio
must be considered because a procedure associated with some
risk should be contraindicated if the information derived from
it is of no benefit to the patient.
• Relative contraindications are as follows:
• Severe uncontrolled hypertension
• Ventricular arrhythmias
• Acute stroke
• Severe anemia

7. • Active gastrointestinal bleeding
• Allergy to radiographic contrast
• Acute renal failure
• Uncompensated congestive failure (patient cannot lie flat)
• Unexplained febrile illness and/or untreated active infection
• Electrolyte abnormalities (eg, hypokalemia)
• Severe coagulopathy
These many of these factors can be corrected before the
procedure, thereby lowering the risk. This always should be
considered unless the procedure is being performed in an
emergency situation.

8. EQUIPMENTS
• As procedure to be done in specialized area like cath-labs and
critical care units, so numerous items of disposable equipment
are used for the procedure, thereby follows
• Catheters
• Wires & needles
• Syringes
• Introducer sheaths
• Stopcocks.

9. • A Swan - Ganz catheter is used for measuring right heart
pressures, collecting blood to measure oxygen saturation in
various chambers, and determining cardiac output. Pressure
measurements within the left ventricle usually are obtained
using a pigtail catheter and this same catheter is used for left
ventricular and aortic angiography.
• The outer diameter of a catheter is measured in French units
(F); 1 F is 0.33 mm. The inner diameter of the catheter is
smaller than the outer diameter because of the thickness of the
catheter material.

11. PRE-OP
• Patient Preparation - Before the procedure, the responsible specialized
nurse should fully explain the risks and benefits to the patient,
• Patients should fast for at least 8 hours before the procedure.
• Should obtain written consent, and should answer questions asked by
the patient or family.
• A close nurse-patient relationship is important to reduce fears about the
procedure.
• Before the procedure, a complete history, physical examination,
complete blood count, blood chemistries, chest radiograph, and ECG
should be obtained.
• Premedication with a mild sedative is common, and some operators
administer diphenhydramine or a narcotic.

12. • Special attention should be given to identifying patients with
insulin-dependent diabetes mellitus, renal insufficiency, peripheral
vascular disease, contrast allergy, or long-term anticoagulation use
because these conditions are associated with a higher risk of
procedure-related complications.
• Appropriate therapies before the procedure can minimize these
risks. For example, adequate hydration before the contrast load
will minimize the risk of contrast-induced nephropathy and
pretreatment with corticosteroids will diminish the likelihood of
an allergic reaction to contrast. Evidence is strong that
pretreatment with sodium bicarbonate, theophylline, and
acetylcysteine are nephroprotective.

13. PROCEDURE
• Cardiac catheterization is often done in a special operating room
called a catheterization lab. The catheterization lab has special X-
ray and imaging machines that normal operating rooms don't have.
• Cardiac catheterization is usually performed while you're awake,
but sedated.
• An Intravenous (IV) line will be inserted in your hand or arm, and
will be used to give you any additional medications you might
need during your procedure. You may also have monitors
(electrodes) placed on your chest to check your heartbeat during
the test.

14. • Just before the procedure, a technician may shave the hair from
the site where the catheter will be inserted. Before the catheter is
inserted in your artery, you'll be given a shot of anesthetic to
numb the area. You may feel a quick, stinging pain before the
numbness sets in.
• After you feel numb, the catheter will be inserted. A small cut is
made, usually in your leg, to access an artery. A plastic sheath
will be inserted in the cut to allow physician to insert the catheter.

15. • What happens next depends on why you're having a cardiac
catheterization:

19. • Right heart catheterization - This procedure checks the
pressure and blood flow in the right side of your heart. For this
procedure, the catheter is inserted in the artery in your neck or
groin. The catheter has special sensors in it to measure the
pressure and blood flow in your heart.
• Heart biopsy - If your doctor is taking a sample of heart tissue
(biopsy), the catheter will usually be placed in the artery in
your neck. A catheter with a small, jaw-like tip is used to cut a
small sample of tissue from your heart. You may feel pressure
as this catheter is being used, but you likely won't feel the
actual tissue being snipped.

20. POST-OP
• It usually takes several hours to recover from a cardiac
catheterization. After your procedure is finished, you'll be taken to
a recovery room while the anesthesia wears off. This usually takes
about an hour.
• The plastic sheath inserted in your groin, neck or arm will be
removed soon after unless you've had a blood-thinning
medication during your procedure.
• It's very important not to move the limb that your catheter's been
inserted in, or to lift your head if your catheter is in your neck, so
as not to cause serious bleeding.

21. • After your catheter has been removed, the nurse who has removed
your sheath will apply pressure to the insertion sites, and you'll
need to lie flat for one to six hours after the procedure to avoid
serious bleeding and to allow the artery to heal.
• You'll be able to eat and drink after the procedure. The length of
your stay in the hospital will depend on your condition. You may
be able to go home the same day as your catheterization, or you
may need to stay overnight or longer. Longer stays are common if
you have a more serious procedure immediately after your
catheterization, such as angioplasty.

22. COMPLICATIONS
Common risks of cardiac catheterization are:
• Bruising
• Infection
Rare risks include:
• Heart attack or Stroke
• Damage to the artery where the catheter was inserted
• Irregular heart rhythms (arrhythmias)
• Allergic reactions to the dye or medication
• Tearing the tissue of your heart or artery
• Kidney damage
• Excessive bleeding