OM VERMA ASSOCIATE PROFESSOR GRACIOUS COLLEGE OF NURSING ABHANPUR RAIPUR C.G

1. GRACIOUS COLLEGE OF NURSING
ABHANPUR RAIPUR C.G.

3. INTRODUCTION
• Cardiac catheterization is a test to check one’s heart.
This test can include a coronary angiogram, which
checks the coronary arteries.
• A cardiac catheterization can check blood flow in
the coronary arteries, blood flow and blood
the coronary arteries, blood flow and blood
pressure in the chambers of the heart, find out how
well the heart valves work, and check for defects in
the way the wall of the heart moves. In children, this
test is used to check for heart problems that have
been present since birth (congenital heart defect).

4. • A coronary angiogram is used to find out if a
person has disease in their coronary
arteries (atherosclerosis). If a person
has atherosclerosis, this test can pinpoint the
size and location of fat and calcium deposits
(plaque) that are narrowing their coronary
arteries.
• Percutaneous coronary intervention (PCI) is
• Percutaneous coronary intervention (PCI) is
similar to coronary angiogram, but it is used to
open up a narrowed coronary artery with
special tools.
• The two common types of PCI are:
1) Angioplasty with or without coronary stents.
2) Atherectomy.

5. • Cardiac catheterization (also called cardiac
cath or coronary angiogram) is an invasive
imaging procedure that tests for heart
disease by allowing doctor to "see" how well
their patient’s heart is functioning.
During the test, a long, narrow tube, called
During the test, a long, narrow tube, called
a catheter, is inserted into a blood vessel in
patient’s arm or leg and guided to their
heart with the aid of a special X-ray
machine. Contrast dye is injected through
the catheter so that X-ray movies of their
valves, coronary arteries, and heart
chambers can be created.

6. • Cardiac catheterization is a procedure
in which a thin, flexible tube (catheter)
is guided through a blood vessel to the
heart to diagnose or treat certain
heart conditions, such as clogged
heart conditions, such as clogged
arteries or irregular heartbeats.
• According to Lippincott

7. • Evaluate or confirm the presence of heart disease (such as
coronary artery disease, heart valve disease, or disease of the
aorta).
• Evaluate heart muscle function.
• Determine the need for further treatment (such as an
• Determine the need for further treatment (such as an
interventional procedure or bypass surgery).
• At many hospitals, several interventional, or therapeutic,
procedures to open blocked arteries are performed after the
diagnostic part of the cardiac catheterization is complete.
Interventional procedures include balloon
angioplasty, brachytherapy, atherectomy, rotoblation, balloon, and
stent placements.

8. To diagnose or evaluate:
• Cardiac amyloidosis
• Causes of congestive heart
failure or cardiomyopathy
• Coronary artery disease
• Heart defects that are present at birth
(congenital)
• Heart defects that are present at birth
(congenital)
• High blood pressure in the lungs (pulmonary
hypertension)
• Problems with the heart valves
• Unstable angina or Chest pain [uncontrolled
with medications or after a heart attack]
• Heart attack

9. • Before a bypass surgery
• Abnormal treadmill test results
• Determine the extent of coronary artery
disease
• Disease of the heart valve causing
• Disease of the heart valve causing
symtpoms (syncope, shortness of breath)
• To monitor rejection in heart transplant
patients
• Syncope or loss of consiousness in patients
with aortic valve disease

10. conti
conti...
...
The following procedures may also be
done using cardiac catheterization:
• Repair of certain types of heart defects
• Open a narrowed (stenotic) heart valve
• Open blocked arteries or grafts in the
heart (angioplasty with or without
stenting)

11. • Allergy to contrast (dye) medium
• Uncontrolled Blood Pressure (Hypertension)
• Problems with blood coagulation
(Coagulopathy)
• Kidney failure or dysfunction
• Severe anemia
• Severe anemia
• Electrolyte imbalance
• Fever
• Active systemic infection
• Uncontrolled rhythm disturbances
(arrhythmias)
• Uncompensated heart failure
• Transient Ischemic attack

13. • Patients may be required to be admitted to
the hospital the night before the
procedure. For some patients, overnight
stay is not required.
• Nil per oral [NPO] or nothing to eat or
• Nil per oral [NPO] or nothing to eat or
drink by mouth 6-8 hours before the test.

14. • The nurse should explain the procedure and
risks associated with it.
• Consent form should be signed before the
procedure.
• Any questions or doubts should be asked and
• Any questions or doubts should be asked and
clarified with the nurse before surgery.
• The nurse should be informed of allergies to
medications, iodine or food. It should also
be documented legibly (clear) in the patient’s
chart.

15. • Previous allergic reactions to contrast
dyes must be mentioned.
• Catheterization procedure requires X-
ray fluoroscopy.
ray fluoroscopy.
• Women patients in childbearing age can
undergo pregnancy test to rule out
pregnancy.

16. • Medications that are taken on the day
of cardiac catheterization should be
discussed with the doctor and nurse.
Some medicines taken for blood
thinning (e.g., Aspirin), erectile
dysfunction (Sildenafil or Tadalafil) or
dysfunction (Sildenafil or Tadalafil) or
diabetic medication (metformin) needs
to be stopped on the day or few days
before the procedure.

17. • Kidney disease should be assessed before, as
contrast materials or dyes may not be used in
patients with abnormal kidney function.
• Some blood tests and electrocardiogram (ECG)
will be performed before the procedure.
• A mild sedative will be given orally or
intravenously to comfort the patient and
relieve anxiety.
• All personal belongings and jewellery will be
removed and patient will be dressed in a
hospital gown before being transported to the
catheterization laboratory.

19. Procedure……
• Local anaesthetic is injected into
the skin to numb the area.

20. • A puncture is then made with a needle
in either the femoral artery in
the groin or the radial artery in the
wrist, (Seldinger technique=
is commonly used procedure to obtain safe
is commonly used procedure to obtain safe
access to central vein.), before a
guidewire is inserted into the arterial
puncture.

21. • A plastic sheath (with a stiffer plastic
introducer inside it) is then threaded over
the wire and pushed into the artery. The
wire is then removed and the side-port of
the sheath is aspirated to ensure arterial
blood flows back. It is then flushed with
saline. This arterial sheath, with a
blood flows back. It is then flushed with
saline. This arterial sheath, with a
bleedback prevention valve, acts as a
conduit into the artery for the duration
of the procedure.

22. • Catheters are inserted using a guidewire and
moved towards the heart. Once in position
above the aortic valve the guidewire is then
removed. The catheter is then engaged with
the origin of the coronary artery (either left
coronary artery or right coronary artery) and
coronary artery or right coronary artery) and
x-ray opaque iodine-based contrast is
injected to make the coronary vessels show
up on the x-ray fluoroscopy image.
• When the necessary procedures are
complete, the catheter is removed.

23. • Firm pressure is applied to the site to
prevent bleeding. This may be done by hand
or with a mechanical device.
• Other closure techniques include an
internal suture and plug.
internal suture and plug.
• If the femoral artery was used, the
patient will probably be asked to lie flat
for several hours to prevent bleeding or
the development of a hematoma.
• If the arm is used, the patient can
ambulate sooner.

24. • Cardiac interventions such as the insertion
of a stent prolong both the procedure
itself as well as the post-catheterization
time spent in allowing the wound to clot.
However, the femoral artery is associated
However, the femoral artery is associated
with local complication in up to 3% of
patients and hence,

25. • more interventional physicians are
moving towards the radial (wrist)
artery, as an alternative site.
Disadvantages of the radial
artery include small vessel caliber
and a different "learning curve" for
and a different "learning curve" for
physicians used to the femoral
(groin) access.

26. POST PROCEDURE CARE
• Post procedure, the patient will be
monitored for a few hours in
an observation or recovery room.
• In patients, where the puncture site is at
the arm or wrist, they may be allowed to
walk around the observation room.
the arm or wrist, they may be allowed to
walk around the observation room.
• These patients will be asked not to bend
their arm or lie on it.
• The nurses should provide pain
medications to alleviate back pain if
induced by lying on the back for a very long
time.

27. POST PROCEDURE CARE conti..
• Some of the symptoms that needs to
be notified to the nurses or doctors without
delay are: -
• Pain in the insertion site
• Bleeding in the insertion site
• Tingling or numbness in the fingers
• Tingling or numbness in the fingers
• Chest pain
• Nausea
• Difficulties in breathing
• Dizzy
• Irregular heart beat
• Rash/hives

28. POST PROCEDURE CARE conti..
• Redness, bruise, small swelling or lump in the
insertion site is considered normal and will duly
subside in a few days.
• Patients may be asked to drink lots
of water after cardiac catheterization to remove
the contrast medium from the body.
the contrast medium from the body.
• The doctor will plan the treatment options based
on the results of the test and discuss it with the
patient and family.
• Some patients will be allowed to go home on the
same day and some will be monitored overnight at
the hospital. Others may stay back for further
tests or surgery depending on the outcome.

29. POST PROCEDURE CARE conti..
Few restrictions for the patient to follow
at home after catheterization are:
• Leave the bandage and dressing in place
until instructed (usually - 24 to 48 hrs).
until instructed (usually - 24 to 48 hrs).
• Lifting heavy weights must be avoided.
• Avoid strenuous exercise.
• Contact the doctor, when there are signs
of infection.

30. RISK
 The overall risk for complications from cardiac
catheterization is about 1 in 1000. Contrast dyes cause
adverse effects in almost 1 out of 10 patients. The
common side effect is nausea or vomiting. Some of the
complications due to dye allergy are
• Fast heartbeat
• Slow heartbeat
• Nausea
• Nausea
• Vomiting
• Shock
• Kidney failure
• Epilepsy
• Itching
• Rashes

31. COMPLICATIONS:
• Bleeding at the insertion site
• Damage to the blood vessels used for catheter entry
• Infection
• Ventricular arrhythmias
• Pneumothorax [air collection between the chest wall and the
lungs]
lungs]
• Cardiac tamponade [fluid collection around the heart]
• Heart attack
• Stroke [0.1%]
• Air embolism
• Death [0.1- 0.2%]
• In rare cases, patients undergoing angiogram will be shifted to
the operation room for an emergency bypass surgery.

32. THANK
YOU