a slide show from http://theblogger911.blogspot.com and http://sellerfriend.blogspot.com created by theblogger911 about Cardiac catheterization

1. Grace Frances Pedrena
July 15, 2009

3.  Cardiac Catheterization -is one of the invasive
procedures used to visualize the heart’s
chambers, valves and great vessels in order to
diagnose and treat disease related to
abnormalities of the coronary arteries.
 The procedure involves inserting a
long, flexible, radiopaque catheter into a
peripheral vein peripheral artery and guiding it
under fluoroscopy (x-ray observation) or
angiography.

4.  Werner Forssman

6.  Chamber pressure
 Oxygen Saturation
 Ventricular Function
 Valvular Insufficiencies and stenosis
 Septal defects
 Congenital abnormalities
 Myocardial Function

7.  The indications for cardiac catheterization are to:
 Confirm suspected heart disease, including coronary artery
disease, myocardial disease, valvular disease and valvular dysfunction
 To determine the location and extent of the disease process.
 To assess the following:
 Stable, severe angina unresponsive to medical management
 Unstable angina pectoris
 Uncontrolled heart failure, ventricular dysrhythmias, or
cardiogenic shock associated with acute myocardial
infarction, papillary muscle dysfunction, ventricular aneurysm, or
septal perforation.

8.  To determine best therapeutic option
(percutaneous transluminal coronary
angioplasty, stents, coronary artery bypass
graft, valvulotomy versus valve replacement)
 To evaluate effects of medical or invasive
treatment on cardiovascular
function, percutaneous transluminal coronary
angioplasty, or coronary artery bypass graft
patency.

9.  Allergy to the contrast medium used in the study
 Pregnancy, unless the benefits of performing the study
greatly outweigh the risk to the fetus. It is a relative but
not absolutely contraindicated.
 Clients who will not allow cardiac surgery to be performed
to correct pathology diagnosed by the study.
 Medical conditions such as severe infection, irreversible
brain damage, or congestive heart failure (CHF), which are
considered relative to their extent emergency status, and
potential benefit as opposed to the risk.

10.  Coagulopathy, impaired renal function, and
debilitation usually contraindicate
catheterization of both sides of the heart.
Unless a temporary pacemaker is inserted to
counteract induced ventricular asystole, left
bundle-branch block contraindicates
catheterization of the right side of the heart.
 Digitalis toxicity, anemia and electrolyte
disturbance

11.  Pressures
 Left ventricular systolic 90-140mm Hg
 Left ventricular end diastolic 4-12mm Hg
 Central venous Pressure (CVP) 2-14cm H2O
 Left atrium 2-12mm Hg
 Pulmonary artery systolic/end-diastolic 17-32/4-13mm
Hg
 Pulmonary wedge pressure 6-13 mm Hg
 Cardiac Output 3-6 L/min
 Ejection Fraction 60-70%

12.  Superior vena cava 70%
 Inferior vena cava 80%
 Coronary sinus 20%
 Right chambers 75%
 Pulmonary artery 75%
 Left chambers 95%

13.  Nursing assessment before the procedure
1. measuring the client’s vital signs
2. auscultate the heart and the lungs
3. evaluating the peripheral pulses
4. Asking the client about any history of allergy
to iodine-based contrast agents
5. asking if the client normally takes a digitalis
preparation or diuretic

14. 1. monitoring vital signs every 15 minutes for 1
hour, every 30 minutes for the next hour and every
hour if stable
2. taking peripheral pulses. The radial pulse should be
palpable and as strong as it was prior to the
catheterization.
3. assessing the skin color and temperature on both
extremities of the site and comparing for circulatory
alterations
4. assess site blood leaks and apply pressure.

16.  Catheters most frequently used for right and
left-heart catheterization are:
1. Sones
2. Judkins
3. Amplatz

17.  Coronary arteriography
1. Pigtail
2. Eppendorf
3. NIH
4. Lehman
5. Sones
6. Judkins
7. Amplatz

18. Judkins Catheter
Amplatz Catheter
Swan-Ganz
pigtail

19. 1. The client is placed in a supine position on the x-ray table, and securely
strapped into the table
2. An infusion of D5W
3. ECG leads are positioned and attached to the client as well as a cardiac monitor
4. Blood pressure, pulse and respiration equipment is used for continuous
monitoring of the heart activity and vital signs.
5. The catheterization site is shaved if necessary, cleansed and draped to
establish a sterile field.
6. A local anesthetic is injected at the insertion or cutdown site,
7. General anesthesia via gas or rectal suppository is administered to young
children under age 12
8. The vein or artery is punctured with a needle and a wire inserted through the
needle.The catheter is then passed over the wire and into the vessel after the
needle is removed

21.  femoral and antecubital vein

24.  brachial or femoral artery

26. Coronary Arteriography
The transseptal
technique

29. 9.The site is sutured if the cutdown was
performed
10. a sterile pressure dressing is applied
11. patient is returned to a recovery area for
further observation

30. Cardiac catheterization involves
radiation exposure for staff
members as well as the patient.

31. SEEVIDEO

32. Before the Procedure
Explain to the client:
 That the procedure is performed in a special cardiac laboratory equipped
with monitors and supplies to minimize the risk of complications.
 That the procedure is performed by a physician (cardiologist) and takes
about 1-3 hours, depending on the test to be performed.
 That the food and fluids are withheld for at least 4-6 hours before the
study
 That some medications are withheld according to physician’s
instruction, especially anticoagulant therapy, which is discontinued
before the study.
 That the site is shaved, cleansed, and anesthetized with a local
anesthetic and that the catheter is inserted and that a sensation is
experienced as the catheter is advanced.

33.  That a sedative, analgesic, or other medication to allay anxiety
and promote comfort is given 1 hour before the study.
 The ECG activity, pulse, and blood pressure are monitored during
the procedure because a temporary increase in pulse or
arrhythmias can occur during the advancement of the catheter.
 That the contrast medium can be injected into the heart and
vessels and cause a warm feeling or metallic taste but that it lasts
only a few minutes.
 That the client can be requested to cough or breathe deeply
during the study to enhance the blood flow through the heart.

34. Prepare for the procedure:
 Obtain informed consent
 Obtain the client’s height and weight, which will be used to determine
dye administration.
 Ensure that dietary and fluid restrictions have been followed.
 Ensure that routine medications are restricted or allowed per physician
order and that anticoagulants have been discontinued.
 Provide a hospital gown without metallic closures. Allow the client to
retain dentures, glasses, or hearing aids, as they do not interfere with the
study.
 Ensure that medications to reduce allergic response to the contrast
medium are administered, that is, antihistamine and corticosteroid.

35.  Obtain baseline pulse, blood pressure, ECG, and peripheral pulses, and
mark the sites of peripheral pulses for comparison after the study.
 Administer a sedative or antianxiety agent such as diazepam (Valium), or
both types of medication, and an analgesic such as meperidine
(Demerol) as ordered before the procedure (30 minutes to 1 hour).
 Initiate an intravenous (IV) line to administer fluids and medications as
needed during the procedure.
 Have the client void before the procedure.
 Obtain a history of suspected or known cardiac
conditions, cardiovascular status, cardiac medications, allergies to
iodine, and previous tests and procedures.

36.  Place the patient in the supine position on a tilt-
top table and secured by restraints.
 ECG leads in place for continuous monitoring.
 The patient may be asked to cough or deep
breathe.
 Monitor patient’s heart rate and rhythm;
respiratory and pulse rates, and blood pressure
frequently during the procedure.

37.  resuscitation bag
 oxygen
 Suction
 oximetric device
 endotracheal tube
 defibrillator
 monitor for pulse and blood pressure
 ECG
 external temporary pacemaker
 medications such as
lidocaine, bretylium, epinephrine, atropine, morphine, isoproterinol

38.  Monitoring vital signs every 15 minutes for 1 hour, every 30
minutes for the next hour, and every hour if stable
 Taking peripheral pulses and assessing skin for color and
temperature on both extremities of the site and comparing for
circulatory alterations.
 Maintain bed rest for 4 to 6 hours, depending on the procedure
 Extend the extremity used and immobilize it with sand bags
 Encourage movement of the unaffected extremity.
 Schedule post procedure ECG and future suture removal from the
insertion site.

39.  Observe for complications of cardiac catheterization.
 Complaints of pain and discomfort at the insertion site, chest pain,
nausea, feelings of light-headedness should be reported.
 Because the contrast medium acts as an osmotic diuretic, monitor
urine output and ensure that the client receives sufficient oral and
IV fluids for adequate excretion of the medium.
 Pain medication for insertion site and back discomfort may be
given as prescribed.
 Neurologic changes such as visual disturbances, slurred speech,
swallowing difficulties, and extremity weakness should also be
reported (Ignatavicius, 2006, 698).

40.  For the next 24 hours, do not bent at the waist (to lift anything),
strain, or lift heavy objects.
 Avoid tub baths, but shower as desired.
 Talk with physician about when to return to work, drive or resume
strenuous activities.
 Call physician if bleeding, swelling, bruising, pain from procedure
puncture site, temperature of 38.60C occurs.
 If test results showed coronary artery disease, talk with physician
about treatment and rehabilitation programs.
 Talk with physician or nurse about lifestyle changes to reduce
further or future heart problems

44.  allergic reaction to contrast media
 dysrhythmias and bleeding from puncture site
 Arterial thrombosis
 Perforation of the heart or intratoracic great vessels
 Vagal reactions
 Myocardial infarction
 Pyrogen reaction
Complications