Cardiac catheterization is a procedure used to examine the heart and blood flow. It involves inserting a catheter into the heart to measure pressures, take biopsies, and inject contrast dye. Central venous pressure measurement uses a catheter placed in the jugular or subclavian vein to measure right atrial pressure. Both procedures carry risks of complications like infection, bleeding, arrhythmias, and puncturing vessels. Nurses monitor vital signs, the insertion site, and catheter placement after the procedures.

1. Cardiac
Catheterizatio
7
n
Central
Venous
Pressure

3. Definition:
Cardiac catheterization
(heart cath) is the insertion of
a catheter into a chamber or
vessel of the heart. This is done
for both investigational and
interventional purposes.
This is a procedure to examine
blood flow to the heart and test
how well the heart is pumping.

4. Preparation:
Patients should give the physician
or nurse a complete list of their
regular medications, including
aspirin and
nonsteroidal anti-inflammatory d
(NSAIDs), because they can affect
blood clotting. Diabetics who are
taking either metformin or insulin
to control their diabetes should
inform the physician, as these
drugs may need to have their
dosages changed before the

5. Patients should also notify staff
members of any allergies to
shellfish containing iodine, iodine
itself, or the dyes commonly used
as contrast agents before cardiac
catheterization.

6. Because cardiac catheterization
is considered surgery, the
patient will be instructed to fast
for at least six hours prior to
the procedure. A mild sedative
may be administered about an
hour before the procedure to
help the patient relax. If the
catheter is to be inserted
through the groin, the area
around the patient's groin will
be shaved and cleansed with an
antiseptic solution.

7. Goals:
This technique has several
goals:
•confirm the presence of a
suspected heart ailment
•quantify the severity of the
disease and its effect on the heart
•seek out the cause of a symptom
such as shortness of breath or
signs of cardiac insufficiency
•make a patient assessment prior
to heart surgery

8. Investigative techniques
used with coronary
catheterization
•to measure intracardiac and
intravascular blood pressures
•to take tissue samples for biopsy
•to inject various agents for measuring
blood flow in the heart; also to detect
and quantify the presence of an
intracardiac shunt
•to inject contrast agents in order to
study the shape of the heart vessels
and chambers and how they change as

9. Indications:
Cardiac catheterization
is performed to:
• Diagnose or evaluate
coronary artery disease
• Diagnose or evaluate
congenital heart defects
•Diagnose or evaluate problems
with the heart valves
•Diagnose causes of
heart failure or
cardiomyopathy

10. The following may also be performed
using cardiac catheterization:
•Repair of certain types of heart defects
•Repair of a stuck (stenotic) heart valve
•Opening of blocked arteries or grafts in the heart

11. Contraindications:
o Renal insufficiency
o Coagulopathy
o Fever
o Systemic infection
o Uncontrolled arrhythmia or
hypertension
o Uncompensated heart
failure
o Radiopaque dye allergies in
patients who have not been
appropriately premedicated

12. How its done:

13. Implementation:
•The patient is placed supine on
padded table and his heart rate and
rhythm, respiratory status, and
blood pressure are monitored
throughout theprocedure.
•An I.V. line is started, if not already
in place, and a local anesthetic is
injected at the insertion site.
•A small incision is made into the
artery or vein, depending on
whether the test is for the left or
right.

14. •The catheter is passed through the
sheath into the vessel and guided using
fluoroscopy.
•In the right-sided
catheterization, the catheter
is inserted into the
antecubital or femoral vein
and advanced through the
vena cava into the right side
of the heart and into the
pulmonary artery.

15. •If left-sided heart
catheterization, the catheter
is inserted into the brachial
or femoral artery and
advanced retrograde
through the aorta into the
coronary artery ostium and
left ventricle.
•When the catheter is in
place, contrast medium is
injected to make visible the
cardiac vessels and
structures.

17. •Nitroglycerin is given
to eliminate catheter-
induced spasm or
watch its effect on the
coronary arteries.
•After the catheter is
removed, direct
pressure is applied to
the incision site until
bleeding stops, and a
sterile dressing is
applied.

18. Complications:
•Heart attack or stroke
•Abnormal heartbeat
(cardiac arrhythmia)
•Puncture of a blood vessel
or of the heart
•Bleeding, blood clot, or
infection at the catheter
insertion site
•A blocked blood vessel in
the arm or leg in which the
catheter was inserted

19. •An allergic reaction to the X-
ray dye
•Ineffective endocarditis in a
patient with vulvular heart
disease.
•Myocardial infarction,
arrhythmias, cardiac
tamponade, pulmonary edema,
hematoma, blood loss, adverse
reaction to contrast media, and
vasovagal response.

20. Because some of these
problems may be life
threatening, heart
catheterization should
always be done in a
hospital that has the
necessary equipment and
personnel to deal with any
complications
immediately.

21. Certain patients have a
higher-than-average risk
of complications. These
include infants younger
than 1 month, people
older than 80 years,
people with very poor
heart function, and people
with certain chronic
illnesses, such as kidney
failure, insulin-dependent
diabetes, and severe lung
disease.

22. Nursing Responsibilities:
•Monitor the patient’s heart rate and
rhythm, respiratory and pulse rates, and
blood pressure frequently.
•Monitor the patient’s vital signs every
15 minutes for 2 hours after the
procedure, every 30 minutes for the next
2 hours, and then every hour for 2 hours.
•If no hematoma or other problems arise,
begin monitoring every 4 hours. If vital
signs are unstable, check every 5
minutes and notify the practitioner.

23. •Observe the insertion site for a
hematoma or blood loss.
Additional compression may be
necessary to control bleeding.
•Check the patient’s color, skin
temperature, and peripheral pulse
below the puncture site.
•Enforce bed rest for 8 hours. If
the femoral route was used for
catheter insertion, keep the
patient’s leg extended for 6 to 8
hours.

24. •If medications were withheld before the test,
check with the practiotner about resuming
their administration.
•Administer prescribed analgesics.
•Make sure a posttest ECG is scheduled to
check for possible myocardial damage.

26. Definition:
Blood from systemic veins flows
into the right atrium; the
pressure in the right atrium is
the central venous pressure
(CVP). CVP is determined by the
function of the right heart and
the pressure of venous blood in
the vena cava.

27. Central venous pressure is considered a
direct measurement of the blood
pressure in the right atrium and vena
cava. It is acquired by threading a
central venous catheter (subclavian
double lumen central line shown) into
any of several large veins. It is threaded
so that the tip of the catheter rests in
the lower third of the superior vena
cava. The pressure monitoring assembly
is attached to the distal port of a
multilumen central vein catheter.

28. Sites for Insertion:

30. Materials:
•Sterile pack and antiseptic solution
•Local anaesthetic - e.g. 5ml
lignocaine 1% solution
•Appropriate CV catheter for
age/route/purpose
•Syringes and needles
•Saline or heparinised saline to
prime and flush the line after
insertion
•Suture material - e.g. 2/0 silk on a
straight needle

31. •Sterile dressing
•Shaving equipment for the area if
very hairy (especially the femoral)
•Facility for chest X-ray if available
•Additional equipment required for
CVP measurement includes:
manometer tubing, a 3-way
stopcock, sterile saline, a fluid
administration set, a spirit level
and a scale graduated in
centimeters

32. Preparations:
Assisting with CVP placement
•Adhere to institutional Policy and
Procedure.
•Obtain history and assess the patient.
•Explain the procedure to the patient,
include:
local anesthetic
trendelenberg positioning
draping
limit movement
need to maintain sterile field.
post procedure chest X-ray

33. •Obtain a sterile, flushed and pressurized
transducer assembly
•Obtain the catheter size, style and length
ordered.
•Obtain supplies:
Masks
Sterile gloves
Line insertion kit
Heparin flush per policy
•Position patient supine on bed capable of
trendelenberg position
•Prepare for post procedure chest X-ray

34. Factors Affecting CVP:
- Systemic vasodilatation and
hypovolaemia,
which leads to reduced venous return in
the
vena cava and reduced RAP
- Right ventricular failure
- Tricuspid and Pulmonary valve disease
- Pulmonary hypertension
- Right ventricular dysfunction and
pulmonary hypertension leads to raised
right atrial pressure, as does tricuspid
and pulmonary stenosis.

35. Indications:
- Systemic vasodilatation and
hypovolaemia,
which leads to reduced venous return in
the
vena cava and reduced RAP
- Right ventricular failure
- Tricuspid and Pulmonary valve disease
- Pulmonary hypertension
- Right ventricular dysfunction and
pulmonary hypertension leads to raised
right atrial pressure, as does tricuspid and
pulmonary stenosis.

36. Normal CVP
Measurements:
- The normal CVP is between 5 –
10 cm of H2O (it increases 3 – 5 cm
H2O when patient is being
ventilated)
- CVP normal range:
- (2-5) mmHg
- (3-8)cm H2O

37. Increase of CVP
- Over hydration
- Right-sided heart failure
- Cardiac tamponade
- Constrictive pericarditis
- Pulmonary hypertension
- Tricuspid stenosis and regurgitation
- Stroke volume is high

38. CVP Reading is High

39. Decrease of CVP
- Hypovolemia
- Decreased venous return
- Excessive veno or vasodilation
- Shock ?
- If the measure is less than 5 cm
water that mean that the circulating
volume is decrease.

40. CVP Reading is Low

41. Complications
(Immediate):
- Hemothorax
- Pneumothorax: most common,
noticed after CXR, “hypoxemia and
absent breath sound” requires chest
tube placement
- Bleeding : More common in
patients with coagulopathy“easily
control femoral”

42. - Arterial puncture
- Vessel erosion: Large vessel
perforation “Dialysis”
- Nerve Injury
- Dysrhythmias
- Catheter malplacement
- Embolus
- Cardiac tamponade

43. Complications (Delayed):
- Dysrhythmias
- Infection “Late, Femoral > IJ >
subclavian
- Catheter malplacement
- Vessel erosion
- Embolus
- Cardiac tamponade
- Thrombosis

44. Nursing Responsibility:
Insertion CVL
- Patient position:
- Patient is moved to the side of the bed so
physician would not lean over
- The bed is high enough so physician would
not have to stoop over
- Patient should be flat without a pillow,
Trendelenburg position if patient is
hypovolemic
- The head is turned away from the side of
the procedure
- Wrist restraints if necessary

45. The Procedure
- Skin preparation:
- Prepare before putting sterile gloves
- Allow time for the sterilizing agent to
dry
- Drape:
- Large enough and Handed sterilely by
the assistant
- Hole in the area of placement
- Prepare the tray:
- Prepare the equipment before starting
- Anesthesia:
- Use local anesthesia with lidocaine

46. AFTER THE INSERTION
- Dispose all sharps
- Place an occlusive sterile dressing
- Flush lumens to maintain patency
- Obtain a chest x-ray (ask for order if
physician doesn’t mention it)
- Monitor site for bleeding
- Assess breath sounds
- Assess circulation
- Assess for hematoma
- Document insertion, site, dressing and
flushing