This document outlines nursing protocols for transradial catheterization procedures. It discusses pre-admission preparation including medication changes, testing, and education. It also details catheterization lab setup, the procedure, post-procedure care including wound dressings and recommendations, and follow-up phone calls. The goal is to provide concise guidance to nurses on the key steps and considerations for transradial catheterization patients.

1. NURSING PEARLS FOR TRANSRADIAL CATHETERIZATION Maryse Lemyre, B.Sc., R.N. Myriane Coulombe, B.Sc., R.N. clinical nurses Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ) Québec, Canada

2. PRE-ADMISSION Ambulatory

3. Patient will receive call one week before procedure Appointment at Local Day Care Center or Laval Hospital for EKG, blood tests, and teaching on procedure 2-3 days before STOP Warfarin 72 hours before Notify if allergies to iodine or other Type 2 diabetes: STOP metformine and glyburide on day procedure

4. Patient from referring hospital center PRE-ADMISSION

5. Patient is prepared by his referring center Arrival: on evening before or at 7:00 am on day of procedure If not possible, the preparation will be done on day of admission

6. DAY OF PROCEDURE

7. Nursing data collection: health information, history, medications Vitals, EKG Blood tests: coagulation, hematology, creat IV site: avoid wrists, favor left arm unless CABG implicated LIMA Clopidogrel (300 or 600 mg) Nursing checklist:

8. Shave groins and wrists Obtain CABG protocol if indicated Verify letter from referring physician Remove rings: risk of swelling Benadryl 50 mg and ASA 325 mg when called to cath. lab Nursing checklist:

9. Renal failureprotocol for N-acetylcysteine Creatinine ≥ 130 μmol/L Creatinine 110-130 μmol/L with a risk factor: myeloma, diabetes, heart failure, NSAID Administer 600 mg PO bid for 48 hours begun day before procedure On day of procedure: 600mg if <4h before procedure, OR 1200mg if >4h before procedure

10. Protocol for iodine’s allergy Administer in three times

11. iodine’s allergy in emmergency In cathlab, administer: -Benadryl 50 mg I.V -Hydrocortisone 250 mg I.V

12. oxymetry test

13. CATHLAB OBSERVATION ROOM Nurse and X-Ray technician walk with patient from observation room to procedure table Transfer by stretcher if patient unstable or at risk

14. CATHLAB OBSERVATION ROOM

15. CATHLABsetup FAST AND FURIOUS Electrodes on arms and legs Plexiglass board and cushion for wrists Armrest on arterial access side

16. CATHLABsetup

17. CATHLABsetup If arterial access is on left wrist, the set up is the same The left arm will then be slightly folded over the chest or groin Following arterial access: heparin 70U/Kg IV

18. CATHLABsetup

19. Post-procedurewrist bracelet

20. brachial venoushemostasis

21. Post-procedure Patient returns to observation room on foot with a nurse and an X-Ray technician Narcotics: the patient will return to observation room on stretcher

22. Post-procedure

23. Recommendations before discharge Do not put any pressure or lean heavily on the access site for 48 hours Shower and bath are allowed. Protect the site with a plastic wrap Remove the elastoplast after 24 hours Do not drive for a period from 2 days to 1 month (as per clinical presentation)

24. Recommendations before discharge If elective angioplasty was performed, we recommend a week of rest at home with progressive increase in daily activities

25. phone follow-up Chest pain since discharge from hospital? State of the access site (hematoma)? Appointment with their cardiologist in 4 to 6 weeks and interventional cardiologist as needed CLOPIDOGREL and ASA Phone number of discharge liaison nurse

26. NURSING PEARLS FOR TRANSRADIAL CATHETERIZATION Maryse Lemyre, B.Sc., R.N. Myriane Coulombe, B.Sc., R.N. clinical nurses Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ) Québec, Canada