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Nursing management in cardiac catheterization Laboratory unit (Nursing …
Nursing management in cardiac catheterization Laboratory unit
(Nursing Intervention)
Nursing before the procedure
Information the pt.
The pt. will be monitoring in intensive care Instruct the pt. that the procedure will be same cardiac cath.
Advice the pt. they’re chest pain or angina.
Encurage the pt. and pt.’s family to ask question of the procedure.
Admit
Palpation of femoral,pedal,tibial pulse.
Prepare of the target lesion. (Rt. And Lt. grion)
Prepare and drape in the sterile set.
Medication
Prevent coronary spasm and slow flow ,
Heparin intravenous maintain an activate clotting time.
NTG and Ca channel blockers ( verapamil )
Nursing during the procedure
Temporary pace in pt. rotablator to RCA.
( prevent Bradycardia ) obs. HR
Vasoconstrictive drugs such as Dopamine
Monitor oxygenation , nasal cannula ( 95%)
Imformation decrease anxiety
Comfortable
Arterial and venous sheath
Peri-pci Assessment & Monitoring
Spo2 Monitoring
BP
Respiratory Rate
Nurse Should Frequently Assess Pt. And Record To Document Of Timely Manner In Pt. Medical Form.
Continuous ECG
To Be Aware Ecg During The Pci Procedure
Possible Complications During the Procedure
MI
Bleeding at puncture site
Tamponade
Coronary artery dissection
Thromboembolism
Allergy to contrast medium
Vasovagal reaction
Pulmonary edema
Arrhythmia
Pulmonary embolism
Cerebral vascular accident
Intervention Equipment
CAD Treatment Evolution
Drug-eluting Stents
Vessel Expansion
Plaque Compression
Compression Resistance
In Stent Re-stenosis Driver
Minimal Luminal Hyperplasia
Minimal Elastic Recoil
Stenting ~ 20-40% Binary Restenosis
Rotational Atherectomy
LASER: Coronary Angioplasty
Invasive Coronary Imaging For Researching
Optical Coherence Tomography
Intravascular Ultrasound (IVUS)
Quantitative Coronary Flow
PCI (Percutaneous Coronary Intervention)
Indications
Unstable or chronic angina
Acute or post acute MI
Post ACB with post operative angina
Contraindications
Disease distal to area for intervention
Coronary orifice
Diffuse disease
Stenosis
Left main disease unless protected with bypass
Variant angina – spasm
Torturous vessels – some can be PCI without stent1
Arterial & Venous Access
Percutaneous
Femoral Artery, Vein
Radial Artery , Vein
Allen’s test
Patient Selection
Brachial Artery , Vein
Anatomical Snuffbox
Nursing after the procedure
Oxygenation is adequate
Pulse distal decrease or change
Puncture sites ,sheath ( bleed,hematoma)
Intake/Output ( avoid = hypotension hypovolemia)
Obtain baseline ECG
Observe side effect from contrast medium
Continuous hemodynamic monitoring
Maintain fluid, PCWP 12-15mmHg.
Record V/S
Assess pt. for sign and symptom of ischemia = Angina ,ECG change
Pt. keep puncture straight ,elevate the head of the bed 30 องศา if femoral sheath sewn
Instruct pt. notify to nurse of comfortable or angina
Emotion support
Post Cardiac Catheterization
Monitoring coagulation
Monitoring renal function
Arterial access site
Monitoring V/S
Monitor hemodynamic and observe bleeding at puncture site, keep leg straight.
Don’t bend groin leg.
Prepare equipment for take off introducer sheath
If take time so long during step bleeding check ACT and tell doctor
After 1 hr. the patient can turn position and sit up after 6 hrs.
Observe area puncture site if rebleeding or hematoma hold manual pressure again.
Nursing Care In Patient On Sheath Or Off Sheath
Ccu/Ward Activity
Lie Down On The Bed Can Elevate Head Up 30’ And After Take Off 6-8 Hrs
Ward Activity
Can Walk If No Complication At Area Puncture
Potential Complications
Vasovagal Reaction
Acute Occlusion resulting
in angina
Cardiac Tamponade
Pseudoaneurysm
Pain at puncture site
Angioedema
Acute tubular necrosis
& renal failure
Embolic complications
Due to thromboembolism
Complication
Other
Stroke
Aortic dissection
Infection
Death
Swelling
Cerebrovascular accident
Vascular injury
Major
Hematoma
MI
Bleeding
VT, VF
Distal ischemia
Post Procedure Management
Must Avoid Anything Which Will Increase Intraabdominal Pressure
Off Sheath
Rules For Manual Compression
Check The Site For Hematoma And Distal Pulses: Dorsal Pedis, Post Tib.
Manual Compression Above Sheath Access Point. 15-20 Min Is Normally Adequate.
Note Patients Starting Bp And Heart Rate. Patients Can Vagal During Sheath Pulls. ( Atropine , Fluids, Trendelenburg)
If Hematoma Occurs Firm Compression Is Best First Response.
Patient Needs To Remain Flat During Clamp Time And For Several Hours Post Removal
Clamp Remains On For Approximately 30 min. –Released In Increments
Monitoring
Discharge Instructions Coronary Angiogram
Education about heart disease
Reduction/Cessation of Smoking
Increasing Physical Activity
Improve/Manage Diabetes
Improved exercise tolerance
Weight Loss/Control
Symptom control
Controlling High Blood Pressure
Return to work
Lipid Management
Psychological well-being/stress management
Avoid strenuous activity, no driving for 24hrs, limit lifting until site heals