Definition
Cardiac cath often called a cardiac catheterization is a minimally invasive procedure used to diagnose and treat heart conditions by directly visualizing the heart and its blood vessels from the inside.
An invasive diagnostic procedure in which one or more catheters are introduced into heart and selected blood vessels to measure pressures and to determine oxygen saturation in the various heart chambers. The procedure is carried out in cardiac catheterization laboratory.
Purposes
- To assess patency of coronary arteries.
- To decide on appropriate treatment, e.g., percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG) if atherosclerosis is present.
- To measure pressures in various chambers of the heart.
- To obtain blood samples for measurement of hematocrit and oxygen saturation.
- To confirm diagnosis of heart disease and to determine the extent to which the disease has affected structure and function of heart.
- To obtain clear picture of cardiac anatomy prior to heart surgery.
- To determine cardiac output.
- To obtain endocardial biopsies.
- To allow infusion of fibrinolytic agents directly into the occluded coronary artery to restore coronary blood flow.
- To detect shunts.
Cardiac catheterization
There are several methods of cardiac catheterization, each tailored to specific diagnostic and therapeutic needs:
- Right Heart Catheterization:
- A catheter is inserted into a vein (typically the jugular, femoral, or subclavian vein) and guided into the right atrium, right ventricle, and pulmonary artery.
- Used to measure pressure and oxygen levels in the right side of the heart and lungs.
- Left Heart Catheterization:
- A catheter is inserted into an artery (usually the femoral or radial artery) and guided into the left atrium, left ventricle, and coronary arteries.
- Used to assess coronary artery disease, valve function, and heart muscle performance.
- Coronary Angiography:
- A specialized form of left heart catheterization where contrast dye is injected into the coronary arteries.
- Helps visualize blockages or narrowing in the arteries supplying the heart.
- Electrophysiology Study (EPS):
- A catheter is placed inside the heart to map electrical activity and diagnose arrhythmias.
- Used to determine the need for pacemakers or ablation therapy.
- Interventional Catheterization:
- Includes procedures such as angioplasty, stent placement, and valve repair.
- Used to treat rather than just diagnose heart conditions.
Articles
Equipment
- Cardiac monitor.
- Pressure monitoring device.
- Fluoroscope.
Catheterization set containing
- Sterile tray.
- Drape sheet-5.
- Gauze piece.
- Long sheet-1.
- Big bowl-1.
- Medium bowl-5.
Other articles
- Luer lock syringes-20 mL (1); 10 mL (2).
- Plain syringes-10 mL-4; 5 mL-1.
- Multiflow adapter.
- Sterile radiopaque catheters-Pig tail catheter size 6F.
- Guidewire.
- Sheath-Femoral access (4F, 5F/7F); radial access (5F/6F)
- Scalpel blade.
- Cut-down set.
- Surgical blade.
Personal protective equipment
- Sterile linen for draping.
- Sterile gloves.
- Sterile gown, cap, mask
Injection and solutions
- Radiopaque dye (25 ml. = 10 ml. contrast + 15 ml. Normal saline).
- Normal saline.
- Betadine.
- Local anesthetic agents-Inj. Xylocaine.
- Inj. Heparin-2500 IU.
- Inj. Dilzem-2.5 mg.
- Inj. Nitroglycerine (50 mg in 500 mL NS).
Dressing
- TR band (if required): A compression device designed to assist hemostasis of the radial artery after transradial procedure.
- Femoral pressure dressing: For example, small roller bandage: Femostop or external compression devices as per need and agency policy.
- Emergency articles.
Contraindications
- Pregnancy because of risk of radioactive iodine crossing the blood placental barrier.
- Cardiomyopathy.
- Severe dysrhythmias.
- Uncontrolled congestive heart failure.
- Patient allergic to local anesthesia, iodine or radiopaque contrast material.
- Bleeding disorders.
Preparation of the Patient
Preparing a patient for cardiac catheterization involves several important steps to ensure safety and effectiveness.
- Medical History Review:
- Confirm the patient’s medical history, including heart conditions, allergies, and medications.
- Ensure necessary blood tests, such as clotting studies and kidney function tests, have been conducted.
- Fasting:
- Patients are typically required to avoid eating or drinking for 6-8 hours before the procedure.
- Medication Adjustments:
- Blood-thinning medications may need to be stopped as per the healthcare provider’s instructions.
- Inform the healthcare provider about any allergies, especially to contrast agents or iodine.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions.
- Obtain informed consent before proceeding.
- Clothing and Accessories:
- Advise the patient to wear loose, comfortable clothing and remove any jewelry or metallic items.
- Transportation:
- Arrange for someone to drive the patient home after the procedure, as sedation may impair their ability to drive.
Procedure
| Nursing actions | Rationale | |
| Before procedure | ||
| 1. | Assess patient’s knowledge about the procedure and explain the procedure to the patient. | Allays anxiety and ensures cooperation of the patient. |
| 2. | Assess vital signs including peripheral pulses, heart and lung sounds, and body weight. | Provides baseline data for comparison of findings during and after the procedure. |
| 3. | Determine whether right or left heart is being studied. | Enables nurse to anticipate patient’s teaching needs and post procedure interventions. |
| 4. | Assess whether the patient has signed consent forms. | Both types of procedures usually require informed consent to reduce legal risk. |
| 5. | Assess the time of last ingested fluid or food. Patient should be NPO for 6-8 hours before the procedure. | Prevents possible aspiration since patient is sedated for the procedure. Excessive hydration causes dilution of the contrast medium which makes structures more difficult to visualize. |
| 6. | Assess if the patient is allergic to iodine dye. If so, notify the cardiologist or radiologist. | An iodine-based radiopaque contrast medium may be used during the procedure; however, a hypoallergenic contrast medium is more frequently used. |
| 7. | Assess blood count, platelets and prothrombin time, electrolytes, BUN, creatinine levels, etc., prior to the procedure. | Abnormal findings might contraindicate the procedure since hemorrhage or renal failure may occur. |
| 8. | Review physician’s order for pre-procedural medication: a. Atropine (contraindicated in glaucoma). b. Benadryl. c. Sedative. | Decreases or prevents bradycardia, caused by vagal stimulation, and decreases oral secretions. Prophylaxis against allergic reaction to dye. Decreases anxiety and promotes relaxation. |
| 9. | Mark distal pulses. | Enables easy reference after the procedure. |
| 10. | Ensure intravenous access and shift patient to the angiography laboratory or cath-lab. | Ensures that the patient will be comfortable during the procedure. |
| During procedure | ||
| 11. | Wash hands and prepare area as for surgical procedure. Don mask, goggles, sterile gown, cap and gloves. | Reduces transmission of microorganisms. Protects nurse from risk of infection. |
| 12. | The scrub nurse prepares the instrument table for the procedure using aseptic technique. The cardiac catheter, manifold and the sheath is primed using heparinized saline solution. | Maintains surgical asepsis. |
| 13. | The nurse assists the cardiologist/radiologist throughout the procedure and should be well versed with the sequential steps of the procedure as follows: | |
| Position the patient appropriately in a supine position with only the required insertion site exposed. | Proper position ensures easy access to site and ease of performing procedure. | |
| Prepare the insertion site with betadine. | Prepare the site using aseptic techniques. | |
| Drape the patient with sterile drapes appropriately with the insertion site adequately exposed using slit sheet. | Minimal exposure ensures minimal contamination and easy access. | |
| Administer local anesthesia with 2% lignocaine. Catheter is inserted through either of the selected site (femoral/radial). | Helps alleviate pain during the procedure. | |
| Sequence of catheter insertion: Needle with sheath inserted → intra-arterial medication administration (heparin dilzem nitroglycerine) → thread guidewire-remove needle → insert catheter → remove guidewire → retrograde insertion of catheter from aorta to specific artery → connection of multiadaptor or manifold adapter. | A properly assisted insertion prevents coiling of the catheter. | |
| Catheter placement is confirmed using fluoroscopy, continuous monitoring of coronary artery pressure and femoral/radial pressure is established using pressure monitoring device via multiadaptor and then transducer. Contrast agent is injected and fluoroscopic images are obtained. | Permits radiographic visualization of structure. | |
| Inform the patient that, dye when injected may cause flushing of face, feeling of heat, and desire to cough when catheter with sheath is removed. | Adequate explanation reduces anxiety of patient and gain cooperation. | |
| Manual compression at insertion site. Apply pressure for 10-20 minutes. | Pressure on puncture site promotes clotting and prevents bleeding. | |
| 14. | Apply pressure followed by pressure dressing over puncture site. Femoral pressure dressing varies as per hospital practice and supply, i.e., the dressing can be done using sterile gauze roll or femostop used for the femoral artery and TR band used for radial access by inflating it by injecting 15 ml of air. | Prevents bleeding. |
| After procedure | ||
| 15. | Monitor vital signs, apical and peripheral pulses, auscultate heart and lungs after cardiac catheterization every 15 minutes until stable and compare with baseline values. | Verifies patient’s physiologic status and evaluates effect of procedure on physiologic functions. |
| 16. | Assess patient for possible delayed reaction to iodine dye, such as dyspnea, hives, tachycardia, or rash. | Reaction may occur up to few hours after injection of dye. |
| 17. | Assess post-procedure laboratory values, such as blood count, prothrombin time, electrolytes, blood count, and creatinine. | Changes in laboratory values may indicate the onset of complications. |
| 18. | Instruct the patient about strict bed rest for 12 to 24 hours and to keep affected extremity straight for 12 hours. | Prevents bleeding. |
| 19. | Encourage fluid intake. | Promotes excretion of dye. |
| 20. | Record type of cardiac catheterization done and patient’s tolerance of the procedure. | Documents patient’s response to invasive procedure. |
| 21. | Record type of dressing, amount and type of drainage, and the presence of pain or discomfort. | Provides baseline data for determining patients’ progress. |
Special considerations
- Check for symptoms, such as nausea, hypotension, bradycardia, etc. which indicate vagal stimulation.
- Evaluate for signs and symptoms of myocardial infarction, also check for back pain or groin pain which may indicate retroperitoneal bleeding.
- Ensure bed rest for 6 hours in case of femoral artery used and 2-3 hours if radial artery is used.
- Instruct the patient to avoid flexing or hyperextending the affected extremity for 12-24 hours.
- The head of the bed may be raised to 30 degree.
- Femoral dressing is removed after 48 hours and in case of TR band at radial site the band is deflated after 2 hours by removing 2-3 ml. of air per hour.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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