cardiac cath and angiocardiography adult ii final 2/2015
TRANSCRIPT
Cardiac Cath and Angiocardiography
Adult II
FINAL
2/2015
Definition of Cardiac Catheterization
• An invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to the heart with the aid of a special x-ray machine.
• Contrast dye is injected through the catheter so that the valves, coronary arteries and heart chambers are can be visualized.
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Definition of Cardiac Catheterization
• Diagnostic– Collects data to evaluate PT’s condition
• Therapeutic– To intervene by mechanical means to treat
disorders of the vascular and conduction systems within the heart
Principles of Cardiac Catheterization
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Indications• Suspected or known coronary • heart disease
• Myocardial infarction
• Valvular heart disease
• Congenital heart disease
• Aortic dissection
• Pericardial constriction
• Cardiomyopathy
• Initial and follow up assessment for heart transplant
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Contraindications
• Active GI bleed• Renal failure• Recent stroke• Fever from infection• Electrolyte imbalance• Anemia• Short life expectancy• Digitalis intoxication
• PT refusal• Uncontrolled
hypertension• Bleeding disorders• Pulmonary edema• Uncontrolled
ventricular arrhythmias
• Allergic to contrast
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Complications and Risks
• Death• Myocardial infarction• CVA• Arrhythmia• Hemorrhage• Contrast• Hemodynamic• Perforation
Angiographic Supplies and Equipment
•Catheters
•Contrast Media
•Pressure Injector
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Catheters
• For LT cardiac cath similar to those for angio
• RT cath requires specialized catheters– Typically flow directed
catheters– With manifolds
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Contrast Media
• High Osmolar Ionic– Sometimes causes ECG changes
• Widely used– Non-ionic– Ionic low osmolar
• Restricted costs causes limited use of low osmolar contrast agents.
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Pressure injector
Imaging
•Image chain
•Digital Angiography imaging equipment
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Digital Angiography Imaging equipment
• Long term storage of large amounts of digital files has benefited from advances in computer technology
Ancillary Equipment and Supplies
•Physiologic Equipment
•Other equipment
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Physiologic Equipment
• Equipment to monitor– ECG – Hemodynamic pressures
• Vital signs to
• record PT function
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Other Equipment
• Crash cart• Oxygen and suction• Defibrillator• Temporary pacemaker• Pulse oximeter• Blood pressure cuff• Equipment to perform cardiac output studies• Activated clotting time (ACT) equipment
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Patient Positioning forCardiac Catheterization
• PT must be positioning so that they will not have to be moved during procedure
• Must be positioned so anatomic structures of interest are demonstrated
• PT is supine with shielding as appropriate
Catheterization Methods and Techniques
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Pre-Catheterization Care
• Informed consent obtained• PT history• Physical exam• CXR• Blood work• ECG• Echocardiogram• Exercise stress test
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Pre-Catheterization Care
• IV started– Sedation.
• Nothing to eat 4-6 hours before procedure• Records of procedure
– PT hemodynamic data– Fluoro times– Medications administered– Supplies used– Other pertinent information
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Catheter Introduction
• Prepare catheter introduction site with aseptic technique– Shaved and cleaned
• Can be at femoral (most common), brachial, radial, axillary, jugular and subclavian areas
• Selinger technique used
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Selinger Technique
Needle with cannula inserted
Needle withdrawnuntil there is blood flow
Inner cannula removed& guidewire inserted
Needle removedCatheter over guidewire Guidewire removed
leaving catheter in artery
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Data Collection
• Physiologic data unusually collected– Hemodynamic parameters
• Includes blood pressure • Cardiac output• Vascular pressures (inside & outside the heart)
– ECG– Oximetry readings– Cardiac output– Blood samples to measure oxygen
saturations levels in various parts of the heart
Nursing Management after cardiac catheterization
• Catheter Site is observed for bleeding or hematoma .
• Temperature and color of the affected extremity are evaluated .
• Dysrhythmias are carefully assessed by observing the cardiac monitor .
• Bed rest must be maintained for 2to 6 hours after the procedure .
• Observe for contrast agent induced renal failure.
