CARDIAC CATHETERIZATION

INTRODUCTION
Cardiac Catheterization is a procedure performed both for diagnostic and interventional
purposes. The role of nurse is important while pre catheterization, intra and post
catheterization.

DEFINITION
Cardiac catheterization is an invasive diagnostic procedure in which radiopaque arterial and
venous catheters are introduced into selected blood vessels of the right and left sides of the
heart. Catheter advancement is guided by fluoroscopy. Most commonly, the catheters are
inserted percutaneously through the blood vessels, or via a cutdown procedure if the patient
has poor vascular access. Pressures and oxygen saturation levels in the four heart chambers
are measured.

PURPOSE
To analyze
 Chamber pressure
 O2 saturation
 Ventricular function
 Valvular insufficiency
 Stenosis
 Septal defects
 Congenital abnormalities
 Myocardial infarction

Indications

Both diagnostics and therapeutics

Therapeutic

❏ Percutaneous coronary angiogram

❏ Percutaneous transluminal coronary angioplasty

Contraindication

❏ Hypersensitivity to contrast medium

Sites used in cardiac catheterization

Right side:
● Femoral vein
● Antecubital vein

Left heart:
● Brachial artery
● Radial artery
● Femoral artery
Contrast agents
● Sodium diatrizoate
● Iohexol
● Ioversol
● Ioxaglate

TYPES OF HEART CATHETERIZATION

Right Heart Catheterization

Right heart catheterization usually precedes left heart catheterization. It involves the passage
of a catheter from an antecubital or femoral vein into the right atrium, right ventricle,
pulmonary artery, and pulmonary arterioles. Pressures and oxygen saturation levels from
each of these areas are obtained and recorded. Although right heart catheterization is
considered relatively safe, potential complications include cardiac dysrhythmias, venous
spasm, infection of the insertion site, cardiac perforation, and, rarely, cardiac arrest.

Left Heart Catheterization

Left heart catheterization is performed to evaluate the patency of the coronary arteries and
the function of the left ventricle and the mitral and aortic valves. Potential complications
include dysrhythmias, MI, perforation of the heart or great vessels, and systemic
embolization. Left heart catheterization is performed by retrograde catheterization of the left
ventricle. In this approach, the physician usually inserts the catheter into the right brachial
artery or a femoral artery and advances it into the aorta and left ventricle. After the procedure,
the catheter is carefully withdrawn and arterial hemostasis is achieved using manual pressure
or other techniques previously described. If the physician performed an arterial or venous
cutdown, the site is sutured and a sterile dressing is applied.

Nursing Interventions

Nursing responsibilities before cardiac catheterization include the following:

• The patient is instructed to fast, usually for 8 to 12 hours, before the procedure. If
catheterization is to be performed as an outpatient procedure, a friend, family member, or
other responsible person must transport the patient home.
• The patient is informed of the expected duration of the procedure and advised that it will
involve lying on a hard table for less than 2 hours.

• The patient is reassured that IV medications are given to maintain comfort.

• The patient is informed about sensations that will be experienced during the catheterization.
Knowing what to expect can help the patient cope with the experience. The nurse explains
that an occasional pounding sensation (palpitation) may be felt in the chest because of extra
heartbeats that almost always occur, particularly when the catheter tip touches the
endocardium. The patient may be asked to cough and to breathe deeply, especially after the
injection of contrast agent. Coughing may help disrupt a dysrhythmia and clear the contrast
agent from the arteries. Breathing deeply and holding the breath help lower the diaphragm for
better visualization of heart structures. The injection of a contrast agent into either side of the
heart may produce a flushed feeling throughout the body and a sensation similar to the need
to void, which subsides in 1 minute or less.

• The patient is encouraged to express fears and anxieties. The nurse provides teaching and
reassurance to reduce apprehension.

Nursing responsibilities after cardiac catheterization may include the following:

• The catheter access site is observed for bleeding or hematoma formation. Peripheral pulses
are assessed in the affected extremity (dorsalis pedis and posterior tibial pulses in the lower
extremity, radial pulse in the upper extremity) every 15 minutes for 1 hour, and then every 1
to 2 hours until the pulses are stable.

• Temperature, color, and capillary refill of the affected extremity are frequently evaluated,
per local nursing standards. The patient is assessed for affected extremity pain, numbness, or
tingling sensations that may indicate arterial insufficiency. Any changes are reported
promptly.

• Dysrhythmias are carefully screened by observing the cardiac monitor or by assessing the
apical and peripheral pulses for changes in rate and rhythm. A vasovagal reaction, consisting
of bradycardia, hypotension, and nausea, can be precipitated by a distended bladder or by
discomfort from manual pressure that is applied during removal of an arterial or venous
catheter. The vasovagal response is reversed by promptly elevating the lower extremities
above the level of the heart, infusing a bolus of IV fluid, and administering IV atropine to
treat the bradycardia.
 • Bed rest is maintained for 2 to 6 hours after the procedure. If manual or mechanical
pressure is used, the patient must remain on bed rest for up to 6 hours with the affected leg
straight and the head of the bed elevated no greater than 30 degrees. For comfort, the patient
may be turned from side to side with the affected extremity straight. If the cardiologist
deployed a percutaneous vascular closure device or patch, the nurse checks local nursing care
standards and anticipates that the patient will have fewer activity restrictions. The patient may
be permitted to ambulate within 2 hours. Analgesic medication is administered as prescribed
for discomfort.

• The patient is instructed to report chest pain and bleeding or sudden discomfort from the
catheter insertion sites promptly.

• The patient is monitored for contrast agent–induced nephropathy by observing for

• Patient safety is ensured by instructing the patient to ask for help when getting out of bed
the first time after the procedure. The patient is monitored for bleeding from the catheter
access site and for orthostatic hypotension, indicated by complaints of dizziness or
lightheadedness.

SELF MANAGEMENT AFTER CARDIAC CATHETERIZATION

After discharge from the hospital for cardiac catheterization, guidelines for self-care include
the following:

• For the next 24 hours, do not bend at the waist (to lift anything), strain, or lift heavy
objects.

• Avoid tub baths, but shower as desired.

• Talk with your physician about when you may return to work, drive, or resume strenuous
activities.

• Call your physician if any of the following occur: bleeding, swelling, new bruising or pain
from your procedure puncture site, temperature of 38.6C (101.5F) or more.

• If test results show that you have coronary artery disease, talk with your physician about
options for treatment, including cardiac rehabilitation programs in your community.
• Talk with your physician and nurse about lifestyle changes to reduce your risk for further
or future heart problems, such as quitting smoking, lowering your cholesterol level, initiating
dietary changes, beginning an exercise program, or losing weight.

• Your physician may prescribe one or more new medications depending on your risk factors
(medications to lower your blood pressure or cholesterol; aspirin or clopidogrel to prevent
blood clots). Take all of your medications as instructed. If you feel that any of them are
causing side effects, call your physician immediately. Do not stop taking any medications
before talking to your doctor.

Complications

● Arrhythmias

● Thrombosis

● Pericardial tamponade

● Embolism

● Stroke

● Myocardial Infarction

● Bleeding/Hematoma

● Contrast reaction