Cardiology In Critical Care

Cardiac Catheterization Pre and Post Care

 

A cardiac catheterization is perhaps one of the most diagnostic and interventional tools available to the cardiologist today While many of these diagnostic and treatment procedures have become retained for most cardiac nurses in it is a native and alien procedure for the patient. It is incumbent upon the Mars to take the time to educate the patient and to have an understanding of what happens to the patient before, during, and after their procedure.

A. Pre-Catheterization

Before a patient undergoes a cardiac catheterization there are certain assessments and interventions which must be accomplished.

1. Before the patient undergoes cardiac catheterization a precardiac catheterization patient teaching plan must be established and initiated. This cardiac catheterization teaching plan must be individualized to fit the patient's needs.

2. As part of the teaching plan the patient should be visited by the nurse from the cardiac cath. laboratory. Among the functions she needs to accomplish is to; introduce yourself, advise the patient as to what time the procedure may occur, check the patient's chart for precath orders, allergies, cardiac cath. permit, verify counseling by the physician, and to establish that patients knowledge level. The most important purpose of this visit is to help alleviate any fears the patient may have and to provide the patient an opportunity to answer questions.

3. Before going to the cardiac cath. laboratory the nurse will complete the precardiac cath. checklist. This policy, should be established by your institution. If conscious sedation is ordered the nurse should be familiar with the institutional policy for carrying for patients who have undergone conscious sedation.

4. As part of the preparation for cardiac catheterization the nurse should check anc document the status of peripheral pulses.

B. Documentation:

1. All Documentation of Patient Teaching, and preop evaluation should be dead end of patient's clinical record.

2. Each institution should have a precardiac catheterization checklist much as they do for patients going to surgery.

 

C. Post-Catheterization

1. Assessment

a. when the patient returns from the cardiac catheterization laboratory, the stability of the patient should be established initially. This will include, but is not limited to, EKG, vital signs, oxygenation level, urine output, cardiac, respiratory, pulmonary, gastrointestinal, and gentle urinary assessment.

b. Particular attention must be paid to the peripheral vascular assessment of the lower extremities.

c. Often the patient may return from the cardiac catheterization laboratory with a sheath in place. if this is the case, the institutional procedures for caring for sheaths should be applied. Some institutions, may allow the nurse to remove that sheath. Other institutions, require that the physician removes the sheath.in the latter instance, the institutions policies and procedures must be followed.

d. In some institutions a ACT may be required to check the patients clotting time prior to sheath removal.

e Generally, the nurse should monitor vital signs, and distal pulses every 15 minutes X 4, every 30 minutes X 2, then every hour X 2, then routine. If there is any change in the patient's neurovascular status for physician should be notified immediately.

d. If the cardiac catheterization was done under conscious sedation to institutional policy for conscious sedation should be followed.

2. Interventions:

a. Before the patient returns to the unit, the nurse should ensure that all equipment is avialble to evaluate and maintain the patient once he arrives. these are things such as, intravenous pole with plump, blood pressure cuff, pulse oxmetry, telemetry if ordered, and sand bag.

b. when the patient returns he may be placed on bed rest with the head of the bed no higher than 30 degrees. The patients affected extremity must be kept straight.

c.Insure the patient is fully awake, encourage the patient to drink at least two liters of fluid during the first 12 hours post cardiac cath. if his condition warrants and if it is not counterindicated.

d. Maintain the patient on hourly intake and output.

f. If the patient starts to bleed at the puncture site, hold pressure above the insertion site until the bleeding is stopped. Do not hold pressure directly on the departure site. Notify the physician.

f. If patient re-bleeds at catheter site: find pulse above the insertion site and hold pressure with a guaze sponge until hemostasis is achieved. Note: do not totally obliterate distal pulses.

3. Teaching: Reinforce post cath teaching.

4. Documentation:

a. Document Initial vital signs/observations on approved Medical Record Form.

b. Document further observations in nursing note or on approved Medical Record Form.

REFERENCES:

1. Coyne, C., Baier, W., Perra B., & Sherer, B.K. (1994). Controlled trial of backrest elevation after coronary angiography. American Journal of Critical Care 3:282-288.

2. Keeling, A.W., Knight, E., Taylor, V., & Nordt, L.A. (1994). Postcardiac catheterization time-in-bed study: Enhancing patient comfort through nursing research. Applied Nursing Research 7:14-17.

3. Prinkey, L.A. (1992). Diagnostic testing. In C.E. Guzzetta & B.M. Dossey (Eds). Cardiovascular Nursing: Holistic Practice, pp. 126-159. St. Louis: C.V. Mosby.

4. Nursing Department Policy, "Care of Patients with Arterial Lines", January 1995.

5. Nursing Department Standard of Practice, "Care of the Patient with an Arterial Line (Radial and Brachial)", August 1994.

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