Cardiac catheterisation is an invasive diagnostic procedure where a catheter is inserted through a peripheral blood vessel to acquire important information about the structure and function of the heart. Through angiography, x-ray images are produced, showing the coronary arteries supplying blood to the myocardium. Treatment of cardiovascular conditions are also possible through cardiac catheterisation.
Cardiac Catheterisation Indications
- Emergency situation eg. STEMI or NSTEMI presenting with chest pain;
- Urgent situation eg. STEMI treated with fibrinolysis or NSTEMI;
- Elective situation eg. in stable coronary artery disease (patient experiences pain during exercise or climbing a flight of steps which goes away after rest – non-urgent situation where planning is possible).
Cardiac Catheterisation Contraindications
- anaemia
- electrolyte imbalance
- uncontrolled hypertension
- arrhythmias
- renal impairment
- allergy to radiographic contrast used in procedure (in which case a different technique may be used)
- peripheral vascular disease (in this case the best route to be used to advance catheter should be sought)
- recent cerebrovascular accident
- severe cardiac failure (in which case patients should NOT be put in supine position due to dyspnoea)
- coagulopathy (patient could bleed excessively)
- uncontrolled diabetes mellitus (blood glucose should be controlled prior to the procedure)
- pregnancy (dye used in procedure could be toxic for the foetus)
Nurse Responsibilities
- know about the patient’s comorbidities that may increase complication rate
- allergy history especially to drugs and iodine/seafood
- know patient haemoglobin level before patient reaches operating table so as to know how to manage bleeding if needed
- acquire patient signature on consent form
- explain frequently experienced sensations such as hot flush or metallic taste that comes with the procedure when dye is injected
- keep patient monitored on ECG with remote defibrillation pads available especially with unstable patients during procedure (a rapid pulse is a normal finding)
Access Route
Cardiac catheterisation is done through the femoral or radial artery. The radial artery is quicker and safer (due to the palmar arch) than the femoral artery since it is wider, making it easier to advance wire through it. It also allows the patient to sit up right after the procedure, whereas in femoral access the patient has to stay on bed rest with the femoral area frequently monitored. However, the femoral artery is still preferred by many operators.
Femoral Arterial Sheats Removal Nurse Responsibilities
Ensure that the patient has been prescribed analgesia prior to sheath removal.
In hypertensive patients, prolonged manual pressure should be applied before sheath removal.
If a haematoma is present, blood flow to the lower limb could be compromised. Thus, the nurse should access the pedal pulse to confirm if blood flow is being impeded. Comparing both limbs and asking the patient to move toes may also help. Manual pressure or through a mechanical device should be used in the case of a haematoma.
Gelafundin, which is a sterile powder indicated in surgical procedures to obtain haemostasis, can be helpful when dealing with a haematoma, however it has an effect on blood pressure. The systolic pressure needs to be less than 90 to use Gelafundin.
Record length and width of haematoma by marking the edges so you can compare later on to confirm whether it is spreading or reducing.
Bleeding
In the case of bleeding from the angio site, occlude femoral artery with manual pressure and assess whether bleeding stops. If it doesn’t stop it means that the bleeding is superficial. In this case apply manual pressure. For mild bleeding apply pressure for 10-20 minutes either using manual pressure or FemoStop, which is a compression device. In the case of major bleeding, a drop in haemoglobin may be noted. This may require blood transfusion. For this reason, the patient should be cross-matched prior to the procedure.
Pseudoaneurysm happens when blood flowing through the tunica media is captured behind the tunica advanticia, which can lead to a rupture due to its weakness. Pseudoaneurysm can cause nerve compression leading to neuralgia.
In retroperitoneal bleeding, which is the result of a ruptured pseudoaneurysm, the patient deteriorates in a very short time, especially since this cavity is very big and can accumulate a large amount of blood which leads to cardiogenic shock. Symptoms of retroperitoneal bleeding include hypotension and severe back pain. It should be reported immediately.
Patient Education
- apply pressure to femoral site when coughing or sneezing, or if warmth or wetness is felt
- after femoral sheath removal, patient should stay on bed rest for 4 hours
- unless contraindicated, fluid intake should be encouraged to promote contrast medium excretion
- patient should report any bleeding or pain at the angio site immediately
Below you can find a collection of videos that can help provide a more visual approach to cardiac catheterisation.
Cardiac Catheterisation Procedure
Angioplasty Procedure
Cardiac Catheterisation Sheath Removal
FemStop Femoral Artery Compression Device
TR-Band Radial Compression Device
Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Beaumont Health, Fortis Healthcare, Houston Methodist DeBakey CV Education, Nicole McMullen and Radcliffe Group.
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
- The NUPO Diet Review: trying NUPO before going under the knife - 19/12/2023
- Antimicrobial Resistance Symposium - 11/11/2023
- Examination of the Abdomen for Nursing Students - 01/07/2023
