CARDIAC CATHETERIZATION

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Clarification for catheterization and chronic stable angina patient:
Main reasons a cardiac catheterization is recommended for a patient with chronic stable
angina (according to American College of Cardiology Foundation and American Heart
Association):
Patients with disabling chronic stable angina despite medical therapy
High-risk criteria on clinical assessment or noninvasive testing regardless
of anginal severity
Patient who have survived sudden cardiac death or serious ventricular
arrhythmia
Patients with angina and symptoms and signs of congestive heart failure

PRE:
1. Assess for allergies to radiopaque dye, iodine, or shellfish. Patient may be
pretreated for the allergies.
2. Written, informed consent by physician
3. NPO for 6-8 hours prior to procedure
4. Adequate hydration
a. IV insertion with fluids as ordered
b. Clear liquids up to 4 hours before procedure may be allowed
5. Use of N-acetylcysteine (Mycomyst) prior to and post cardiac catheterization in
patients who are at risk for contrast nephropathy (for example, may treat if
creatinine > 1.5, but depends on the hospital policy)
6. Assessment of baseline vital signs, oxygen saturation, and peripheral pulses.
Abnormal labs that may affect the catheterization should be communicated to the
cath lab (information on front of chart, called to cath lab).
7. Explain the procedure to the patient. Explain that they will be awake and may
experience a flushing sensation as the dye is injected or feel fluttering as the
catheter passes through the heart.
8. Medications: Hold metformin (Glucophage). Generally, hold low molecular
weight heparin (for example, Lovenox) on the day of the catheterization. Check
adjusted insulin order for day of catheterization.
POST:
1. View post procedure orders and agency policy
2. Maintain strict bedrest per physician’s orders (up to 4-6 hours) with head of
bed elevated < 15-30 degrees
3. Continuous EKG monitoring
4. Monitor VS, oxygen saturation per agency protocol.
5. Assess peripheral pulses, color, sensation, temperature of extremity, signs of
bleeding or hematoma at insertion site with vital signs
6. Maintain dressing at insertion site
7. Maintain IV, encourage oral fluids, and monitor intake and output
8. Report significant problems to physician: chest pain, dysrhythmias, bleeding,
hematoma, significant changes in vital signs or peripheral pulses