Percutaneous Coronary

Intervention (PCI)
BY: Huson Amin

:Outline

Definition.
History.
Indication.
Contraindication.
Procedure.
Nursing care (pre- post).
Complication.

:DEFINITION
Percutaneous Coronary Intervention
(PCI, formerly known as angioplasty with
stent) is a non-surgical procedure that
uses a catheter (a thin flexible tube) to
place a small structure called a stent to
open up blood vessels in the heart that
have been narrowed by plaque buildup,
a condition known as atherosclerosis.
though it was developed and originally
.performed by interventional radiologists

History
Coronary angioplasty, also known as
percutaneous transluminal coronary
angioplasty (PTCA), because it is
done through the skin and through
the lumen of the artery, was first
developed in 1977 by Andreas
Gruentzig.

: Indication for PCI

Acute ST-elevation MI (STEMI)
NonST-elevation acute coronary syndrome
(NSTE-ACS)
Stable angina
Anginal equivalent (eg, dyspnea, arrhythmia,
or dizziness or syncope)
Asymptomatic or mildly symptomatic patient
with objective evidence of a moderate-sized to
large area of viable myocardium or moderate
to severe ischemia on noninvasive testing

:Contraindication for PCI

Clinical contraindications for PCI
include intolerance of chronic
antiplatelet therapy and the
presence of any significant comorbid
conditions that severely limit patient
lifespan (this is a relative
contraindication).

:PCI procedure
procedures done during a
percutaneous coronary intervention
include:
Balloon angioplasty.
Implantation of stents
Rotational or laser atherectomy
Brachytherapy (use of radioactive
source to inhibit restenosis.

:PCI technique
Access into the femoral artery in the
leg (or, less commonly, into the
radial artery or brachial artery in the
arm) is created by a device called an
"introducer needle". This procedure
is often termed percutaneous access.

 Once access into the artery is gained, a "sheath

introducer" is placed in the opening to keep the
artery open and control bleeding.
Through this sheath, a long, flexible, soft plastic
tube called a "guiding catheter" is pushed. The tip
of the guiding catheter is placed at the mouth of
the coronary artery. The guiding catheter also
allows for radio-opaque dyes (usually iodinebased) to be injected into the coronary artery, so
that the disease state and location can be readily
assessed using real time X-ray visualization.

 During the X-ray visualization, the

cardiologist estimates the size of the
coronary artery and selects the type
of balloon catheter and coronary
guidewire that will be used during
the case. Heparin (a "blood thinner"
or medicine used to prevent the
formation of clots) is given to
maintain blood flow.

 The coronary guidewire, which is an

extremely thin wire with a radioopaque flexible tip, is inserted
through the guiding catheter and into
the coronary artery. While visualizing
again by real-time X-ray imaging, the
cardiologist guides the wire through
the coronary artery to the site of the
stenosis or blockage.

 While the guidewire is in place, it now acts as

the pathway to the stenosis. The tip of the
angioplasty or balloon catheter is hollow and is
then inserted at the back of the guidewire
thus the guidewire is now inside of the
angioplasty catheter. The angioplasty catheter
is gently pushed forward, until the deflated
balloon is inside of the blockage.
The balloon is then inflated, and it compresses
the atheromatous plaque and stretches the
artery wall to expand

 If an expandable wire mesh tube

(stent) was on the balloon, then the
stent will be implanted (left behind)
to support the new stretched open
position of the artery from the inside

 Newer drug-eluting stents (DES) are

traditional stents coated with drugs,
which, when placed in the artery,
release certain drugs over time.
These types of stents have been
shown to help prevent restenosis of
the artery
Umirolimus, zotarolimus, sirolimus,
everolimus, and paclitaxel

Nursing care pre PCI

If the patient is an In-patient on the unit,
try to arrange a visit from the nurse from
the cath lab. Among the things she should
accomplish is to ; introduce herself, advise
the patient as to what time the procedure
may occur, check the patients chart for:
pre-cath orders, allergies, signed
permission, verify counseling by the
physician and establish the patients
knowledge level.

 Physicians orders may include fasting for 3 to 8 hours

before the procedure and withholding or decreasing
the dosage of scheduled medications (including
insulin, antihypertensive drugs, and diuretics-unless
otherwise instructed by a physician).

Before sending the patient to the cardiac cath lab

make sure the pre-cardiac cath checklist is
completed and assess them for allergies, especially
to iodine or shellfish; some contrast material often
contain iodine.

Nursing care post PCI

The hemodynamic stability of the
patient should be assessed
immediately when the patient
returns from the cath lab. The initial
assessment should include vital
signs, O2 level, urine output,
strength and presence of pulses in
the extremities.

 Assess the affected puncture site. Followed by assessment of

cardiac, respiratory, pulmonary, and gastrointestinal.

When the patient returns they will be placed on bedrest with

the head of the bed no higher than 30 degrees (6-12 hrs).
The patients affected extremity must be kept straight.
Once the patient is fully awake and their condition warrants,
encourage the patient to drink fluids during the first 12 hours
post-cath, unless contraindicated by physician.
Maintain hourly intake and output.

 If the patients puncture site starts to

bleed, pressure should be held
just above the insertion site until
bleeding stops. If able, find the pulse
just above the insertion site and
apply pressure until hemostasis is
obtained. Note: Do Note
obliterate the distal pulses.

Complications of PCI
:Intravascular contrast
Sever delayed reactions have been
known to occur 30-60 minutes after
administration. Rare undesirable
reactions, ranging from mild nausea
to life threatening anaphylaxis have
occurred.

:Intravascular contrast complication

Hemodynamic effects- Transient impairment
in ventricular contractility, relaxation and
hypotension.
Electrophysiologic effects- Bradycardia, AV
Block, ST segment and T wave changes,
prolonged QT interval and Ventricular
tachycardia/fibrillation have been attributed to
the calcium channel binding buffers used in
contrast media.
Dye induced renal dysfunction is the most
common cause of renal insufficiency.

Complications / Risks Associated with Heart

:Catheterization

The main risks of the procedure are:

Bruising at the access site.
Trauma to the vein.
Puncturing the lung if the neck or chest
veins are used.
Very rare instances a patient may suffer
cardiac arrhythmias, cardiac tamponade,
low blood pressure, infection, or embolism
caused by blood clots at the tip of the
catheter

 The risk of complications is higher in:

People aged 65 and older
People who have kidney disease or
diabetes
Women
People who have poor pumping
function in their hearts
People who have extensive heart
disease and blockages

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