Cardiac Catheterization

Cardiac Catheterization

Description
• Cardiac catheterization is a diagnostic procedure in which a catheter(s) is (are) introduced into the heart and blood vessels to 1) measure oxygen concentration, saturation, tension, and pressure in the various heart chambers; 2) detect shunts; 3) provide blood samples for analysis; and 4) determine cardiac output and pulmonary blood flow.
• Right-heart catheterization—A radiopaque catheter is passed from an antecubital or femoral vein into the right atrium, right ventricle, and pulmonary vasculature under direct visualization with a fluoroscope.
 Right atrium and right ventricle pressures are measured; blood samples are taken for hematocrit and oxygen saturation.
 After entering the right atrium, the catheter is then passed through the tricuspid valve, and similar tests are performed on blood within the right ventricle.
 Finally, the catheter is passed through the pulmonic valve and as far as possible beyond that point; capillary samples are obtained and “capillary pressures” (wedge pressure) are recorded.
 Complications—Cardiac dysrhythmias, venous spasm, thrombophlebitis, infection of cutdown site, cardiac perforation, and cardiac tamponade.
• Left-heart catheterization—Usually done by retrograde catheterization of the left ventricle or by transseptal catheterization of the left atrium.
 Retrograde approach—Catheter inserted under direct vision into right brachial artery and advanced under fluoroscopic control into the ascending aorta and into the left ventricle; or, catheter may be introduced percutaneously by puncture of femoral artery.
 Transseptal approach—Catheter is passed from the right femoral vein (percutaneously or by saphenous vein cutdown) into right atrium. A long needle is passed up through the catheter and is used to puncture the septum separating the right and left atria; needle is withdrawn and the catheter is advanced under fluoroscopic control into left ventricle.
 The catheter tip is placed at the coronary sinus, and contrast medium is injected directly into one or both of the coronary arteries to evaluate patency.
 Gives hemodynamic data—Permits flow and pressure measurements of left heart.
 Most often performed to evaluate the function of the left ventricular muscle and mitral and aortic valves, or the patency of coronary arteries.
 Used to evaluate patients before and after cardiac surgery.
 Complications of left heart catheterization and implications for nursing assessment are :
 Dysrhythmias (ventricular fibrillation), syncope, vasospasm
 Pericardial tamponade, MI, pulmonary edema
 Allergic reaction to contrast medium
 Perforation of great vessels of heart; systemic embolization (stroke, MI)
 Loss of pulse distal to arteriotomy and possible ischemia of lower arm and hand.
• Angiography is usually combined with heart catheterization for coronary artery visualization.
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Nursing/Patient Care Considerations
Pre procedure:
• Know which approach is to be used in order to anticipate possible complications.
• Withhold food and fluid 6 hours before procedure to prevent vomiting and aspiration.
• Ascertain history of previous allergies.
• Mark distal pulses for easy reference after catheterization.
• Explain that patient will be lying on an examining table for a prolonged period and that certain sensations may be experienced:
 Occasional thudding sensations in the chest—from extrasystoles, particularly when the catheter is manipulated in ventricular chambers.
 Strong desire to cough may occur during contrast medium injection into right heart during angiography.
 Transient feeling of heat, particularly in the head, from injection of contrast medium.
• Remove dentures; give prescribed medication.

Post procedure:
• Record the blood pressure and apical pulse every 15 minutes (or more frequently) until vital signs are stable after the procedure to discern dysrhythmias.
• Check peripheral pulses in affected extremity (dorsalis pedis, posterior tibial pulse in the lower extremity, and radial pulse in upper extremity); evaluate extremity temperature, color, and complaints of pain, numbness, or tingling sensation to determine signs of arterial insufficiency.
• Watch puncture (cutdown) sites for hematoma formation. Question patient about increase in pain/tenderness at site.
• Assess for complaints of chest pain and report occurrence immediately. MI may occur and is a serious complication of cardiac catheterization.
• See that the patient remains in bed with little movement of the involved extremity until the following morning.
• Evaluate complaints of back pain, thigh or groin pain (may indicate retroperitoneal bleeding).
• Be alert for signs/symptoms of vagal reaction (nausea, diaphoresis, hypotension, bradycardia); treat as directed with atropine and fluids.