b.inside
| موضوع: Cardiac Catheterization 6/11/2009, 00:45 | |
| 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is passed up through the catheter and is used to puncture the septum separating the right and left atria; needle is withdrawn and the catheter is advanced under fluoroscopic control into left ventricle.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. • 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. | |
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عدي الزعبي
| موضوع: رد: Cardiac Catheterization 9/11/2009, 04:46 | |
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theredrose
| موضوع: رد: Cardiac Catheterization 23/6/2011, 05:54 | |
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دلع المنتدى
| موضوع: رد: Cardiac Catheterization 23/6/2011, 16:00 | |
| موضوع القسطره رائع الله يحمي الجميع | |
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