14.18: Cardiac Catheterization IV: Nursing Management

Nursing responsibilities before cardiac catheterization include:

Assess for allergies and establish baseline health status.

Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory values, including cardiac biomarkers and creatinine levels.

Patient education and procedure explanation

Educate the patient and caregiver about the procedure and post-procedure care. Inform them that the procedure typically lasts less than two hours, with the patient lying on a table. Explain that local anesthesia will be applied at the insertion site, and the patient might feel occasional palpitations, especially when the catheter tip touches the endocardium. The injection may cause a flushed feeling and a sensation of needing to urinate, which usually subsides within a minute. Administer sedatives and other prescribed medications as needed.

Post-procedure nursing care

Nursing responsibilities after cardiac catheterization include the following.

Baseline comparison and initial assessments

After the procedure, a thorough assessment is performed, and the results are compared to the pre-procedure baseline. This includes vital signs, pulse oximetry, and heart and breath sounds. Watch for signs of hypotension, hypertension, or pulmonary embolism, such as respiratory difficulty.

Ongoing monitoring and assessments

Follow hospital policy for post-procedure assessment, which is typically every 15 minutes during the first hour, every 30 minutes during the second hour, and hourly for the next four hours or until discharge. Assess the catheter access site for bleeding or hematoma and evaluate peripheral pulses in the affected extremity (e.g., dorsal pedis, posterior tibial, or radial pulse). Check the extremity’s temperature, color, and capillary refill and monitor for pain, numbness, or tingling indicating arterial insufficiency.

Monitor for arrhythmias and vasovagal reactions

Screen for arrhythmias by observing the cardiac monitor or assessing apical and peripheral pulses for changes in rate and rhythm. Be alert for vasovagal reactions, which can cause bradycardia, hypotension, and nausea. These are often triggered by a distended bladder or discomfort from manual pressure during catheter removal. Manage this by elevating the lower extremities, infusing IV fluids, and administering IV atropine as prescribed.

Activity restrictions and hemostasis management

Maintain activity restrictions for 2 to 6 hours post-procedure. The duration of bed rest, chair activity, and ambulation depends on the arterial approach, catheter size, medications, and hemostasis method. If manual pressure or a mechanical device was used during a femoral artery approach, keep the patient on bed rest for up to 6 hours with the affected leg straight and elevate the head of the bed to no more than 30 degrees. For comfort, the patient may turn from side to side while keeping the affected extremity straight.

Patient instructions and safety

Instruct the patient to report any bleeding, chest pain, or sudden discomfort at the catheter insertion site. Monitor for contrast-induced nephropathy (CIN) by checking serum creatinine levels and ensuring IV hydration to increase urinary output. Record accurate oral and IV intake and urinary output. Advise the patient to request assistance when getting out of bed for the first time after the procedure. Monitor for bleeding from the catheter access site and signs of orthostatic hypotension, such as dizziness or lightheadedness.