Faculty of Nursing

Cairo University
Second Year

BY
Aya Mohamed Farouk
Supervision By
Dr. Ali Hussien
 Outlines
 Introduction
 Anatomy of cardiovascular system
 Definition of cardiac catheterization
 Purpose of cardiac catheterization
 Procedures of cardiac catheterization
 Sites of insertion
 Complications
 Nursing care
 Health teaching
 Reference
 Cardiac Catheterization
 

Introduction
Cardiac Catheterization this test can measure blood
pressure within the heart and how much oxygen is in the
blood. It's also used to get information about the
pumping ability of the heart muscle. Catheters are also
used to inject dye into the coronary arteries. This is
called coronary angiography or coronary arteriography .
Catheters with a balloon on the tip are used in the
procedure called coronary angioplasty (commonly
referred to as percutaneous coronary intervention [PCI]).
Catheterization of the heart may also be done on infants
and children to examine for congenital heart defects.

Anatomy of cardiovascular system

The Systemic Circulation
Definition of cardiac catheterization
 Cardiac catheterization (heart cath) is the insertion of
a catheter into a chamber or vessel of the heart. This is
done for both investigational and interventional
purposes.
 Cardiac catheterization is a medical procedure used to
diagnose and treat certain heart conditions.

Purpose of cardiac catheterization

 Check blood flow and blood pressure in the chambers
of the heart.

 Check blood flow in the coronary arteries and, if you

have coronary artery disease(CAD), determine
whether surgery or another type of procedure, such as
angioplasty with stenting, is needed to open the
blocked blood vessels.

 Check the pumping action of the heart.

 Find out if a congenital heart defect is present and how
severe it is. Cardiac catheterization sometimes can also
be used to help correct the defect.

 Check blood flow through the heart after surgery.

 Find out how well the heart valves work.
 Confirm the presence of a suspected heart ailment.
 Quantify the severity of the disease and its effect on
the heart.

 Seek out the cause of a symptom such as shortness of

breath or signs of cardiac insufficiency.

 To take tissue samples for biopsy.

Procedures of cardiac catheterization
Local anaesthetic is injected into the skin, usually in the
right groin, to numb the area. In some centers access to
the coronary arteries is made via the right radial or
brachial artery (hand or arm), but the majority of cases
are still done from the groin region. A puncture is then
made with a needle in either the femoral artery in
the groin or the radial artery in the wrist,(Seldinger
technique), before a guidewire is inserted into the arterial
puncture. A plastic sheath (with a stiffer plastic
introducer inside it) is then threaded over the wire and
pushed into the artery. The wire is then removed and the
side-port of the sheath is aspirated to ensure arterial
blood flows back. It is then flushed with saline. This
arterial sheath, with a bleedback prevention valve, acts as
a conduit into the aretery for the duration of the
procedure.

Catheters are inserted using a guidewire and moved

towards the heart. Once in position above the aortic valve
the guidewire is then removed. The catheter is then
engaged with the origin of the coronary artery (either left
main stem or right coronary artery) and x-ray opaque
iodine-based contrast is injected to make the coronary
vessels show up on the x-ray fluoroscopy image.

When the necessary procedures are complete, the

catheter is removed. Firm pressure is applied to the site
to prevent bleeding. This may be done by hand or with a
mechanical device. Other closure techniques include an
internal suture and plug. If the femoral artery was used,
the patient will probably be asked to lie flat for several
hours to prevent bleeding or the development of
a hematoma. If the arm is used, the patient can ambulate
sooner. Cardiac interventions such as the insertion of
a stent prolong both the procedure itself as well as the
post-catheterization time spent in allowing the wound to
clot.
A cardiac catheterization is a general term for a group of
procedures that are performed using this method, such
as coronary angiography, as well as left ventrical
angiography. Once the catheter is in place, it can be used
to perform a number of procedures
including angioplasty, PCI (percutaneous coronary
intervention) angiography, balloon septostomy, and an
Electrophysiology study.

Sites of insertion
Complications
 Bleeding around the point of puncture
 Abnormal heart rhythms
 Blood clots
 Infection
 Allergic reaction to the dye
 Stroke
  Heart attack
 Perforation of a blood vessel
 Air embolism (introduction of air into a blood
vessel, which can be life-threatening)
 Continued chest pain or angina
 Kidney failure
 Acute closure of coronary artery

Nursing care:
Before Procedure
 Explain the procedure to the patient and answer
his questions. Provide booklets, videos, or other
educational tools to reinforce learning.
 The cardiologist will discuss benefits and risks,
such as arrhythmias, bleeding, stroke, or MI. Make
sure the patient has signed an informed-consent
form.
 Assess him for allergies, especially to iodine or
shellfish; some contrast materials contain iodine.
Also note if he's allergic to medications: including
lidocaine, the local anesthetic commonly used for
catheter insertion.
 For 3 to 8 hours before the procedure and
withholding or decreasing the dosages of
scheduled medications (including insulin,
antihypertensive drugs, and diuretics unless
instructed otherwise by the physician).
 Establish two I.V. lines and infuse fluids to
prevent dehydration. Obtain specimens for lab
tests (complete blood cell count, electrolytes,
blood urea nitrogen, creatinine, clotting studies,
 cardiac enzymes, and urinalysis). Also obtain a
chest X-ray and an ECG.
 The femoral and brachial arteries are common
catheter insertion sites, although the radial artery is
also an option. Mark pulses on the arm or leg that
will be used.
 Have the patient void. (He may wear his dentures
and eyeglasses during the test.) and given a
hospital gown to wear.
 Administer analgesics, sedatives, or tranquilizers
as directed.

During Procedure
 The cardiac catheterization room is cool and dimly
lit. The air must be kept cool to prevent damage to
the x-ray machinery that is used during the
procedure. You will be offered warm blankets to
make you more comfortable.
 Patient lie on a special table. If you look above,
you will see a large camera and several TV
monitors. You can watch your cardiac cath on the
monitors.
 Clean the skin at the site where the catheter
(narrow plastic tube) will be inserted (arm or
groin). The catheter insertion site may be shaved.
 Sterile drapes are used to cover the site and help
prevent infection. It is important that you keep
your arms and hands down at your sides, under the
sterile drapes.
 Electrodes (small, flat, sticky patches) will be
placed on your chest. The electrodes are attached
 to an electrocardiograph monitor (ECG), which
monitors your heart rate and rhythm.
 Given a mild sedative to relax, but patient will be
awake and conscious during the entire procedure.
 In some cases, a urinary catheter may be needed
during the procedure.
 The doctor will use a local anesthetic to numb the
site. A plastic introducer sheath (a short, hollow
tube through which the catheter is placed) is
inserted in a blood vessel in your arm or groin. A
catheter will be inserted through the sheath and
threaded to the arteries of your heart. You may feel
pressure as the introducer sheath or catheter are
inserted, but you should not feel pain. Tell the
nurse or doctor if you feel any pain.
 When the contrast material is injected into heart,
you may feel hot or flushed for several seconds.
This is normal and will go away in a few
seconds. Please tell the doctor or nurses if you
feel:
1. an allergic reaction (itching, tightness in the
throat, shortness of breath)
2. nausea
3. chest discomfort
4. any other symptoms
 Asked patient to hold your breath while the x-
rays are taken.

After Procedure
 After x-rays are taken, the catheter is renoved
  A band-aid or pressure dressing will be placed
over the area where the catheter was inserted
 Firm pressure is applied for 15-30 mintues until
the bleeding stop, then a stand bag is placed over
the site for about six hours. Lately, when the
vascular anatomy allows, a AngioSeal (a kind of
silicon plug) can be used to stop the bleeding and
avoid the sand bag, allowing for early discharge
 If an artery in the arm is used, pressure will be
applied
 The patien will be observed for 6-8 hours before
discharged home
 The insertion site will be checked frequently for
signs of bleeding
 Blood pressure and the pulse in the leg or arm
will be checked frequently
 Most patients are discharged in 3 to 8 hours with
minimal
 Activity restrictions

Health teaching
 Going Home
1. During your drive home, stop every hour and walk
for 5 to 10 minutes.
 Care for the Catheter Insertion Site
1) The morning after your procedure, you may take the
dressing off. The easiest way to do this is when you
 are showering, get the tape and dressing wet and
remove it.
2) After the bandage is removed, cover the area with a
small adhesive bandage. It is normal for the catheter
insertion site to be black and blue) for a couple of
days. The site may also be slightly swollen and
pink, and there may be a small lump (about the size
of a quarter) at the site.
3) Wash the catheter insertion site at least once daily
with soap and water. Place soapy water on your
hand or wash- cloth and gently wash the insertion
site; do not rub.
4) Keep the area clean and dry when you are not
showering. Do not use creams, lotions or ointment
on the wound site.
5) Wear loose clothes and loose underwear.
6) Do not take a bath, tub soak, go in a Jacuzzi, or
swim in a pool or lake for one week after the
procedure.
7) If stitches were placed to close the catheter insertion
site, the doctor will tell you how to care for the
incision until the stitches are removed, usually after
1 week.

 Activity Guidelines
1) Your doctor will tell you when you can resume
activities. In general, you will need to take it easy
for the first two days after you get home. You can
expect to feel tired and weak the day after the
procedure. Take walks around your house and plan
to rest during the day.
 2) Do not strain during bowel movements for the first
3 to 4 days after the procedure to prevent bleeding
from the catheter insertion site.
3) Avoid heavy lifting (more than 10 pounds) and
pushing or pulling heavy objects for the first 5 to 7
days after the procedure.
4) Do not participate in strenuous activities for 5 days
after the procedure. This includes most sports -
jogging, golfing, playing tennis, bowling.
5) You may climb stairs if needed, but walk up and
down the stairs more slowly than usual.
6) Gradually increase your activities until you reach
your normal activity level within one week after the
procedure.
7) Ask your doctor when it is safe to resume sexual
activity.

 Driving
 Your doctor will tell you when it is safe to resume
driving. Most people are able to resume driving
within 24 hours after going home.
 Returning to Work
 Most people are able to return to work within 1 to 2
weeks after an interventional procedure. If you had
a heart attack, your recovery may be longer. Your
doctor will provide specific guidelines about
returning to work.
 Medications
1) Please review your medications with your doctor
before you go home. Ask your doctor if you should
continue taking the medications you were taking
before the procedure.
2) If you have diabetes, your doctor may adjust your
diabetes medications for one to two days after your
procedure. Please be sure to ask for specific
directions about taking your diabetes medication
after the procedure.
3) Depending on the results of your procedure, your
doctor may prescribe new medication. Please make
sure you understand what medications you should
be taking after the procedure and how often to take
them.

 Fluid Guidelines
1) Be sure to drink eight to ten glasses of clear fluids
(water is preferred) to flush the contrast material
from your system.

 Follow Up
 Your Cleveland Clinic cardiologist will contact your
referring or primary care doctor by phone or fax to
report the results of your catheterization. Your
doctor also will receive a written report from
Cleveland Clinic in the mail that will include a
general summary of your medical condition
including the procedure you underwent, your
prescribed medications and care plan.  Ask your
primary care doctor when you should return for
follow-up testing.
 Call your doctor if:
 Your arm or leg becomes numb or painful, or if
there is redness or a yellow discharge at the catheter
insertion site. It is normal to have soreness at the
catheter insertion site.
 You have pain or numbness below the catheter
insertion site (leg, toes, arm, fingers).
 The catheter insertion site swells or bleeds. If this
happens, lie down immediately on a firm surface
and have someone apply pressure to the catheter
insertion site for 10 minutes by pressing the heels of
both hands over the lump and pushing down. If the
swelling and/or bleeding don't stop, call your doctor
or go to the emergency room while continuing to
hold pressure to the site. Seek emergency medical
care immediately if you have chest pain like the
pain before or during your catheterization.

Reference
 Carroll, P. (1995). "Chest Tubes made easy". RN,
December. pp. 46 -55.
 Gordon, P.A., Norton, J.M. & Merrell, R. (1995).
Refining Chest Tube Management: Analysis of the
 State of Practice Dimensions of Critical Care
Nursing. 14 (1), pp. 6 -12.
 Kozier, B. & Erb, G. Eds. (1993). "Monitoring a
Client with Chest Drainage". Techniques in Clinical
Nursing. pp. 817 -821.
 O'Hanlon-Nichols. "Clinical Savvy: commonly
asked questions about chest tubes". American
Journal of Nursing. May 1996. 96, pp. 60-64.
 Springhouse Corporation (1991). "Chest Drainage",
Procedures Video Series. Springhouse PA
 Ignatavicius, Donna D., et al. Medical-Surgical
Nursing Across the Health Care Continuum.
Philadelphia: W.B. Saunders Company, 1999.
 Blank-Reid, Cynthia A., and Paul C. Reid. "Taking
the Tension Out of Traumatic Pneumothoraxes."
Nursing 29 (April 1999): 41.
 Pettinicchi, Theodore A. "Trouble Shooting Chest
Tubes." Nursing 28 (March 1998): 58.
 Deanna M. Swartout-Corbeil, R.N
 Elizabeth D Agabegi; Agabegi, Steven S.
(2008). Step-Up to Medicine (Step-Up Series).
Hagerstwon, MD: Lippincott Williams &
Wilkins. ISBN 0-7817-7153-6.