Page 463 - Cardiac Nursing

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CHAPTER
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C C C C Cardiac Catheterization
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Michaelene Hargrove Deelstra / Carol Jacobson
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physiollo ic severity of the ddisease iis determined, the prresence or
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C Ca diiac catheterization is wid ly us d for diiagnos ic ev lua ion ph ys io gi f th e d et er mi ne d p
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an andd therapeuticc intervention inn thee management of patients with ab absencee of related coonditions is explored, and the need for PCI
in
cardiac disease. Nurses have an important role in precatheteriza- can be determined.. Cardiac catheterization alsoo is usedd ffor the
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tion tea hchiing, i tracatheterizationn, and posttc thhete iriza ion care. ev lua ition off patients with acquired (Chapter 29) or congenital
The many nursing responsibilities related to cardiac catheteriza- (Chapter 31) heart disease. The ACC and the American Heart
tion are outlined in the American College of Cardiology/Society Association (AHA) have published guidelines for coronary an-
for Cardiac Angiography and Interventions (ACC/SCA&I) Clin- giography and indications for cardiac catheterization. 7–9 Indica-
ical Expert Consensus Document on Cardiac Catheterization tions for coronary angiography are classified for specific clinical
Laboratory Standards. 1 presentations, including risk stratification for patients with
Cardiac catheterization developed as a result of 50 years of chronic stable angina and asymptomatic patients with ischemia
clinical effort. Werner Forssman performed the first documented on noninvasive stress testing, and patients with acute coronary
cardiac catheterization in 1929. Guided by fluoroscopy, Forssman syndrome: non-ST elevation myocardial infarction (NSTEMI)
passed a catheter into his own right heart through an antecubital and ST elevation myocardial infarction (STEMI). 8–10
vein. He then walked upstairs to the radiology department and
confirmed the catheter position by radiograph. The techniques of Recommendations for Coronary
right and left heart catheterization were developed during the Angiography for Risk Stratification
1940s and 1950s. 2–4 In 1953, the percutaneous techniques of ar- in Patients With Chronic Stable
5
terial catheterization were introduced by Seldinger, and, in 1959,
selective coronary arteriography was introduced by Sones et al. 6 Angina: ACC/AHA Practice
Important advances related to cardiac catheterization included the Guidelines 8
development of the Swan–Ganz catheter in 1970 for measuring Class I indications:
right heart pressures and the thermodilution method for determi-
nation of cardiac output (CO); percutaneous coronary interven- 1. Patients with disabling (Canadian Cardiovascular Society
tions (PCIs), including percutaneous transluminal coronary an- [CCS] class III and IV) chronic stable angina despite medical
gioplasty, atherectomy, laser therapy, and stent placement; therapy. (Level of evidence: B)
electrophysiologic mapping and catheter ablation for the manage- 2.High-risk criteria on noninvasive testing regardless of anginal
ment of arrhythmias; valvuloplasty; and noncoronary devices for severity. (Level of evidence: B) (Display 20-1).
patent foramen ovale atrial septal defect closure, and ventricular 3. Patients with angina who have survived sudden cardiac death
1
septal defect closure (Chapter 23). or serious ventricular arrhythmia. (Level of evidence: B)
Although noninvasive diagnostic techniques have an impor- 4. Patients with angina and symptoms and signs of heart failure
tant role, cardiac catheterization remains the most definitive (HF). (Level of evidence: C)
procedure for the diagnosis and evaluation of coronary disease. 5. Patients with clinical characteristics that indicate a high likeli-
Coronary angiography together with adjunctive technologies hood of severe CAD. (Level of evidence: C)
during angiography, including intravascular ultrasound (IVUS),
fractional flow reserve (FFR), and coronary flow reserve (CFR), Recommendations for Coronary
provide direct quantitative measurements to evaluate signifi-
cance of coronary lesions. This chapter describes cardiac Angiography for Risk Stratification
catheterization procedures and their possible complications. It in Asymptomatic Patients: ACC/AHA
also describes the nursing care given before and after catheteri- Practice Guidelines 8
zation and the interpretation of data as they relate to coronary
artery disease (CAD). Class IIa indications:
1. Patients with high-risk criteria suggesting ischemia on nonin-
vasive testing. (Level of evidence: C)
INDICATIONS FOR CARDIAC
CATHETERIZATION Class IIb indications:
1. Patients with inadequate prognostic information after nonin-
C)
evidence:
el
of
(Lev
wide
a
Cardiac catheterization is indicated in a wide variety of circum- vasive testing. (Level of evidence: C)
Car
diac
indicated
is
in
catheterization
v
cum-
asiv
testing
e
cir
ariety
v
of
stances. The most frequent use of cardiac catheterization is to 2. Patients with clinical characteristics that indicate a high likeli-
confirm or define the extent of suspected CAD. Anatomical and hood of severe CAD. (Level of evidence: C)
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