Page 467 - Cardiac Nursing

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C HAPTER 2 0 / Cardiac Catheterization 443
11. The patient should report angina, shortness of breath (SOB), General Exclusion Criteria for Early
and other symptoms to the staff. DISPLAY 20-2 ( 2–6 Hour) Discharge After Invasive
12. The patient should be told the expected length of bed rest af- Cardiac Procedure in Adults
ter the catheterization.
High risk due to identification of left main disease
New York Heart Association class III or IV HF
Outpatient Cardiac Catheterization Unstable ischemic symptoms at any time after the
procedure
Improvements in cardiac procedures and decline in risk associated Recent MI with postinfarction ischemia
with diagnostic cardiac catheterizations have increased the num- Pulmonary edema thought to be caused by ischemia
ber of outpatient procedures. Advantages include decreased costs Severe aortic stenosis with LV dysfunction
and avoidance of an unnecessary overnight hospital stay. Patients Severe aortic insufficiency with a pulse pressure
considered for outpatient cardiac catheterization are those with 80 mm Hg
stable coronary symptoms. Patients in whom the outpatient pro- Poorly controlled systemic hypertension
cedure is contraindicated include those with ACS (UA, NSTEMI, Inadequate or unreliable follow-up over the next 24 hours
or STEMI); uncompensated HF; severe aortic stenosis; suspected Generalized debility or dementia
left main coronary disease; known bleeding disorders; and meta- Renal insufficiency (creatinine 1.8 mg/dL)
Need for continuous anticoagulation therapy or treatment
bolically unstable patients. of a bleeding diathesis
Patients needing preadmission to the hospital for cardiac Large hematoma or vascular complication
catheterization include those who require continuous anticoagu-
lation or who have significant renal insufficiency or brittle dia- Adapted from Bashore, T. M., Bates, E. R., Berger, P. B., et al. (2001). American Col-
betes mellitus. Noninvasive testing may identify patients with lege of Cardiology/Society for Cardiac Angiography and Interventions Clinical Ex-
high-risk coronary or valvular disease before catheterization. Ad- pert Consensus Document on cardiac catheterization laboratory standards: A report
of the American College of Cardiology Task Force on Clinical Expert Consensus
ditional considerations include the distance the patient lives from Documents (ACC/SCA&I Committee to Develop an Expert Consensus Document
the hospital and the availability of someone to drive the patient on Cardiac Catheterization Laboratory Standards). Journal of the American College of
7
7
1
home. Freestanding cardiac catheterization laboratories that are Cardiology, 37, 2170–2214.
not physically attached to a hospital facility are available and are
used for diagnostic studies. It is the responsibility of each free-
standing laboratory to have a formal relationship with a referral ongoing trend toward more complex interventional procedures re-
hospital for emergency services. Patients studied at freestanding sults in greater exposure to radiation for the patient and labora-
laboratories require thorough screening. High-risk patients must tory staff. This radiation exposure is monitored for safety. 1
be excluded to avoid complications that require emergency The technique of imaging has moved away from cineangio-
services. 1 graphic to digital images in most laboratories. The laboratory usu-
Preprocedure teaching is best done before hospital admis- ally has the following equipment:
sion. The content is similar to that for patients undergoing an
inpatient procedure. Patients who have significant CAD or left 1. A patient support table, adjustable height, flat top whose locks
main coronary disease or complications during the procedure can be released to allow the table top to move horizontally
are usually admitted to the hospital for overnight observation head-to-toe and side-to-side for “panning.”
(Display 20-2). 2. Equipment for monitoring intracardiac pressures, CO determi-
After a diagnostic procedure, the patient spends 2 to 6 hours nation, and physiologic recordings.
in a short-stay unit, ambulatory recovery, or similar setting. Post- 3. A suspended C-arm that rotates around the patient and allows
procedure orders are the same for inpatient and outpatient cardiac variable angulations of the x-ray beam.
catheterization. After the required period of bed rest, postural 4. The image chain consists of a generator and cine pulse system,
blood pressure and heart rate are obtained and the patient is ob- an x-ray tube, an image intensifier, an optical distributor, a 35-
served for 30 to 60 minutes while sitting, standing, and walking. mm cine camera, and a television camera and monitor. The im-
During this time, discharge instructions are reviewed. The patient age chain produces fluoroscopy, which is the continuous pres-
is then allowed to leave. Results of the catheterization are reviewed entation of an x-ray image on a fluorescent screen, allowing the
with the patient and/or family after the procedure by the cardiol- viewing of structures in motion. The image intensifier receives
ogist or before discharge. Patients who have had PCI routinely the fluoroscopic image and increases its brightness, permitting
stay overnight for observation and monitoring and are discharged filming (cinefluoroscopy) or digital acquisition of motion pic-
the following morning. tures and viewing of the image with a television camera, televi-
sion screen, and videotape recorder. Although 35-mm film was
originally used for recording, since 1998 all new images are per-
PROCEDURE manently recorded digitally.
5. Single or biplane imaging system can be used. Biplane imaging
Cardiac Catheterization Laboratory provides simultaneous viewing of cardiac structures from two
angles, which is helpful for congenital heart disease, transseptal
The cardiac catheterization laboratory is a specially equipped ra- punctures, and electrophysiology ablations.
diologic laboratory for the study of children and adults with 6. Advanced cardiac life support drugs and equipment with a
known or suspected heart disease. The primary technical focus is cardioverter–defibrillator available for emergency treatment.
the generation, recording, and display of high-quality x-ray 7. Monitoring electrocardiographic activity with continuous
images during diagnostic and interventional procedures. The ECG monitor display.