For the first hour after a client has a cardiac catheterization using the brachial artery

Q: Which nursing action is most important when caring for a client after a cardiac catheterization?

Nursing Interventions Monitor the patients heart rate and rhythm, respiratory and pulse rates, and blood pressure frequently. Monitor the patients vital signs every 15 minutes for 2 hours after the procedure, every 30 minutes for the next 2 hours, and then every hour for 2 hours.

Cardiac Catheterization

A coronary angiogram (or cardiac catheterization) is an imaging procedure that explores the heart, searching for any looming cardiac conditions, such as abnormal blood flow. This test is a bit more invasive than other cardiac exams offered at Midcoast Cardiovascular Associates, as it requires the introduction of a narrow catheter directly into the heart. The catheter we use is soft and slim, so that it provides safe cardiac exploration without damaging delicate tissue.

Inhaltsverzeichnis Show

Cardiac Catheterization
What You Can Expect From This Procedure
Who Needs a Cardiac Angiography and Why?
Results of the Cardiac Angiography
If your incision site is in your groin
If you had a transradial procedure
About Cleveland Abu Dhabi Clinic
Which complication will the nurse monitor the patient for immediately after cardiac catheterization?
Which nursing action is most important when caring for a client after a cardiac catheterization?
Which nursing assessment is most important immediately following cardiac catheterization?
Which of these are possible complications to monitor for after a cardiac catheterization select all that apply?

What You Can Expect From This Procedure

Dr. Ginkel expertly performs this cardiac angiography using three variable approaches. The most common method used in cardiac angiography is to insert the catheter through the femoral artery in the groin. Alternative avenues include using the brachial artery (located in your arm) and radial artery (located in your wrist). While these other access methods aren’t an option for every patient, they do offer advantages for some. Dr. Ginkel will explain the feasibility of either approach as it applies directly to your unique case.

The femoral artery is the most accessible and commonly used pathway to the heart. After injecting a special contrast dye into the heart’s vessels, Dr. Ginkel uses x-rays to carefully monitor the migration of blood through your arteries to ensure that they are clear and open. Once we inject the dye into your blood vessels, we can see the pathways of the blood to the heart. The procedure takes about an hour to complete, although if you choose the femoral artery approach, you will need to lay flat for a few hours to make sure that there’s no additional bleeding at the catheter entry point.

Who Needs a Cardiac Angiography and Why?

Not all cardiovascular patients will need a cardiac angiography, but if you display symptoms of any potentially serious heart conditions, you may be a candidate. Dr. Ginkel will recommend this procedure if:

You’re exhibiting angina (chest pain)
You’re short of breath
You’ve suffered a heart attack in the past and are experiencing pain
You’ve had an echocardiogram or stress test revealing abnormal results

To see particular issues located within the heart, we need to go further than simple surface testing. These issues include coronary blockages or cholesterol buildup that may lead to more serious problems, such as a heart attack. Dr. Ginkel offers these exams to make sure you have the opportunity to proactively address cardiovascular disease in its earliest stages, instead of during an emergency down the road.

Results of the Cardiac Angiography

Since the injected contrast dye shows up in the x-rays of your coronary arteries and heart chambers, it is easier for Dr. Ginkel to accurately assess and explain the results to you. Based on the information from your angiography, Dr. Ginkel may recommend the following cardiac interventions:

Medical therapy
PCI (Percutaneous Coronary Intervention)
Coronary artery bypass
Heart valve repair or replacement

Before considering cardiac angiography, Dr. Ginkel will first perform all of the necessary non-invasive imaging exams. He will then offer a risk assessment and advise you on the best approach to this procedure, explain the surgery in detail, and answer any questions you may have. During your consultation and as you’re undergoing testing, Dr. Ginkel will inform you of anything that requires attention. Call Midcoast Cardiovascular Associates today at 805-354-0112 to start preparing for the rest of your life.

Important: If you do not have a responsible adult with you to drive you home, your procedure will be canceled.

For your safety, please have a responsible adult stay with you for 24 hours after your procedure. You should also have someone with you when you first get out of bed. If you are dizzy when you first get up, call your doctor.

Travel information

You may be able to go home the same day as your procedure. Otherwise, you will spend the night in the hospital and go home the next day.

During your trip home, stop every hour and walk for 5 to 10 minutes. If you are traveling by plane, stand up and walk in the aisle at least once every hour.
If you have any questions about your ride home, please ask a member of your healthcare team.

Care of the incision site

You will have a bandage over the insertion/wound site. You can take this dressing off the morning after the procedure. It is easiest to remove by wetting the tape first, while showering.

Place an adhesive bandage over the area. It is normal for the wound site to be black and blue for a couple days. You may also notice that it looks pink and swollen, and there may be a small lump (about the size of a dirham).
Wash the site at least once each day. Put soap on your hand or a washcloth and gently cleanse and rinse the area. Do not rub the area.
Keep the area clean and dry, except when showering.
Do not use creams, lotions or ointment on the wound site.
Do not take a bath, soak in any kind of water, or swim for one week after the procedure.
Wear clothing that fits loosely over the wound site.

Activity guidelines

Your doctor will tell you when you can get back to your normal routine. You will need to take it easy for the first two days you are home. Expect to feel tired and weak the day after the procedure. Stand up slowly to avoid getting dizzy. Take walks around your house and rest during the day.

If your incision site is in your groin

Do not strain during bowel movements for 3 to 4 days after the procedure. This helps prevent bleeding from the catheter-insertion site.
Do not lift anything that weighs more than 10 pounds or (4.5kg) push or pull heavy objects for the first 5 to 7 days after the procedure.
Do not participate in strenuous activities for 5 days after the procedure. This includes most sports, such as jogging, golfing, playing tennis and bowling.
You may climb stairs if needed but walk up and down the stairs more slowly than usual.
Gradually increase your activity level during the week after the procedure, when you should be back to your normal routine.
Ask your doctor when it is safe to resume sexual activity.

If you had a transradial procedure

The radial artery extends from the brachial artery down the radial side of the forearm to the wrist where it branches in smaller vessels in the palm of the hand and fingers. If the catheterization is done through the radial artery, the following guidelines must be followed:

Do not move your wrist more than you need to for 24 to 48 hours after the procedure.
Do not use the wrist used in the procedure to lift more than (1 kilogram) for 24 hours.
Do not do anything strenuous (bowling, tennis, etc.) for 24 hours.
Do not use a lawn mower, motorcycle, chainsaw, or all-terrain vehicle for 48 hours.
Do not take a bath or hold your affected wrist under water for 48 hours after the procedure. It is okay to take a shower the day after your procedure.
Expect to feel mild tingling in your hand and tenderness at the wound site for up to 3 days. If this lasts longer than 3 days or other symptoms develop, call your doctor.

If your wrist bleeds once you are home, do not panic. Follow these steps to control the bleeding:

Place one or two fingers over the puncture site and keep the pressure on the site to stop the bleeding. You may be able to feel your pulse as you do this.
After 5 minutes, remove your fingers from the site to see if the bleeding has stopped.
Once the bleeding has stopped, gently wipe the area clean and cover it with a bandage.

If the bleeding does not stop after 20 minutes, or if there is a large amount of bleeding or spurting, get emergency treatment (DO NOT drive yourself to the hospital).

Medications

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.

If you had a percutaneous intervention (PCI), you will need to take antiplatelet medication. There are several types of this medication. The most common medications used are clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta).

Ask your doctor if you have any questions about this medication. Before you go home, we will make sure you have enough of this medication to last 30 days. Do not stop taking this medication without talking to your cardiologist.

If you have diabetes, your doctor may adjust your diabetes medications for one to two days after your procedure. You may need to stop taking Glucophage (metformin hydrochloride) or Glucovance for 48 hours after the procedure to reduce the risk of kidney complications. Please ask your doctor if you need to make any changes to your diabetes medications.

Depending on the results of your procedure, your doctor may prescribe new medications. Please make sure you know which medications you should be taking after the procedure and how often to take them.

Please tell us if you will have a problem filling or paying for your medications. We can help.

Fluid guidelines

Be sure to drink eight to ten glasses of clear fluids (water is best) to flush the contrast material from your system.

Driving

Your doctor will tell you when it is safe to resume driving. Most people are able to drive again within 24 hours after they leave the hospital.

Importance of a heart-healthy lifestyle

To achieve the best results, you must be committed to living a heart-healthy lifestyle. Your healthcare team can help you achieve your goals, but it is up to you to take your medications as prescribed, make dietary changes, quit smoking, exercise regularly, keep your follow-up appointments and be an active member of the treatment team.

Cardiac rehabilitation

Enroll in a cardiac rehabilitation (rehab) program to help you set goals and stay committed to living a heart-healthy lifestyle. The rehab staff will help you make the needed changes to your lifestyle and progress toward reaching your heart-healthy goals. Cardiac rehab is covered by most insurance companies after a patient has a heart attack, but check with your insurance provider, as policies differ. Please ask your doctor or nurse about finding and enrolling in a cardiac rehab program that is right for you.

Follow-up

We will contact your referring or primary care doctor to discuss the results of your procedure. Please call your primary care doctor as soon as you return home. He or she may want to see you within the first week you are home.

We will send a written report to your doctor. The report includes a general summary of your medical condition, including information about your procedure, prescribed medications and care plan.

Please be sure to follow all other instructions given to you by your physician.

When to get emergency treatment

Get emergency treatment if you have any of the following symptoms:

Chest pain or discomfort (angina-like) that lasts for 5 minutes and is not relieved by rest or medications. The pain may go away and come back again. It may also feel like a heaviness, tightness, pressure, aching, burning, numbness, fullness or squeezing. Sometimes the feeling is similar to indigestion or heartburn. If you have a prescription for nitroglycerin and have these symptoms, place a tablet/spray once under your tongue and wait 5 minutes. If the angina continues, get emergency treatment. If you have chronic stable angina and still have symptoms after taking your nitro and waiting 5 minutes, take another tablet. You can take up to 3 tablets (1 every 5 minutes, for 15 minutes). If you still have angina after 15 minutes, get emergency treatment.
Bleeding from the catheter insertion site that doesn't stop after 20 minutes. Bleeding is rare, but if it does happen, remove all of the dressing over the site. Use a clean compress (clean gauze, washcloth) to apply pressure directly on the site. If the catheter was inserted at the arm/wrist, apply the pressure to the site while keeping your arm straight and raised above the level of your heart. If the catheter was inserted at the groin, lie down and apply pressure to the site. Get emergency treatment if the bleeding doesn't stop after 20 minutes.
Fast heart rate - more than 120 beats per minute, especially if you are short of breath.
New irregular heartbeat.
Trouble breathing or shortness of breath that is NOT relieved by rest.
Sudden numbness or weakness in your arms or legs.
Fainting spells.
Pain or discomfort in your arm(s), left shoulder, back, neck, jaw or stomach.
Sweating or a cold sweat".

Feeling full - This can feel like indigestion or heartburn. You may feel like you're choking.
Nausea or vomiting.
Feeling light-headed, dizzy, very weak or anxious.

When to call your doctor

Call your doctor if you have:

Pus-like drainage, redness or unusual warmth at the catheter insertion site
Feelings of coldness, numbness, tingling, discoloration or excessive swelling of the leg or arm used for the catheter insertion site
A lump at the insertion site: Golf ball-sized at the groin or grape-sized at the wrist
Extreme pain or swelling at the catheter insertion site
Signs of infection: Redness, warmth, drainage at the wound site or a fever (temperature over 38°C)
Signs of activity intolerance that last longer than 20 minutes or that return on a regular basis, including chest discomfort, excessive shortness of breath, dizziness or irregular heartbeats.
Questions about your procedure, medications, follow-up schedule or treatment plan.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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Which complication will the nurse monitor the patient for immediately after cardiac catheterization?

The puncture site itself should be routinely assessed to look for bleeding, haematomas, infection, and ecchymosis. The risk of major complications of diagnostic cardiac catheterization procedure is usually less than 1%, and the risk and the risk of mortality of 0.05% for diagnostic procedures.

Which nursing action is most important when caring for a client after a cardiac catheterization?

Nursing Interventions Monitor the patient's heart rate and rhythm, respiratory and pulse rates, and blood pressure frequently. Monitor the patient's vital signs every 15 minutes for 2 hours after the procedure, every 30 minutes for the next 2 hours, and then every hour for 2 hours.

Which nursing assessment is most important immediately following cardiac catheterization?

The most important nursing action following cardiac catheterization is assessing the groin for bleeding and the leg for color, warmth (circulation) and pulse. Postcatheterization care involves monitoring vital signs every 15 minutes for an hour, then every 30 minutes for an hour or until stable.

Which of these are possible complications to monitor for after a cardiac catheterization select all that apply?

Possible risks of cardiac catheterization are:.

Bleeding..

Blood clots..

Bruising..

Damage to the artery, heart or the area where the catheter was inserted..

Heart attack..

Infection..

Irregular heart rhythms (arrhythmias).

Kidney damage..