Speaker: Maj YS Swapna Sudha

Chair person: Maj Swapna Dharmaji

Moderator: Col S.Sengupta
What is Cardiac Catheterization?
 It is an invasive procedure
used to identify the cardiac
anatomy, to measure intra
cardiac pressure, oxygen
saturations and to calculate
systemic and pulmonary
vascular resistance.
 It is also called Cardiac
Cath or Coronary
Angiogram.
What is Cardiac Catheterization?
 An insertion of a catheter
into a chamber or vessel of
the heart
 This is done for both
diagnostic and
interventional purposes
When do we perform?
 To evaluate or confirm the presence of heart disease
(coronary artery disease, heart valve disease, or disease of
the aorta)
 To evaluate heart muscle function
 To determine the need for further treatment (an
interventional procedure or bypass surgery)
Common procedures of Cardiac
Catheterization
 Coronary angiogram
 Right/Left Heart Catheterization
 Percutaneous coronary interventions
Balloon angioplasty
With/without stenting
 Electro physiological procedure
Device Placement
Ablation
 Cardiac biopsy
 Balloon valvuloplasty
Access sites for cardiac catheterization
Internal
Jugular

 Radial artery
 Femoral artery/vein
 Brachial artery
 Antecubital vein
 Internal jugular vein
Access sites-Alternative
• Popliteal access
• Rare access for select peripheral interventions
Access sites-Alternative
• Pedal access
• Select peripheral interventions
• Access via dorsalis pedis, anterior tibial, or posterior tibial
artery
Pre Cath preparation
 A complete history, physical examination and evaluation
by cardiologist
 Pre cath counselling
 Investigations needed prior to cardiac catheterization
 ECG
 CXR
 TMT CBC
Bio chemistry
 2D ECHO Coagulation Profile
 Blood investigation Viral markers
Before the day of procedure
 Part preparation
 Consent
 NPO for at least 6hrs/as advised
 Administration of prescribed pre cath medications
Avoid OHA’s/Insulin
No heparin
 Check and document the peripheral pulse status.
 Contd..
 History regarding allergic to medicines to be noted
 Pre cath check list to be filled which is established by our
institution.
 Vitals to be recorded before sending the patient to cath lab
Pre cath checklist
Post Cardiac Catheterization Care
 Physical assessment
 General management
 Identification of risk factors
 Maintain intake output chart
 Continuous cardiac monitoring
Post Cardiac Catheterization Care
 Assessment
 Identify whether patient had under gone a diagnostic or
interventional procedure
 Identify the access site

 Check for the rhythm by doing ECG

 Check for whether the patient is on any anticoagulant’s

 Asses if the patient had any complication in theatre during

process
 Check for the findings after the procedure

 Check for the medications to be administered as advised

by cardiologist.
 Assess access site
 Radial/Femoral

 Bleeding- check for any oozing or bleeding from

puncture site
 Hematoma- assess site for swelling redness and pain

(Hematoma can indicate internal bleeding into the

thigh, pelvis or retro peritoneal space)
 Distal pulses/ temperature
Increase in temperature can cause tachycardia and rigors
 Tenderness
 Assess for arrhythmias
By seeing the patients ECG rhythms on the
monitor
Ensure patient is in sinus rhythm or is in rhythm
deemed normal for the patient
Management of complications
 Bleeding
Monitor the puncture site to assess patient
recovery
If the patient suffering from cough/vomit
immediately check for bleeding
Apply the pressure over the puncture site
With gauge over 5 to 10mins to achieve hemostasis
Apply pressure bandage
Inform physician
Management of complications
 Femoral access - Hematoma
Assess for swelling, redness or pain
Manual compression over the hematoma to prevent
further bleeding.
If the patient has heparin infusion to be stopped
immediately
Any signs of intravascular volume depletion should be
assessed
Monitor vital signs
Inform physician
Femoral access - Hematoma
 Retroperitoneal Hematoma
Rare complication
Bleeding into the retroperitoneal space
Initially may go undetected since no bleeding
occurs at the surface
Results in significant bleeding with hypotension and
flank pain
Diagnosis with Ultra sound or CT
Retroperitoneal Hematoma
 Radial access - Hematoma

Elevate the arm

Loosen the pressure bandage
Place cold compress on Hematoma
 Arrhythmia
Assess patient ECG rhythm
Ensure patient is in sinus rhythm or in a rhythm
deemed normal for the patient
Monitor ECG
Place on continuous cardiac monitoring
Inform physician
Patient care after the procedure
Monitor:
 Conscious levels
 Vital signs
 Saturation levels
 Complete bed rest and immobilization
 Assessing the puncture site 30mins for 4hrs then hourly till
ambulation
 Reassess the site after the first ambulation
 Contd..
 Ensure head of the bed is no higher than 300 during bed
rest
 Patient should be kept lying flat for several hours
 Not to remove any dressing until unless ordered by
cardiologist
 Patient should be allowed to eat and drink after the
procedure if it is not contraindicated
 Administration of prescribed medications
 Follow the sheath removal instructions as given in the
case sheet
Post cath findings
What are risks of Cardiac
Catheterization?
 Bleeding or bruising
 Pain
 Blood clot or damage to the blood vessel
 Infection where the catheter is put into the body
Rare complications
 Ischemia/Chest pain
 Hidden blockage of a
coronary artery
 A tear in the lining of an
artery
 Kidney damage due to
usage of dye
 Stroke
Investigations
 Prior to discharge, who under go diagnostic cardiac
catheterization no investigations are typically required
unless complications are suspected….
Chest X-Ray
ECG
ECHO
Prevention
 Recognize the symptoms
 Lose weight
 Quit smoking
 Keep cholesterol at a normal level
 Keep blood pressure under control
 Use techniques to ease stress
 Eat right
 Regular Exercise
CATH Lab of MH Sec’bad
 Record of MH Secunderabad cath lab
wef Nov 2018 to Sep 2019
Total No of Angiography -158
Total No of Angioplasty -52
Total No of PPI -2
Total No of TPI -4