02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review

Nursing Points

General

1. 1. Cardiac Catheterization
      1. Diagnose coronary artery disease
      2. View cardiac function
      3. Intervene and treat CAD
      4. Right side
         1. Assess pressure in right ventricle, atrium, and pulmonary artery
         2. Determine oxygen level
         3. View left to right shunt
         4. Evaluate cardiac output
         5. View tricuspid and pulmonic valves
         6. Electrophysiology
      5. Left Side
         1. View coronary arteries
            1. Find any lesions
            2. Intervene as needed
               1. Percutaneous Coronary Intervention (
                  PCI)
               2. Percutaneous Transluminal Coronary Angioplasty (PTCA)
               3. Stents (with or without drugs) -> Educate patient on continuing aspirin and Plavix
               4. Extraction Atherectomy
         2. Assess pressure in left ventricle
         3. View mitral and aortic valves
      6. Prevent nephropathy induced by contrast
         1. Low dose
         2. Hydrate with NS
         3. Mucomyst day before (vasodilating)
      7. Hold drugs that affect kidneys (24 hours before procedure)
         1. Some antibiotics
         2. Cyclosporine
         3. NSAIDS
         4. Metformin
      8. Post-procedure
         1. Pressure 20-30 minutes
         2. Vitals
         3. Assess legs (pulse checks, temperature, color, pain)
         4. Assess site for bleeding internal and external
         5. How often? -> q 15 min. for one hour, q 30 min. for one hour, then hourly
         6. Bedrest and leg straight for 2-4 hours after procedure
      9. Complications
         1. Hematoma
         2. Thrombosis
         3. Retroperitoneal bleed
         4. MI
         5. CVA
         6. Death
         7. Renal dysfunction
   2. Acute Coronary Syndrome
      1. Heart isn’t being perfused with oxygen
      2. Treat immediately
      3. 20 minutes causes irreversible injury
      4. Unstable angina
      5. Non-stemi
      6. Stemi (candidates for reperfusion therapy)