Cardiac/Vascular Catheterization (Diagnostic, Interventional)

Definition/Etiology:

• Definition
  • The insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.
    • Diagnostic = Detects problem
    • Interventional = minimally invasive surgery = FIX
      PROBLEM
      • Goal = PERFUSION
• Every Procedure = 1 Goal
  • Analogy= Perfusion is the plumbing of the heart, much like a hose and your organs/tissues are the garden. If the hose at your house gets clogged, you are not able to water your garden. No water = no garden. No blood = no life.
• Etiology
  • Coronary Artery Disease/ACS (Review, rereview)

Pathophysiology:

• Procedure Pathophysiology
  • Interventionist will choose site (Femoral or Radial)
    • Diagnostic = Detect Problem
      • Maybe just meds?
      • Maybe cannot intervene?
        • LEFT MAIN DISEASE
    • Interventional = Fix (3 Common Fixes)
      • PCI- Balloon pushed plaque back against vessel wall
      • STENT – Acts as a frame inside of vessel
        • DES vs BM
      • Atherectomy – Drills through hard plaque “roto rooter”

Noticing: Assessment & Recognizing Cues:

• Subjective Cues
  • Neurovascular Status of limb (5 P’s)
    • pain, pallor, pulse, paresthesia, and paralysis
• Objective Cues
  • Vitals
    • Hypotension/Bradycardia possible
    • Affected LIMB pulse
      • Example RIght femoral artery = palpable pulse right foot
  • Procedure Site: Femoral or Radial
    • Hematoma
    • Bleeding
  • Retroperitoneal Hemorrhage Cues
    • tachycardia/hypotension
    • back/flank pain
    • Grey-Turner’s Sign (flank bruising)

Interpreting: Analyzing & Planning:

• Labs
  • APTT (50 70 seconds)
    • Loads of Heparin
  • Troponin (0.04)
    • Trend Down
  • H/H
    • Hemorrhage watch
  • BUN/Creatinine
    • Procedure Dye
• Diagnostics = Monitor for NEW ISCHEMIA
  • Post Procedure ECG = NEED BASELINE PICTURE
  • Telemetry/Bedside Monitor = ST Segment Monitoring Assess for stent occlusion
    • PAIN

Responding: Patient Interventions & Taking Action:

• Pharmacological Interventions
  • Narcotics – incisional pain
  • ASA & Plavix – “Dual antiplatelet therapy”
    • .Keeps stent open
  • Nitro – Spasms
  • Fluids/Albumin – Pressure Support
    • Need Pressors? → ICU
• Non-Pharmacological
  • Positioning
    • Bedrest/HOB 30 degrees 4 hours
    • Affected limb straight 4 hours
  • Bleeding
    • Teach splinting for cough
    • Puncture Site bleeding = pressure 30 mins
• Adjunct Medical Therapy
  • Interventionist = Cath Lab Doctor

Reflecting: Evaluating Patient Outcomes:

• Ischemia free = GOOD perfusion
  • Patient MUST REPORT IMMEDIATELY
• Puncture Site = No complications
• No indications of retro peritoneal bleed
• Good Kidney Function
  • No more than “20 Buns”
  • Creatinine = ↑1.3 = Bad Kidney
• Patient understands ASA/Plavix compliance
  • NO DPT = STENT CLOSES

Linchpins (Key Points):

• Notice
  • Site, Limb & Bleed Symptoms
• Interpret
  • ST Elevation = CLOSED STENT
• Respond
  • Bleeding at Site = pressure 30 mins & Call doctor
  • Hemorrhage signs = RAPID RESPONSE
• Reflect
  • Patient stops ASA/PLAVIX = WILL RETURN