This study guide is about cardiac catheterization and 4 nursing care plan examples for cardiac catheterization. It can be used to create nursing care plans for cardiac catheterization.
What is Cardiac Catheterization?
Cardiac catheterization is an invasive procedure in which a small flexible catheter is inserted through a vein or artery (usually the femoral vein) into the heart for diagnostic and therapeutic purposes. It is usually done with angiography as radiopaque contrast media is injected through the catheter and visualization of the blood flow is seen on fluoroscopic monitors. Catheterization allows measurement of blood gases and pressures within the heart chambers and great vessels; measurement of cardiac output; and detection of anatomic defects such as septal defects or obstruction to blood flow. Therapeutic, or interventional, cardiac catheterizations use balloon angioplasty to correct such defects as stenotic valves or vessels, aortic obstruction (particularly re-coarctation of the aorta), and closure of patent ductus arteriosus.
What are some of the other procedures that may be done during or after a cardiac cath?
- Angioplasty. In this procedure, your doctor can inflate a tiny balloon at the tip of the catheter. This presses any plaque buildup against the artery wall and improves blood flow through the artery.
- Stent placement. In this procedure, your doctor expands a tiny metal mesh coil or tube at the end of the catheter inside an artery to keep it open.
- Fractional flow reserve. This is a pressure management technique that’s used in catheterization to see how much blockage is in an artery
- Intravascular ultrasound (IVUS). This test uses a computer and a transducer to send out ultrasonic sound waves to create images of the blood vessels. By using IVUS, the doctor can see and measure the inside of the blood vessels.
- A small sample of heart tissue (called a biopsy). Your doctor may take out a small tissue sample and examine it under the microscope for abnormalities.
During the test, you will be awake, but a small amount of sedating medicine will be given before starting to help you be comfortable during the procedure.
Why might I need cardiac catheterization?
Your doctor may use cardiac cath to help diagnosis these heart conditions:
- Atherosclerosis. This is a gradual clogging of the arteries by fatty materials and other substances in the blood stream.
- Cardiomyopathy. This is an enlargement of the heart due to thickening or weakening of the heart muscle
- Congenital heart disease. Defects in one or more heart structures that occur during fetal development, such as a ventricular septal defect (hole in the wall between the two lower chambers of the heart) are called congenital heart defects. This may lead to abnormal blood flow within the heart.
- Heart failure. This condition, in which the heart muscle has become too weak to pump blood well, causes fluid buildup (congestion) in the blood vessels and lungs, and edema (swelling) in the feet, ankles, and other parts of the body.
- Heart valve disease. Malfunction of one or more of the heart valves that can affect blood flow within the heart.
You may have a cardiac cath if you have recently had one or more of these symptoms:
- Chest pain (angina)
- Shortness of breath
- Extreme tiredness
If a screening exam, such as an electrocardiogram (ECG) or stress test suggests there may be a heart condition that needs to be explored further, your doctor may order a cardiac cath.
Another reason for a cath procedure is to evaluate blood flow to the heart muscle if chest pain occurs after the following:
- Heart attack
- Coronary artery bypass surgery
- Coronary angioplasty (the opening of a coronary artery using a balloon or other method) or placement of a stent (a tiny metal coil or tube placed inside an artery to keep the artery open)
There may be other reasons for your doctor to recommend a cardiac cath.
What are the risks of cardiac catheterization?
Possible risks associated with cardiac cath include:
- Bleeding or bruising where the catheter is put into the body (the groin, arm, neck, or wrist)
- Pain where the catheter is put into the body
- Blood clot or damage to the blood vessel that the catheter is put into
- Infection where the catheter is put into the body
- Problems with heart rhythm (usually temporary)
More serious, but rare complications include:
- Ischemia (decreased blood flow to the heart tissue), chest pain, or heart attack
- Sudden blockage of a coronary artery
- A tear in the lining of an artery
- Kidney damage from the dye used
If you are pregnant or think you could be, tell your doctor due to risk of injury to the fetus from a cardiac cath. Radiation exposure during pregnancy may lead to birth defects. Also be sure to tell your doctor if you are lactating, or breastfeeding.
There is a risk for allergic reaction to the dye used during the cardiac cath. If you are allergic to or sensitive to medicines, contrast dye, iodine, or latex, tell your doctor. Also, tell your doctor if you have kidney failure or other kidney problems.
For some people, having to lie still on the cardiac cath table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
How do I prepare for cardiac catheterization?
- Your doctor will explain the procedure to you and give you a chance to ask any questions.
- You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is unclear.
- Tell your doctor if you have ever had a reaction to any contrast dye; if you are allergic to iodine; or if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
- You will need to fast (not eat or drink) for a certain period before the procedure. Your doctor will tell you how long to fast, usually overnight.
- If you are pregnant or think you could be, tell your doctor.
- Tell your doctor if you have any body piercings on your chest or abdomen (belly).
- Tell your doctor of all medicines (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
- You may be asked to stop certain medicines before the procedure. Your doctor will give you detailed instructions.
- Let your doctor know if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop some of these medicines before the procedure.
- Let you doctor know if you have any kidney problems. The contrast dye used during the cardiac cath can cause kidney damage in people who have poor kidney function. In some cases, blood tests may be done before and after the test to be sure that your kidneys are working properly.
- Your doctor may request a blood test before the procedure to see how long it takes your blood to clot. Other blood tests may be done as well.
- Tell your doctor if you have heart valve disease.
- Tell your doctor if you have a pacemaker or any other implanted cardiac devices.
- You may get a sedative before the procedure to help you relax. If a sedative is used, you will need someone to drive you home afterward.
- Based on your medical condition, your doctor may request other specific preparations.
What happens during a cardiac catheterization?
A cardiac cath can be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Generally, a cardiac cath follows this process:
- You’ll remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aids if you use either of these.
- Before the procedure, you should empty your bladder then change into a hospital gown.
- A healthcare professional may shave the area where the catheter will be put in. The catheter is most often put in at the groin area, but other places used are the wrist, inside the elbow, or the neck.
- A healthcare professional will start an intravenous (IV) line in your hand or arm before the procedure to inject the dye and to give you IV fluids, if needed.
- You will lie on your back on the procedure table.
- You will be connected to an ECG monitor that records the electrical activity of your heart and monitors your heart during the procedure using small electrodes that stick to your skin. Your vital signs (heart rate, blood pressure, breathing rate, and oxygen level) will be monitored during the procedure.
- Several monitor screens in the room will show your vital signs, the images of the catheter being moved through your body into your heart, and the structures of your heart as the dye is injected.
- You will get a sedative in your IV before the procedure to help you relax. But you will likely be awake during the procedure.
- Your pulses below the catheter insertion site will be checked and marked so that the circulation to the limb can be checked after the procedure.
- Your doctor will inject a local anesthetic (numbing medicine) into the skin where the catheter will be put in. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.
- Once the local anesthetic has taken effect, your doctor inserts a sheath, or introducer into the blood vessel. This is a plastic tube through which the catheter is thread into the blood vessel and advanced into the heart. If the arm is used, your doctor may make a small incision (cut) to expose the blood vessel and put in the sheath.
- Your doctor will advance the catheter through the aorta to the left side of the heart. He or she may ask you to hold your breath, cough, or move your head a bit to get clear views and advance the catheter. You may be able to watch this process on a computer screen.
- Once the catheter is in place, your doctor will inject contrast dye to visualize the heart and the coronary arteries. You may feel some effects when the contrast dye is injected into the catheter. These effects may include a flushing sensation, a salty or metallic taste in the mouth, nausea, or a brief headache. These effects usually last for only a few moments.
- Tell the doctor if you feel any breathing difficulties, sweating, numbness, nausea or vomiting, chills, itching, or heart palpitations.
- After the contrast dye is injected, a series of rapid X-ray images of the heart and coronary arteries will be made. You may be asked to take a deep breath and hold it for a few seconds during this time. It’s important to be very still as the X-rays are taken.
- Once the procedure is done, your doctor will remove the catheter and close the insertion site. He or she may close it using either collagen to seal the opening in the artery, sutures, a clip to bind the artery together, or by holding pressure over the area to keep the blood vessel from bleeding. Your doctor will decide which method is best for you.
- If a closure device is used, a sterile dressing will be out over the site. If manual pressure is used, the doctor (or an assistant) will hold pressure on the site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site.
- The staff will help you slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the catheter was placed in your groin, you will not be allowed to bend your leg for several hours. If the insertion site was in your arm, your arm will be elevated on pillows and kept straight by placing it in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a tight plastic band may be put around your arm near the insertion site. The band will be loosened over time and removed before you go home.
What happens after cardiac catheterization?
In the hospital
After the cardiac cath, you may be taken to a recovery room or returned to your hospital room. You will stay flat in bed for several hours. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.
Let your nurse know right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
Bedrest may vary from 4 to 12 hours. If your doctor placed a closure device, your bedrest may be shorter.
In some cases, the sheath or introducer may be left in the insertion site. If so, you will be on bedrest until your doctor removes the sheath. After the sheath is removed, you may be given a light meal.
You may feel the urge to urinate often because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so you don’t bend the affected leg or arm.
After the period of bed rest, you may get out of bed. The nurse will help you the first time you get up, and may check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.
You may be given pain medicine for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.
Drink plenty of water and other fluids to help flush the contrast dye from your body.
You may go back to your usual diet after the procedure, unless your doctor tells you otherwise.
After the recovery period, you may be discharged home unless your doctor decides otherwise. In many cases, you may spend the night in the hospital for careful observation. If the cardiac cath was done on an outpatient basis and a sedative was used, you must have another person drive you home.
Once at home, you should check the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, contact your doctor.
If your doctor used a closure device at your insertion site, you will be given instructions on how to take care of the site. There may be a small knot, or lump, under the skin at the site. This is normal. The knot should go away over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
Your doctor may advise you not to participate in any strenuous activities for a few days after the procedure. He or she will tell you when it’s OK to return to work and resume normal activities.
Contact your doctor if you have any of the following:
- Fever or chills
- Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
- Coolness, numbness or tingling, or other changes in the affected arm or leg
- Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting
Your doctor may give you other instructions after the procedure, depending on your particular situation.
4 Nursing Care Plan Examples for Cardiac Catheterization
What are some of the available nursing care plans for cardiac catherization?
Nursing care planning goals for a child who will undergo cardiac catheterization include promoting adequate perfusion, alleviating fear and anxiety, providing teaching and information, and preventing injury. Close monitoring of a child post cardiac catheterization is also crucial for the early identification of complications that will minimize mortality and morbidity rates.
1. Ineffective Peripheral Tissue Perfusion
- Ineffective Peripheral Tissue Perfusion
May be related to
- Clot formation at the puncture site
Possibly evidenced by
- Decreased or absent pulses distal to catheterization site
- Cool, mottled appearance of the affected extremity
- Tingling sensation on the affected extremity
- Child’s involved extremity will be pink and warm.
- Child will respond to sensation in extremities equally bilaterally.
- Child’s pulses will be present distal to the catheterization site and equal bilaterally.
|Assess affected extremity, noting its color, temperature, and capillary refill; Palpate distal pulses; Use doppler every 15 minutes for 4 times, every 30 minutes for 3 hours, then every 4 hours.||Formation of a clot at the puncture site and the child is at risk of the clots severely obstructing distal blood and resulting in tissue damage. Frequently assessment of the extremity for adequate perfusion enables for prompt intervention as needed.|
|Encourage bed rest and keep affected extremity straight or slight bend in the knee (10 degrees) for 6 hours.||Bed rest and slight, or no flexion, provides improve circulation and minimizes the risk of further trauma which could promote the formation of a clot.|
|Provide warmth to the opposite extremity.||Enhances blood flow without causing risk of increased bleeding at the site.|
|Inform parents and child of a need for frequent vital signs monitoring and importance of bed rest with an extension of the extremity.||Promotes understanding and cooperation.|
May be related to
- Reaction to the radiopaque contrast substance utilized during catheterization
Possibly evidenced by
- Increase body temperature within few hours postoperatively
- Child’s axillary temperature will be less than 100° F.
|Assess body temperature every hour for 6 hours and then routine.||Provides information on which action to take.|
|Monitor and record intake and output hourly.||Evaluates the routine adequacy of fluid intake and elimination.|
|Maintain IV fluids while the child is drowsy, and when fully awake, encourage fluid intake per orem.||Increased fluid intake helps to flush out the dye.|
|Instruct parents to encourage PO fluids.||Including parents in the care boosts the probability of achieving the goal.|
|Instruct parents to monitor child’s temperature at home and notify any elevations after discharge.||Teaching empowers parents to care for the child and helps monitor for hyperthermia.|
May be related to
- Fear of needles and fear of exposure.
- Invasive, painful procedure
- Separation from parents
- Risk of harm
Possibly evidenced by
- Expressed concern over impending procedure.
- In children: increased motor activity
- Clinging to parent
- Verbal protests
- Child will not cry, cling to parents, or protest.
- Parents will verbalize decreased anxiety/concern.
|Assess parents’ and child’s understanding of catheterization and any special fears.||Provides information on parents’ and child’s knowledge, misunderstanding and particular concerns; sources of anxiety for the parents include fear and uncertainty over the procedure, guilt and anxiety over the child’s pain, fear of complications, and
uncertainty over the outcome; for the
child, fears may include separation from parents, fear of the unknown (if the first catheterization), fear of mutilation and death, or remembered fear and pain (if repeat catheterization).
|Encourage expression of fears, clarify any misconceptions or lack of knowledge.||Enables parents and child to express feelings and provides them accurate, complete information.|
|Prepare the child using age-appropriate guidelines; use concrete explanations just prior to an event for younger children.
Include information on what the child will experience through all senses.
|Age-appropriate information given to the child allows for greater understanding and reassurance; young children process information through all their senses and need to know what to expect to better cope.|
|Allow parents to accompany the child
and be with the child when awake postoperatively.
|Children in stressful events adjust well to the presence of their parents.|
|Suggest to parents and child to bring a familiar, comforting item such as a blanket, pillow, stuffed toy.||A familiar object provides comfort and security to the child experiencing unfamiliar events and surroundings.|
|Provide a rationale for pre and
|Having knowledge and awareness of reason for each procedure promotes better understanding and acceptance.|
|Inform parents that the child may
momentarily act differently at home: may need to stay close to parents, have unpleasant dreams, and be less self-sufficient; encourage parents to comfort and reassure the child, to allow the child to “re-live” the experience through stories or play, and to accept temporary setbacks in development.
|Stressful events may cause the child to need extra reassurance and may cause a temporary regression in development as the child reverts to comfortable, familiar “safe” activities; children, like adults, have a need to replay stressful events in order to understand and cope, and this is often accomplished through play activities.|
4. Risk For Injury
- Risk for Injury
May be related to
- Altered hemostasis and trauma from a percutaneous puncture
Possibly evidenced by
- Decreased level of consciousness
- Increased apical heart rate and decreased blood pressure
- Bleeding from the catheterization site
- Child will not experience bleeding from the puncture site.
- Child’s heart rate and blood pressure will remain within normal limit.
|Monitor vital signs every 15 minutes for 4, every 30 minutes for 3 hours, then every 4 hours.||Vital sign changes may reveal blood loss and with internal bleeding may be the first indicator of health problem.|
|Gather baseline laboratory results
from pre-catheterization assessment.
|Provides comparative data for post-catheterization assessment.|
|Keep pressure dressing on the catheterization site and assess every 30 minutes for bleeding. If bleeding does occur, apply continuous direct pressure 1 inch above the puncture site and immediately report to the physician.||Direct constant pressure on site is needed to avoid bleeding; no bleeding, even oozing, should happen.|
|Maintain bed rest for 6 hours
post-catheterization as ordered.
|Bed rest avoids strain to catheterization site which otherwise might hasten bleeding; an elevation of the head (45-degree) and a slight bend at the knees are acceptable; young children may be held by parents, this is beneficial in lessening agitation.|
|Encourage parents and child to engage
in quiet activities such as storytelling, music.
|Allows for expression and interaction without physical stress; provides a distraction for comfort.|
|Inform parents and child of the need for
periodic monitoring and for bed rest.
|Promotes understanding and cooperation.|
|Encourage parents of infants and young children to hold their children as an acceptable option for resting in bed.||Allows parents to be in contact and comfort their child in a more normal manner; this minimizes episodes of agitation, thereby encouraging more rest.|
|Instruct parents to observe and notify any sign of bleeding immediately. Educate parents that pressure dressing will be removed after 24 hours and that they should continue to assess the site and report to the physician if any bleeding is noted.||Increases close monitoring of the site.|