assignment on cardiac catheterization

4 Cardiac Catheterization Nursing Care Plans and Management

This nursing care plan guide offers comprehensive care and management strategies for patients undergoing cardiac catheterization. Enhance your understanding of the nursing assessment , interventions, goals, and nursing diagnosis specific to cardiac catheterization to deliver effective care and support to patients throughout the procedure and recovery process.

Table of Contents

What is cardiac catheterization, nursing problem priorities, nursing assessment, nursing diagnosis, nursing goals, 1. promoting adequate tissue perfusion, 2. regulating body temperature, 3. reducing fear and anxiety, 4. preventing injury and infection due to contrast medium, recommended resources.

Cardiac catheterization is an invasive procedure that involves the insertion of a flexible catheter into the heart through a vein or artery, typically the femoral vein. It serves diagnostic and therapeutic purposes, often combined with angiography to visualize blood flow using contrast media. This procedure allows for the measurement of blood gases, pressures, and cardiac output, as well as the identification of anatomical defects like septal defects or obstructions. In therapeutic cardiac catheterizations, balloon angioplasty is used to correct issues such as stenotic valves or vessels, aortic obstruction, and closure of patent ductus arteriosus.

Nursing Care Plans & Management

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.

The following are the nursing priorities for patients undergoing cardiac catheterization:

• Promoting adequate tissue perfusion . Patients undergoing cardiac catheterization are at risk for bleeding , vascular injury, and impaired tissue perfusion, necessitating close monitoring to prevent complications.
• Preventing injury and infection control . There is a risk of infection at the catheter insertion site or in the bloodstream following cardiac catheterization. Strict aseptic technique, monitoring for signs of infection, and proper wound care are essential to prevent the development of infections.
• Reducing fear and anxiety. Many patients experience anxiety and fear related to the invasive nature of the procedure, potential complications, and uncertainty about the outcomes. Providing emotional support, education, and relaxation techniques can help alleviate anxiety and promote a more positive patient experience.

Assess for the following subjective and objective data:

• Decreased or absent pulses distal to the catheterization site
• Cool, mottled appearance of the affected extremity
• Tingling sensation on the affected extremity
• Increased body temperature within a few hours postoperatively
• Expressed concern over the impending procedure.
• Apprehension
• Increased motor activity in children
• Inattention
• Clinging to parent
• Verbal protests
• Decreased level of consciousness
• Increased apical heart rate and decreased blood pressure
• Bleeding from the catheterization site

Assess for factors related to the cause of cardiac catheterization:

• Clot formation at the puncture site
• Reaction to the radiopaque contrast substance utilized during catheterization
• Fear of needles and fear of exposure.
• Invasive, painful procedure
• Separation from parents
• Risk of harm
• Altered hemostasis and trauma from a percutaneous puncture

A nursing diagnosis helps in identifying and addressing specific patient needs and responses related to cardiac catheterization. By conducting a comprehensive assessment , nurses can formulate an accurate nursing diagnosis that guides the development of a customized care plan.

Goals and expected outcomes may include:

• The client’s involved extremities for cardiac catheterization will be pink and warm.
• The client’s pulses will be present distal to the catheterization site and equal bilaterally.
• The child’s axillary temperature will be less than 100° F.
• The child will not cry, cling to parents, or protest.
• The child’s parents will verbalize decreased anxiety/concern.
• The child will not experience bleeding from the puncture site.
• The child’s heart rate and blood pressure will remain within normal limits.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients undergoing cardiac catheterization may include:

Promoting adequate tissue perfusion is essential for patients undergoing cardiac catheterization to ensure adequate oxygen supply to the heart and prevent tissue damage. Monitoring vital signs, maintaining proper hydration, and ensuring adequate blood flow to the catheter insertion site can help prevent complications such as bleeding or thrombosis . Proper tissue perfusion is crucial for the success of the procedure and the patient’s overall health and well-being.

1. Assess the affected extremity, noting its color, temperature, and capillary refill; Palpate distal pulses; Use Doppler every 15 minutes 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 prompt intervention as needed.

2. Encourage bed rest and keep the affected extremity straight or slight bend in the knee (10 degrees) for 6 hours. Bed rest and slight, or no flexion, provide improved circulation and minimizes the risk of further trauma which could promote the formation of a clot.

3. Provide warmth to the opposite extremity. Enhances blood flow without causing the risk of increased bleeding at the site.

4. Inform parents and child of the need for frequent vital signs monitoring and the importance of bed rest with an extension of the extremity. Promotes understanding and cooperation.

The contrast medium can cause a reaction in some patients, leading to increased body temperature and increased demand on the heart. Regulating the body temperature is necessary for patients undergoing cardiac catheterization to prevent complications such as hypothermia or hyperthermia , which can negatively impact the patient’s hemodynamic stability and recovery. Close monitoring of body temperature and implementing appropriate interventions such as warming blankets or cooling measures can help maintain the patient’s normal body temperature, optimize hemodynamic stability, and prevent adverse events. Proper regulation of body temperature is crucial for the success of the procedure and the patient’s overall well-being.

1. Assess body temperature every hour for 6 hours and then routine. Provides information on which action to take.

2. Monitor and record intake and output hourly. Evaluates the routine adequacy of fluid intake and elimination.

3. 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.

4. Instruct parents to encourage PO fluids. Including parents in the care boosts the probability of achieving the goal.

5. Instruct parents to monitor the child’s temperature at home and notify any elevations after discharge. Teaching empowers parents to care for their children and helps monitor for hyperthermia.

Reducing anxiety and fear is important for patients undergoing cardiac catheterization as these emotions can negatively affect the patient’s hemodynamic stability and recovery. Anxiety and fear can also increase the patient’s perception of pain and discomfort during the procedure. Implementing appropriate interventions such as relaxation techniques, counseling, and pre-procedure education can help alleviate anxiety and fear, improve the patient’s overall experience, and optimize their recovery.

1. 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).

2. Encourage the expression of fears, and clarify any misconceptions or lack of knowledge. Enables parents and children to express feelings and provides them with accurate, complete information.

3. 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.

4. 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.

5. Suggest to parents and child to bring a familiar, comforting item such as a blanket, pillow , or stuffed toy. A familiar object provides comfort and security to the child experiencing unfamiliar events and surroundings.

6. Provide a rationale for pre and post-catheterization procedures. Having knowledge and awareness of the reason for each procedure promotes better understanding and acceptance.

7. 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.

Contrast medium can cause adverse reactions such as allergic reactions or renal failure , and can also increase the risk of infection at the catheter insertion site. Proper administration of the contrast medium, close monitoring of the patient’s vital signs, and appropriate infection prevention measures such as proper hand hygiene and sterile technique can help prevent injury and infection, optimize the success of the procedure, and improve the patient’s overall health outcomes.

1. Monitor vital signs every 15 minutes for 4 times, every 30 minutes for 3 hours, then every 4 hours. Vital sign changes may reveal blood loss and internal bleeding may be the first indicator of health problems.

2. Gather baseline laboratory results from the pre-catheterization assessment. Provides comparative data for post-catheterization assessment.

3. Assess the affected extremity, noting its color, temperature, and capillary refill; Palpate distal pulses; Use Doppler every 15 minutes 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 prompt intervention as needed.

4. 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.

5. Maintain bed rest for 6 hours post-catheterization as ordered. Bed rest avoids strain to the catheterization site which otherwise might hasten to bleed; an elevation of the head (45-degree) and a slight bend at the knees are acceptable; young children may be held by parents, and this is beneficial in lessening agitation.

6. Keep the affected extremity straight or slight bend in the knee (10 degrees) for 6 hours. Bed rest and slight, or no flexion, provide improved circulation and minimizes the risk of further trauma which could promote the formation of a clot.

7. Provide warmth to the opposite extremity. Enhances blood flow without causing the risk of increased bleeding at the site.

8. Inform parents and child of the need for frequent vital signs monitoring and the importance of bed rest with an extension of the extremity. Promotes understanding and cooperation.

9. Encourage parents and children to engage in quiet activities such as storytelling, and music. Allows for expression and interaction without physical stress; provides a distraction for comfort.

10. Inform parents and children of the need for periodic monitoring and for bed rest. Promotes understanding and cooperation.

11. 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 with and comfort their child in a more normal manner; this minimizes episodes of agitation, thereby encouraging more rest.

12. 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.

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care  Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health   Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

Other nursing care plans for cardiovascular system disorders:

• Angina Pectoris (Coronary Artery Disease)
• Cardiac Arrhythmia (Digitalis Toxicity)
• Cardiac Catheterization
• Cardiogenic Shock
• Congenital Heart Disease
• Decreased Cardiac Output & Cardiac Support
• Heart Failure
• Hypertension
• Hypovolemic Shock
• Impaired Tissue Perfusion & Ischemia
• Myocardial Infarction
• Pacemaker Therapy

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• Patient Care & Health Information
• Tests & Procedures
• Cardiac catheterization

Cardiac catheterization (kath-uh-tur-ih-ZAY-shun) is a test or treatment for certain heart or blood vessel problems, such as clogged arteries or irregular heartbeats. It uses a thin, hollow tube called a catheter. The tube is guided through a blood vessel to the heart. Cardiac catheterization gives important details about the heart muscle, heart valves and blood vessels in the heart.

During the procedure, a doctor can test the pressures in the heart or do treatments such opening a narrowed artery. Sometimes a piece of heart tissue is removed for examination.

Usually, you are awake during cardiac catheterization but given medicines to help you relax. The risk of major complications is generally low.

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Why it's done

Cardiac catheterization is a common method to diagnose or treat a variety of heart problems. For example, your doctor may suggest cardiac catheterization if you have:

• Irregular heartbeats, called arrhythmias.
• Chest pain, called angina.
• Heart valve problems.
• Other heart problems.

You might need cardiac catheterization if you have, or your doctor thinks you have:

• Coronary artery disease.
• Congenital heart disease.
• Heart failure.
• Heart valve disease.
• Damage to the walls and inner lining of tiny blood vessels in the heart, called small vessel disease or coronary microvascular disease.

During cardiac catheterization, a doctor can:

• Look for narrowed or blocked blood vessels that could cause chest pain.
• Measure pressure and oxygen levels in different parts of the heart.
• See how well the heart pumps blood.
• Take a sample of tissue from your heart for examination under a microscope.
• Check the blood vessels for blood clots.

Cardiac catherization may be done at the same time as other heart procedures or heart surgery.

More Information

Cardiac catheterization care at Mayo Clinic

• Aortic valve regurgitation
• Aortic valve stenosis
• Arteriosclerosis / atherosclerosis
• Atrial flutter
• Atrial septal defect (ASD)
• Atrioventricular canal defect
• Cardiogenic shock
• Cardiomyopathy
• Coarctation of the aorta
• Congenital heart defects in children
• Congenital heart disease in adults
• Coronary artery disease
• Dilated cardiomyopathy
• Ebstein anomaly
• Eisenmenger syndrome
• Enlarged heart
• Heart attack
• Heart disease
• Heart murmurs
• Hypertrophic cardiomyopathy
• Mitral valve disease
• Mitral valve prolapse
• Mitral valve regurgitation
• Mitral valve stenosis
• Myocarditis
• Patent ductus arteriosus (PDA)
• Pulmonary atresia
• Pulmonary atresia with intact ventricular septum
• Pulmonary atresia with ventricular septal defect
• Pulmonary edema
• Pulmonary hypertension
• Pulmonary valve stenosis
• Tetralogy of Fallot
• Transposition of the great arteries
• Tricuspid valve regurgitation
• Ventricular septal defect (VSD)

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Major complications of cardiac catheterization are rare.

But possible risks of cardiac catheterization may include:

• Blood clots.
• Damage to the artery, heart or the area where the catheter was inserted.
• Heart attack.
• Irregular heart rhythms.
• Kidney damage.
• Allergic reactions to the contrast dye or medicines.

If you are pregnant or planning to become pregnant, tell your health care team before having cardiac catheterization.

How you prepare

Your health care team tells you how to plan for your specific procedure. Some things you might have to do before cardiac catheterization are:

• Do not eat or drink anything for at least six hours before your test, or as told by your health care team. Food or liquids in the stomach can increase the risk of complications from medicines used to put you in a sleep-like state during the procedure. You usually can have something to eat and drink soon after the procedure.
• Tell your health care team about all the medicines you take. Some medicines may need to be temporarily stopped before cardiac catheterization. For example, your doctor may tell you to briefly stop taking any blood thinners, such as warfarin (Jantoven), aspirin, apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto).
• Let your health care team know if you have diabetes. Sometimes dye, called contrast, is used during cardiac catheterization. Some types of contrast may increase the risk of side effects of some diabetes medicines, including metformin. Your health care team will give you instructions on what to do if you need this procedure.

What you can expect

Before the procedure.

Cardiac catheterization is usually done in a hospital room with special X-ray and imaging machines. The room is often called a cath lab, which is short for cardiac catheterization lab.

Before you go into the room, your health care team helps you get ready.

You may be asked to use the toilet to empty your bladder.

You change into a hospital gown. Remove all jewelry and dentures.

Your health care team checks your blood pressure and pulse. Sticky patches go on your chest and sometimes your arms or legs. Wires connect the patches to a computer. The computer constantly checks your heartbeat.

A member of your health care team may shave any hair from the area where the catheter will go.

During the procedure

A health care professional places an IV into your forearm or hand. Medicine called a sedative goes through the IV . The medicine helps you feel relaxed, calm or sleepy.

The amount of sedation needed for cardiac catheterization depends on the reason for the procedure and your overall health. You may be fully awake or lightly sedated. Or you may be given a combination of medicines to put you in a sleep-like state. This is called general anesthesia.

To do cardiac catheterization, a doctor inserts one or more flexible, hollow tubes called catheters into a blood vessel, usually in the groin or wrist. The doctor guides the tube or tubes to the heart.

What happens next depends on why you're having the procedure. These are some common reasons:

• Coronary angiogram. This test checks for blockages in the arteries leading to the heart. The catheter is placed in a blood vessel, usually in the groin or wrist. Dye flows through the catheter. Then X-ray images of the heart arteries are taken. The dye helps blood vessels show up more clearly on the X-ray images.
• Cardiac ablation. Heat or cold energy is used to create tiny scars in the heart to block irregular electrical signals. This procedure is used to correct heart rhythm problems.
• Right heart catheterization. This is done to check the pressure and blood flow in the right side of the heart. A catheter is inserted in a vein in the neck or groin. The catheter has special sensors in it.
• Balloon angioplasty, with or without stenting. This treatment uses a catheter and a tiny balloon to open a narrowed artery in or near the heart. The catheter is inserted in either the wrist or groin. A mesh tube called a stent is sometimes placed in the artery to keep it open.
• Balloon valvuloplasty. This treatment uses a catheter and a tiny balloon to widen a narrowed heart valve. The placement of the catheter depends on the specific type of heart valve problem.
• Heart valve replacement. Doctors can use a catheter to remove a narrowed heart valve and replace it with an artificial valve. An example is transcatheter aortic valve replacement (TAVR).
• Repair a heart problem you're born with, also called a congenital heart defect. Cardiac catheterization methods may be used to close holes in the heart, such as an atrial septal defect or patent foramen ovale.
• Heart biopsy. Sometimes a sample of heart tissue needs to be taken to examine under a microscope. During a heart biopsy, the catheter is usually placed in the vein in the neck. Less often, it may be placed in the groin. A catheter with a small, jaw-like tip is used to obtain a small piece of tissue from the heart.

If you're awake during cardiac catheterization, your doctor may ask you to:

• Take deep breaths.
• Hold your breath.
• Put your arms in different positions.

The table may be tilted at times. But a safety strap keeps you on the table. Tell your health care team if you have any discomfort.

When the test or treatment is done, the catheter is removed. A health care professional puts pressure on the area to stop any bleeding. If the catheter was placed into a blood vessel in the groin area, you may need to lie flat for several hours. This helps prevent serious bleeding and lets the artery heal.

After the procedure

You usually spend a few hours in a recovery room after cardiac catheterization. How long you need to stay in the hospital depends on your health and why you had the procedure.

The skin where the catheter was placed may feel sore for a few days. Tell your health care team if you have:

• New or increased swelling.

After cardiac catheterization, a member of your health care team talks to you and explains any results.

If a blocked artery is found during cardiac catheterization, the doctor may treat the blockage right away. Sometimes a stent is placed to keep the artery open. Ask your doctor whether this is a possibility before your cardiac catheterization begins.

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Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions.

• Cardiac catheterization. Merck Manual Professional Version. http://www.merckmanuals.com/professional/cardiovascular-disorders/cardiovascular-tests-and-procedures/cardiac-catheterization. Accessed April 26, 2023.
• What is cardiac catheterization. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/cardiac-catheterization. Accessed April 26, 2023.
• Cardiac catheterization. American Heart Association. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/cardiac-catheterization. Accessed April 26, 2023.
• Loscalzo J, et al., eds. Diagnostic cardiac catheterization and coronary angiography. In: Harrison's Principles of Internal Medicine. 21st ed. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Accessed April 26, 2023.
• Coronary microvascular disease. American Heart Association. https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd. Accessed April 26, 2023.
• Fuster V, et al., eds. Cardiac catheterization and cardiac angiography. In: Fuster and Hurst's the Heart. 15th ed. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Accessed April 26, 2023.
• Health Education & Content Services. Preparing for your cardiac catheterization or heart rhythm procedure. Mayo Clinic; 2021.
• Ami TR. Allscripts EPSi. Mayo Clinic. April 5, 2023.
• Calkins H, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018; doi:10.1093/europace/eux274.
• Mankad SV, et al. Transcatheter mitral valve implantation in degenerated bioprosthetic valves. Journal of the American Society of Echocardiography. 2018; doi:10.1016/j.echo.2018.03.008.
• AskMayoExpert. Cardiac catheterization. Mayo Clinic; 2022.
• Noseworthy PA (expert opinion). Mayo Clinic. Feb. 5, 2021.
• Ellis C, et al. Leak closure following left atrial appendage exclusion procedures: A multicenter registry. Catheterization and Cardiovascular Interventions. 2022; doi:10.1002/ccd.30139.
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Cardiac Catheterization

• Procedure |
• Specific Tests During Cardiac Catheterization |
• Contraindications to Cardiac Catheterization |
• Complications of Cardiac Catheterization |
• More Information |

Cardiac catheterization is the passage of a catheter through peripheral arteries or veins into cardiac chambers, the pulmonary artery, and coronary arteries and veins.

Cardiac catheterization can be used to do various tests, including

Angiography

Detection and quantification of shunts

Endomyocardial biopsy

Intravascular ultrasonography (ivus).

Measurement of cardiac output (CO)

Measurements of myocardial metabolism

These tests define coronary artery anatomy, cardiac anatomy, cardiac function, and pulmonary arterial hemodynamics to establish diagnoses and help clinicians select treatment.

Cardiac catheterization is also the basis for several therapeutic interventions (see Percutaneous coronary intervention in Treatment of Coronary Artery Disease ).

Procedure for Cardiac Catheterization

Many but not all preprocedure protocols require patients to fast for 4 to 6 hours before cardiac catheterization. Most patients do not require overnight hospitalization unless a therapeutic intervention is also done.

Left heart catheterization

Left heart catheterization is most commonly used to assess

Coronary artery anatomy and presence of coronary artery disease

Left heart catheterization is also used to assess

Aortic blood pressure

Aortic valve function

Left ventricular pressure and function

Mitral valve function

Systemic vascular resistance

Left heart catheterization is done via femoral, subclavian, radial, or brachial artery puncture, with a catheter passed into the coronary artery ostia and/or across the aortic valve into the left ventricle (LV).

Catheterization of the left atrium (LA) and LV is occasionally done using transseptal perforation during right heart catheterization.

Right heart catheterization

Right heart catheterization is commonly used to measure

Right atrial pressure

Right ventricular pressure

Pulmonary artery pressure

Pulmonary artery occlusion pressure (PAOP—see figure Diagram of the Cardiac Cycle )

The most frequent indications for right heart catheterization are to assess hemodynamics, diagnose pulmonary hypertension, guide therapy, and assess need for cardiac transplantation or mechanical cardiac support (eg, a ventricular assist device).

PAOP approximates left atrial and left ventricular end-diastolic pressure. In seriously ill patients, PAOP helps assess volume status and, with simultaneous measurements of cardiac output, can help guide therapy.

Right heart catheterization is also useful for assessing cardiac filling pressures, pulmonary vascular resistance, tricuspid or pulmonic valve function, intracardiac shunts, and right ventricular pressure.

Right heart pressure measurements may help in the diagnosis of cardiomyopathy , constrictive pericarditis , and cardiac tamponade . when noninvasive testing is nondiagnostic, and it is an essential part of the assessment for cardiac transplantation or mechanical cardiac support (eg, use of a ventricular assist device).

The procedure is done via femoral, subclavian, internal jugular, or antecubital vein puncture. A catheter is passed into the right atrium, through the tricuspid valve, into the right ventricle, and across the pulmonary valve into the pulmonary artery.

Selective catheterization of the coronary sinus can also be done.

Hemodynamic assessment via right heart catheterization during exercise is increasingly being done as part of the workup for dyspnea of uncertain etiology. The test can be done at the same time as cardiopulmonary exercise testing, called invasive cardiopulmonary exercise testing. This is considered the standard for diagnosis of cardiac limitation to exercise but is currently available at relatively few centers. An exercise right heart catheterization should be considered in patients at intermediate pretest probability for heart failure with preserved ejection fraction if the diagnosis is uncertain after an initial evaluation. An increase in the PAOP > 25 mm Hg confirms the diagnosis when patients have signs and symptoms of heart failure irrespective of left ventricular ejection fraction.

Diagram of the Cardiac Cycle, Showing Pressure Curves of the Cardiac Chambers, Heart Sounds, Jugular Pulse Wave, and the ECG

Specific tests during cardiac catheterization.

Injection of radiopaque contrast agent into coronary or pulmonary arteries, the aorta, and cardiac chambers is useful in certain circumstances. Digital subtraction angiography is used for nonmoving arteries and for chamber cineangiography.

Coronary angiography via left heart catheterization is used to evaluate coronary artery anatomy in various clinical situations, as in patients with suspected coronary atherosclerotic or congenital disease, valvular disorders before valvular replacement, or unexplained heart failure .

Astier/BSIP/SCIENCE PHOTO LIBRARY

Pulmonary angiography via right heart catheterization can be used to diagnose pulmonary embolism . Intraluminal filling defects or arterial cutoffs are diagnostic. Radiopaque contrast agent is usually selectively injected into one or both pulmonary arteries and their segments. Computed tomographic pulmonary angiography (CTPA) has largely replaced right heart catheterization for diagnosis of acute pulmonary embolism. Pulmonary angiography via right heart catheterization remains commonly used to determine a management plan for suspected chronic thromboembolic disease.

Aortic angiography via left heart catheterization is used to assess aortic regurgitation , coarctation , patent ductus arteriosus , and dissection .

PETER MENZEL/SCIENCE PHOTO LIBRARY

Ventriculography is used to visualize ventricular wall motion and ventricular outflow tracts, including subvalvular, valvular, and supravalvular regions. It is also used to estimate severity of mitral valve regurgitation and determine its pathophysiology. After left ventricular mass and volume are determined from single planar or biplanar ventricular angiograms, end-systolic and end-diastolic volumes and ejection fraction can be calculated.

Coronary artery flow measurements

Coronary angiography shows the presence and degree of stenosis but not the functional significance of the lesion (ie, how much blood flows across the stenosis) or whether a specific lesion is likely to be the cause of symptoms.

Extremely thin guidewires with pressure sensors or Doppler flow sensors are available. Data from these sensors can be used to estimate coronary artery blood flow, which is expressed as fractional flow reserve (FFR). FFR is the ratio of maximal flow through the stenotic area to normal maximal flow obtained during hyperemia (most commonly with adenosine ); an FFR of < 0.75 to 0.8 is considered abnormal. Newer techniques of measuring coronary blood flow, including instantaneous wave-free ratio (iFR) and diastolic hyperemia-free ratio (DFR), have been developed. These techniques have the advantage of not requiring hyperemia. Both iFR and DFR measure gradients across a stenosis during a period in diastole; an iFR or DFR of ≤ 0.89 is considered abnormal ( 1, 2 ).

These flow estimates correlate well with the need for intervention and long-term outcome; patients with lesions with FFR > 0.8, iFR > 0.89, or DFR > 0.89 do not seem to benefit from placement of a stent. These flow measurements are most useful with intermediate lesions (40 to 70% stenosis) and with multiple lesions (to identify those that are clinically most significant).

Miniature ultrasound transducers on the end of coronary artery catheters can produce images of coronary vessel lumina and walls and delineate blood flow. Intravascular ultrasonography is being increasingly used at the same time as coronary angiography in several clinical situations, including to guide optimal stent placement during percutaneous coronary intervention, detect cardiac allograft vasculopathy after heart transplantation, and identify coronary artery dissections.

Optical coherence tomography (OCT)

Optical coherence tomography is an optical analog of intracoronary ultrasound imaging that measures the amplitude of backscattered light to determine the temperature of coronary plaques and can help determine whether lesions are at high risk of future rupture (leading to acute coronary syndromes ). Unlike in IVUS, injection of contrast is required to obtain images. The indications and appropriate use for OCT versus IVUS are currently uncertain.

Tests for cardiac shunts

Measuring blood oxygen content at successive levels in the heart and great vessels can help determine the presence, direction, and volume of central shunts. The maximal normal difference in oxygen content between structures is as follows:

The pulmonary artery and right ventricle: 0.5 mL/dL (0.5 vol%)

The right ventricle and right atrium: 0.9 mL/dL (0.9 vol%)

The right atrium and superior vena cava: 1.9 mL/dL (1.9 vol%)

If the blood oxygen content in a chamber exceeds that of the more proximal chamber by more than these values, a left-to-right shunt at that level is probable. Right-to-left shunts are strongly suspected when LA, LV, or arterial oxygen saturation is low ( ≤ 92%) and does not improve when pure oxygen (fractional inspirational O2 = 1.0) is given. Left heart or arterial desaturation plus increased oxygen content in blood samples drawn beyond the shunt site on the right side of circulation suggests a bidirectional shunt.

Measurement of cardiac output and flow

Cardiac output (CO) is the volume of blood ejected by the heart per minute (normal at rest: 4 to 8 L/minute). Techniques (see table Cardiac Output Equations ) used to calculate CO include

Fick cardiac output technique

Indicator-dilution technique

Thermodilution technique

With the Fick technique, CO is proportional to oxygen consumption divided by arteriovenous oxygen difference.

Dilution techniques rely on the assumption that after an indicator is injected into the circulation, it appears and disappears proportionately to CO.

Usually, CO is expressed in relation to body surface area (BSA) as the cardiac index (CI) in L/minute/m 2 (ie, CI = CO/BSA—see table Normal Values for Cardiac Index and Related Measures ). BSA is calculated using DuBois height (ht)–weight (wt) equation:

Endomyocardial biopsy helps assess transplant rejection and myocardial disorders due to infection or infiltrative diseases. The biopsy catheter (bioptome) can be passed into either ventricle, usually the right. Three to 5 samples of myocardial tissue are removed from the septal endocardium. The main complication of endomyocardial biopsy, cardiac perforation, occurs in 0.3 to 0.5% of patients; it may cause hemopericardium leading to cardiac tamponade . Injury to the tricuspid valve and supporting chordae may also occur and can lead to tricuspid regurgitation .

Tests during cardiac catheterization references

1. Gotberg M, Christiansen EH, Gudmundsdottir IJ, et al : Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. New Engl J Med 376:1813–1823, 2017. doi: 10.1056/NEJMoa1616540

2. Johnson NP, Li W, Chen X, et al : Diastolic pressure ratio: new approach and validation vs. the instantaneous wave-free ratio. Eur Heart J 40:2585–2594, 2019.

Contraindications to Cardiac Catheterization

Relative contraindications to cardiac catheterization include

Acute kidney injury

Chronic kidney disease

Coagulopathy

Radiopaque contrast agent allergies in patients who have not been appropriately premedicated

Systemic infection

Uncontrolled arrhythmia

Uncontrolled hypertension

Uncompensated heart failure

Relative contraindications balance the urgency of the procedure (eg, in an acute myocardial infarction vs an elective case) and the severity of the contraindicating disorder. Periprocedural management of anticoagulants or antiplatelet drugs is individualized based on the type of procedure (ie, arterial vs venous access), the urgency of the procedure, the indication for the drug, and the patient's risk of bleeding. Catheterization laboratories frequently have policies for the periprocedural management of these drugs.

Complications of Cardiac Catheterization

The incidence of complications after cardiac catheterizations ranges from 0.8 to 8%, depending on patient factors, technical factors, and the experience of the operator. Patient factors that increase risk of complications include

Chronic obstructive pulmonary disease (COPD)

Heart failure

Increasing age

Peripheral arterial disease

Valvular heart disease

Most complications are minor and can be easily treated. Serious complications (eg, cardiac arrest , anaphylactic reactions , shock , seizures , renal toxicity) are rare. Mortality rate is 0.1 to 0.2%. Myocardial infarction (0.1%) and stroke (0.1%) may result in significant morbidity. Incidence of stroke is higher in patients > 80 years.

In general, complications involve

The contrast agent

Effects of the catheter

The access site

Contrast agent complications

Injection of radiopaque contrast agent produces a transient sense of warmth throughout the body in many patients. Tachycardia, a slight fall in systemic pressure, an increase in cardiac output, nausea, vomiting, and coughing may occur. Rarely, bradycardia occurs when a large amount of a contrast agent is injected; asking the patient to cough often restores normal rhythm.

More serious reactions (see also Radiographic Contrast Agents and Contrast Reactions ) include

Allergic-type contrast reactions

Contrast-induced kidney injury

Allergic-type reactions Anaphylaxis and anaphylactoid reactions with bronchospasm, laryngeal edema, and dyspnea are rare reactions with an approximate frequency of about 1/5000 tests ( 1

Contrast-induced kidney injury is defined as impairment of renal function (either a 25% increase in serum creatinine from baseline or a 0.5 mg/dL [44 micromole/L] increase in absolute value) within 24 to 48 hours of IV contrast administration judged to be caused by contrast rather than alternative causes. For patients at risk, use of lowest possible dose of low-osmolar or iso-osmolar contrast, avoidance of multiple contrast studies within a short period of time, and infusion of a total 10 to 15 mL/kg normal saline IV beginning 4 to 6 hours before angiography and 6 to 12 hours afterward reduces this risk substantially. In patients at risk of impaired renal function, assess serum creatinine 48 hours after injection of contrast.

Contrast agent complications reference

1. Wang CL, Cohan RH, Ellis JH, et al : Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. AJR Am J Roentgenol 191:409–415, 2008. doi: 10.2214/AJR.07.3421

Catheter-related complications

If the catheter tip contacts the ventricular endocardium, ventricular arrhythmias commonly occur, but ventricular fibrillation is rare. If it occurs, direct current cardioversion (DC cardioversion) is administered immediately.

Disruption of an atherosclerotic plaque by the catheter can release a shower of atheroemboli. Emboli from the aorta may cause stroke or nephropathy . Emboli from proximal to distal coronary arteries may cause myocardial infarction .

Coronary artery dissection is also possible.

Access site complications

Access site complications include

Pseudoaneurysm

Arteriovenous (AV) fistula

Limb ischemia

Bleeding from the access site may occur and usually resolves with compression. Mild bruises and small hematomas are common and do not require specific investigation or treatment.

A large or enlarging lump should be investigated using ultrasonography to distinguish hematoma from pseudoaneurysm. A bruit at the site (with or without pain) suggests an AV fistula, which can be diagnosed using ultrasonography. Hematomas usually resolve with time and do not require specific therapy. Pseudoaneurysms and AV fistulas usually resolve with compression; those that persist may require surgical repair.

Radial artery access is in general more comfortable for the patient and carries a much lower risk of hematoma or pseudoaneurysm or AV fistula formation when compared with femoral artery access.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

ACR Manual on Contrast Media : 2021 ACR Committee on Drugs and Contrast Media provides a guide for safe and effective use of contrast media

Bashore TM, Balter S, Barac A, et al. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol. 2012;59(24):2221-2305. doi:10.1016/j.jacc.2012.02.010

2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine : Provides the most recent consensus opinions on standards for cardiac catheterization labs

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Cardiac Catheterization and Coronary Angiography

• Cardiac Catheterization |
• Coronary Angiography |

Cardiac catheterization is a procedure that can measure heart function through a catheter inserted into a vein or artery and guided into the heart. Coronary angiography , which can be done during cardiac catheterization, is a type of medical imaging that uses x-rays and a contrast agent to produce images of blood vessels that feed the heart (coronary arteries).

Cardiac catheterization and coronary angiography are minimally invasive methods of studying the heart and the blood vessels that supply the heart (coronary arteries) without doing surgery. These tests are usually done when noninvasive tests do not give sufficient information, when noninvasive tests suggest that there is a heart or blood vessel problem, or when a person has symptoms that make a heart or coronary artery problem very likely. One advantage to these tests is that during the test, doctors can also treat various diseases, including coronary artery disease .

More than a million cardiac catheterizations and angiographic procedures are done every year in the United States. They are relatively safe, and complications are rare. With cardiac catheterization and angiography, the chance of a serious complication—such as stroke , heart attack , or death—is 1 in 1,000. Fewer than 1 in 10,000 people undergoing these procedures die, and most of those who die already have a severe heart disorder or other disorder. The risk of complications and death is increased for older adults.

Cardiac Catheterization

Cardiac catheterization is used extensively for the diagnosis and treatment of various heart disorders. Cardiac catheterization can be used to measure how much blood the heart pumps out per minute (cardiac output), to detect birth defects of the heart , and to detect and biopsy tumors affecting the heart (for example, a myxoma).

This procedure is the only way to measure directly the pressure of blood in each chamber of the heart and in the major blood vessels going from the heart to the lungs.

In cardiac catheterization, a thin catheter (a small, flexible, hollow plastic tube) is inserted into an artery or vein in the neck, arm, or groin/upper thigh through a puncture made with a needle. A local anesthetic is given to numb the insertion site. The catheter is then threaded through the major blood vessels and into the chambers of the heart and/or into the coronary arteries. The procedure is done in the hospital and takes 40 to 60 minutes.

Various small instruments can be advanced through the tube to the tip of the catheter. They include instruments to measure the pressure of blood in each heart chamber and in blood vessels connected to the heart, to view or take ultrasound images of the interior of blood vessels, to take blood samples from different parts of the heart, or to remove a tissue sample from inside the heart for examination under a microscope (biopsy). Common procedures done through the catheter include the following:

Coronary angiography : A catheter is used to inject a radiopaque contrast agent into the blood vessels that feed the heart (coronary arteries) so that they can be seen on x-rays.

Ventriculography: Ventriculography is a type of angiography in which x-rays are taken as a radiopaque contrast agent is injected through a catheter into the left or right ventricle of the heart. With this procedure, doctors can see the motion of the left or right ventricle and can thus evaluate the pumping ability of the heart. Based on the heart's pumping ability, doctors can calculate the ejection fraction (the percentage of blood pumped out by the left ventricle with each heartbeat). Evaluation of the heart's pumping helps determine how much of the heart has been damaged.

Percutaneous coronary intervention (PCI) : A catheter with a balloon attached to the tip is threaded into a narrowed coronary artery and the balloon is inflated to open the narrowed area. Doctors typically use the catheter to insert a wire mesh tube (a stent) into the artery to hold it open.

Valvuloplasty : A catheter is used to widen a narrowed heart valve opening.

Valve replacement : A catheter is used to replace a valve in the heart without removing the old valve or doing surgery.

If an artery is used for catheter insertion, the puncture site must be steadily compressed for 10 to 20 minutes after all the instruments are removed. Compression prevents bleeding and bruise formation. However, bleeding occasionally occurs at the puncture site, leaving a large bruise that can persist for weeks but that almost always goes away on its own. Alternatively, suture devices may be used to close the hole in the artery from the catheter.

Because inserting a catheter into the heart may cause abnormal heart rhythms , the heart is monitored with electrocardiography (ECG). Usually, doctors can correct an abnormal rhythm by moving the catheter to another position. If this maneuver does not help, the catheter is removed. Very rarely, the heart wall is damaged or punctured when a catheter is inserted, and immediate surgical repair may be required.

Cardiac catheterization may be done on the right or left side of the heart.

Catheterization of the right side of the heart

Catheterization of the right side of the heart is done to obtain information about the heart chambers on the right side (right atrium and right ventricle) and the tricuspid valve (located between these two chambers) and evaluate the amount of blood the heart is pumping. The right atrium receives oxygen-depleted blood from the veins of the body, and the right ventricle pumps the blood into the lungs, where blood takes up oxygen and drops off carbon dioxide. In this procedure, the catheter is inserted into a vein, usually in the neck, arm, or the groin.

Right-side catheterization is used to detect and quantify heart function and abnormal connections between the right and left sides of the heart. Doctors also use right-side catheterization when evaluating people for heart transplantation or placing a mechanical device to help pump blood or for diagnosing and treating pulmonary hypertension or heart failure .

Pulmonary artery catheterization , in which a balloon at the catheter's tip is passed through the right atrium and ventricle and lodged in the pulmonary artery (which connects the right ventricle to the lungs), is sometimes done during catheterization of the right side of the heart during certain major operations and in intensive care units.

Catheterization of the left side of the heart

Catheterization of the left side of the heart is done to obtain information about the heart chambers on the left side (left atrium and left ventricle), the mitral valve (located between the left atrium and left ventricle), and the aortic valve (located between the left ventricle and the aorta). The left atrium receives oxygen-rich blood from the lungs, and the left ventricle pumps that blood to the body. This procedure is usually combined with coronary angiography to obtain information about the coronary arteries.

For catheterization of the left side of the heart, the catheter is inserted into an artery, usually in an arm (near the elbow or wrist), neck, or the groin, and passed from that artery into the aorta, the large artery that carries blood from the heart.

Coronary Angiography

In angiography , a radiopaque contrast agent , which is a liquid that can be seen on x-rays, is injected into a blood vessel and x-rays are taken to produce detailed images of the blood vessel. Coronary angiography provides information about the coronary arteries, which supply the heart with oxygen-rich blood. Coronary angiography is done during cardiac catheterization of the left side of the heart because the coronary arteries branch off the aorta just after it leaves the left side of the heart (see Blood Supply of the Heart ). The two procedures are almost always done at the same time.

After injecting a local anesthetic, a doctor inserts a thin catheter into an artery through an incision in an arm (near the elbow or wrist) or the neck or groin. The catheter is threaded toward the heart, then into the coronary arteries. During insertion, the doctor uses fluoroscopy (a continuous x-ray procedure) to observe the progress of the catheter as it is threaded into place.

After the catheter tip is in place, a radiopaque contrast agent is injected through the catheter into the coronary arteries, and the outline of the arteries appears on a video screen and is recorded.

Doctors use these images to detect blockages ( coronary artery disease ) or spasms of the coronary arteries. Images can help determine whether angioplasty (opening the blockage with a small balloon inserted through the catheters) and stent placement (small, expandable hollow mesh tubes to keep the coronary artery open) is needed or whether coronary artery bypass surgery should be done to get blood past the area of blockage.

Miniature ultrasound transducers on the end of coronary artery catheters can produce images of coronary vessel walls and show blood flow. This technique (intravascular ultrasound or IVUS) is being increasingly used at the same time as coronary angiography. Miniature pressure sensors on the tip of the catheter can determine how much the pressure changes before and after a narrowing in a coronary artery. This technique (called fractional flow reserve or FFR) is used to determine the severity of the blood vessel narrowing.

Coronary angiography is seldom uncomfortable and usually takes 30 to 50 minutes. Unless the person is very ill, the person can go home a short time after the procedure.

When the radiopaque contrast agent is injected into the aorta or heart chambers, the person has a temporary feeling of warmth throughout the body as the contrast agent spreads through the bloodstream. The heart rate may increase, and blood pressure may fall slightly. Rarely, the contrast agent causes the heart to slow briefly or even stop. The person may be asked to cough vigorously during the procedure to help correct such problems, which are rarely serious. Rarely, mild complications, such as nausea, vomiting, and coughing, occur.

Serious complications, such as shock, seizures, kidney problems, and sudden cessation of the heart's pumping ( cardiac arrest ), are very rare. Side effects of radiopaque contrast agents include allergic reactions and kidney damage. Allergic reactions to the contrast agent range from skin rashes to a rare life-threatening reaction called anaphylaxis . The team doing the procedure is prepared to treat the complications of coronary angiography immediately. Kidney damage almost always goes away on its own. However, doctors are cautious about doing angiography in people who already have impaired kidney function.

Risk of complications is higher in older adults, although it is still low. Coronary angiography is essential when angioplasty or coronary artery bypass surgery is being considered.

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Cardiac catheterization risks and complications.

Yugandhar R. Manda ; Krishna M. Baradhi .

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Last Update: June 5, 2023 .

• Continuing Education Activity

Cardiac catheterization is one of the most widely performed cardiac procedures. In the United States, more than 1,000,000 cardiac catheterization procedures are performed annually. As expected, in any invasive procedure, there are some patient-related and procedure-related complications. This activity reviews the indications, contraindications, and techniques of cardiac catheterization and highlights the role of the interprofessional team in the management of patients with CAD.

• Identify the technique of cardiac catheterization.
• Describe the indications for cardiac catheterization.
• Review the complications of cardiac catheterization.
• Outline the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients undergoing cardiac catheterization.
• Introduction

Cardiac catheterization is one of the most widely performed cardiac procedures. In the United States, more than 1,000,000 cardiac catheterization procedures are performed annually. [1]  As expected, in any invasive procedure, there are some patient-related and procedure-related complications. With significant advances in the equipment used for cardiac catheterization, the improved skill of the operators, and newer techniques, the rates of these complications have been reduced significantly. The term cardiac catheterization can refer to either right heart catheterization or left heart catheterization, or both. The procedure can be either diagnostic or therapeutic, and interventional cardiologists can perform a variety of interventions depending on the clinical need. This review briefly reviews the expected risks and complications for a routine, diagnostic, cardiac catheterization procedure.

• Indications

Cardiac catheterization can be either a diagnostic or a therapeutic procedure. The procedure is done in the evaluation and the treatment of the following conditions.

• Coronary artery disease
• Measuring the hemodynamics in the right and left side of the heart
• Evaluate the left ventricular function
• Evaluation and treatment of cardiac arrhythmias
• Evaluation and treatment of valvular heart disease
• Assessment pericardial and myocardial diseases
• Assessment of the congenital heart diseases
• Evaluation of heart failure
• Contraindications

There are no absolute definitive contraindications for cardiac catheterization procedures. Most of the contraindications are relative depending on the indication for the procedure and the associated comorbidities of the patient. When the risk of complications is expected to be more than what is considered acceptable for the procedure, alternative modes of imaging and assessment can be used to answer the clinical question. Experienced operators will modify the technique of the procedure in a way as to get the best possible outcomes for the patient with the least amount of risk. Before planning for this procedure, the clinician should clearly understand the clinical question that needs to be answered.

A cardiac catheterization procedure is usually performed in a cardiac catheterization laboratory with the help of fluoroscopy to guide and position the catheters in the appropriate position. Along with the experienced operator, support from registered nurses and radiologic technologists is needed for safely performing the procedure. Most of the procedures can be performed with minimal or moderate sedation with the help of a local anesthetic, but some procedures will require anesthesia services for providing deep sedation or general anesthesia. Some of these procedures can be performed at the bedside in a coronary care unit, and the common ones performed bedside include right heart catheterization and temporary pacer wire insertion.

• Preparation

Preparation for the cardiac catheterization procedure starts with a thorough history of the patient along with a detailed examination. After defining the clinical question, the performing interventional cardiologist will decide on the access for the procedure. These procedures may need either arterial or venous access or both. Physical examination should specifically focus on assessing the suitability of the patient for the planned procedure. Special attention has to be paid to reviewing drug allergies of the patient and routine lab work. Basic workup includes a complete blood count (CBC), basic metabolic panel (BMP), prothrombin time, electrocardiogram, and chest X-ray. Patients with documented allergy to radio-iodinated contrast material will need premedication with corticosteroids and antihistamines. Patients with chronic kidney disease will also need adequate planning and pre-hydration to reduce the risk of worsening renal function.

• Technique or Treatment

For cardiac catheterization procedures that require arterial access, the 2 common sites used include the common femoral artery and radial artery.

The target for femoral puncture is the midpoint of the common femoral artery between the origin of the inferior epigastric artery and the bifurcation of the superficial and profunda branches, which is usually at the center of the femoral head. The femoral artery crosses the inguinal ligament at its midpoint, and an imaginary line joining the bony landmarks of the iliac crest and pubic symphysis defines the path of the inguinal ligament. Placing a metal clip at the proposed puncture site and performing a quick fluoro exam to confirm the relationship to the femoral head can improve the accuracy of the puncture site. Some centers routinely acquire femoral access under ultrasound guidance. [2] This has been shown to decrease the risk of complications by 49% in one published series. It is essential to access the femoral artery at the appropriate site as adequate hemostasis can be achieved by applying manual compression over the artery against the femoral head. Higher puncture sites will increase the risk of retroperitoneal bleed, and lower puncture sites will increase the risk of pseudoaneurysm formation.

Optimizing vascular access using fluoroscopy or ultrasound to visualize the anatomical landmarks and accessing the artery using lower profile catheters, including micropuncture sheaths, can minimize the risk of access site complications.

When using the hand/wrist, the common site of access is the radial artery, even though the ulnar artery and brachial artery are also used in some situations. [3]  The ideal place to access the radial artery is 2 cm proximal to the radial styloid. Before accessing the radial artery, an Allen test or Barbeau test is performed to confirm adequate collateral circulation to the palm. Allen test is performed by compressing both the radial and ulnar arteries until the palm blanches, and then the ulnar artery is released. The blush response in the hand is noted, and if the color in the palm returns before 10 seconds, the blood supply to the hand via the ulnar artery and palmar arch is considered satisfactory. Barbeau test removes the subjectivity of the Allen test, and a pulse oximeter is placed on the ipsilateral thumb. Similar to the Allen test, compression of both the arteries is performed until the pulse oximetry trace is blunted. The test is considered normal if the pulse oximetry tracing returns to normal within 10 seconds of releasing the pressure on the ulnar artery.

Transradial versus Transfemoral Approaches

Since its first description in 1989, a transradial approach for coronary angiography has been increasing compared to the transfemoral approach. Several randomized controlled trials and meta-analyses have demonstrated reduced mortality, decreased major bleeding, access site complications, reduced length of stay, and comparable stroke rates using a transradial approach. [4]  The findings have been reproduced in non-emergency diagnostic and percutaneous interventional procedures and as well as in urgent settings of ST-segment elevation myocardial infarction. Radial access procedures also enhance patient comfort, reduce post-procedure bed rest and eventually length of hospital stay.

• Complications

The risk of major complications during diagnostic cardiac catheterization procedure is usually less than 1%, and the risk and the risk of mortality of 0.05% for diagnostic procedures. [5]  For any patient, the complication rate is dependent on multiple factors and is dependent on the demographics of the patient, vascular anatomy, co-morbid conditions, clinical presentation, the procedure being performed, and the experience of the operator. The complications can be minor as discomfort at the site of catheterization, to major ones like death.

Local Vascular Complications

Hematoma/Retroperitoneal Bleeding

These are among the most common complications seen after cardiac catheterization procedures. Hematomas are usually formed following poorly controlled hemostasis post sheath removal. Most hematomas are self-limiting and benign, but large, rapidly expanding hematomas can cause hemodynamic instability requiring resuscitation with fluids and blood.  The incidence of this complication is significantly reduced in transradial access. In patients with transfemoral access, retroperitoneal bleeding should be suspected if there is a sudden change in the patient's hemodynamic stability with or without back pain, as there may not be any visible swelling in the groin for some of these patients. The incidence of this complication is less than 0.2%. [6]  Strong clinical suspicion along with immediate imaging, usually with a CT scan, helps make a diagnosis of this problem. Identification of the bleeding source is essential for patients with continued hemodynamic deterioration. These life-threatening bleeds are more frequent when the artery is punctured above the inguinal ligament. Most patients are managed with a reversal of anticoagulation, application of manual compression and volume resuscitation, and observation. Patients with continued deterioration with need coiling of the bleeding source vessel, or balloon angioplasty, or covered stents for bleeding from larger vessels.

Pseudoaneurysm

When the hematoma maintains continuity with the lumen of the artery, it results in the formation of a pulsatile mass locally, defined as a pseudoaneurysm. This will be associated with a bruit on examination. They happen following low access in the superficial femoral artery as opposed to the common femoral artery. These are usually diagnosed by ultrasound, Doppler imaging, or CT angiography. Small pseudoaneurysms of less than 2 to 3 cm in size may heal spontaneously and can be followed by serial Doppler examinations. Large symptomatic pseudoaneurysms can be treated by either ultrasound-guided compression of the neck of pseudoaneurysm or percutaneous injection of the thrombin using ultrasound guidance or may need surgical intervention.

Arteriovenous Fistula

Direct communication between the arterial and venous puncture sites with ongoing bleeding from the arterial access site leads to the fistula formation and is associated with a thrill or continuous bruit on examination. These usually will require surgical exploration as they are unlikely to heal spontaneously and may expand with time.

This infrequent complication occurs in patients with an increased atherosclerotic burden, tortuous arteries, or traumatic sheath placement. Non-flow limiting dissections usually heal spontaneously following sheath removal. A flow limiting large dissections could lead to acute limb ischemia and should be treated immediately with angioplasty and stenting. Vascular surgery is usually reserved for patients with failed percutaneous techniques.

Thrombosis and Embolism

This complication is extremely rare with the use of low-profile catheters, and predisposing factors include small vessel lumen and associated peripheral arterial disease, diabetes mellitus, female sex, large-diameter sheath, and prolonged catheter dwell time. Treatment involves removal of the occlusive sheath, percutaneous thrombectomy in conjunction with vascular surgery consultation.

Vascular Complications after Transradial Access

The most frequent complication after transradial access is about a 5% risk of radial artery occlusion. This is a clinically insignificant complication if the Allen test is normal. Patients with incomplete palmar arch and abnormal Allen test may have symptoms of hand ischemia after radial artery occlusion.

Radial artery spasm is another frequent complication, and this can be avoided by using local vasodilatory medications and systemic anxiolytics. Perforation of the radial artery is an extremely rare complication and is usually managed with prolonged external compression and rarely requires vascular surgery intervention.

Other Major Complications

The incidence of death with cardiac catheterization has decreased progressively and is less than 0.05% for diagnostic procedures. Patients with depressed left ventricular systolic function and those presenting with shock in the setting of acute myocardial infarction are at increased risk. In some subsets of patients, the risk of mortality can be more than 1%. Other factors that would increase the risk include old age, the presence of multivessel disease, left main coronary artery disease, or valvular heart disease like severe aortic stenosis.

Myocardial Infarction

The reported incidence of periprocedural myocardial infarction for a diagnostic angiography is less than 0.1%. This is mostly influenced by patient-related factors like the extent and severity of underlying coronary artery disease, recent acute coronary syndrome, diabetes requiring insulin, and technique-related factors.

The overall risk of stroke in recently reported series is low at 0.05% to 0.1% in diagnostic procedures and can increase to 0.18% to 0.4% in patients undergoing intervention. [7]  This can be a very debilitating complication associated with a high rate of morbidity and mortality. The risk is higher in patients with extensive atherosclerotic plaque in the aorta and aortic arch, complex anatomy, procedures requiring multiple catheter exchanges or excessive catheter manipulation, or the need for large-bore catheters and stiff wires.

Dissection and Perforation of the Great Vessels

Dissection of the aorta, perforation of the cardiac chambers, perforation of the coronary arteries is an extremely rare complication. The risk is higher in procedures with intervention as opposed to diagnostic procedures only. Patients with type A aortic dissection involving the ascending aorta will require surgical correction. Patients with a cardiac chamber or coronary perforation resulting in the accumulation of the blood in the pericardial space will need urgent pericardiocentesis to restore hemodynamic stability and immediate surgical consultation.

Atheroembolism

Cholesterol emboli from friable vascular plaques can give rise to distal embolization in multiple vascular beds. These are usually recognized by digital discoloration (blue toes), livedo reticularis. This can also manifest as a neurological squeal or renal impairment. The risk of this complication is minimized by exchanging catheters over a long wire and minimizing the catheter exchanges. Retinal artery occlusion causes Hollenhorst plaque.

Allergic Reactions

Allergic reactions can be related to the use of local anesthetic, contrast agents, heparin, or other medications used during the procedure. Reactions to the contrast agents can occur in up to 1% of the patients, and people with prior reactions are pretreated with corticosteroids and antihistamines. The use of iso-osmolar agents decreases the risk compared to high osmolar agents. When severe reactions occur, they are treated similarly to anaphylaxis with intravenous (IV) epinephrine (initial dose 1 ml of 1:10000 epinephrine).

Acute Renal Failure

The incidence of the reported contrast nephropathy is quite variable (range 3.3% to 16.5%) in the patients undergoing cardiac catheterization resulting in a transient increase in the serum creatinine levels after exposure to contrast material. In the National Cardiovascular Data Registry, the incidence of contrast-induced acute kidney injury was 7.1% among the patients undergoing elective and urgent coronary intervention. [8]  The risk is higher in patients with underlying moderate to severe renal disease, people with diabetes, elderly, females, patients on diuretics, ACEI, and metformin. Adequate pre-hydration, use of iso-osmolar agents, and techniques to minimize the amount of dye used will help prevent this complication. Renal atheroemboli can also cause renal failure and are associated with other signs of embolization.

Cardiac catheterization is performed using sterile technique, and local or systemic infection is extremely rare. Routine prophylaxis for endocarditis is not recommended during cardiac catheterization procedures.

Radiation Injury

Radiation skin injury can occur if a patient is exposed to excessive doses of radiation to one particular area of the body, and manifestation could range from mild erythema to deep ulceration. Skin biopsies should be avoided for these lesions as they would make the underlying condition worse. This complication should be managed by a combined team of cardiologists, dermatologists, and plastic surgeons.

Arrhythmias

The occurrence of ventricular fibrillation or ventricular tachycardia during the procedure could be related to irritation or ischemia of the myocardium by the catheter, contrast material, or occlusive balloons. These arrhythmias occur more frequently in people presenting with acute ST-elevation myocardial infarction. Treatment includes cardioversion and antiarrhythmic drugs and restoration of the flow to the occluded artery. Atrial tachyarrhythmias can occur following the irritation of the right atrium during right heart catheterization and is usually self-limiting.

Transient bradyarrhythmias are also a common occurrence in the cardiac cath lab. Prolonged episodes resulting in hypotension will need treatment with intravenous atropine or temporary transvenous pacing. In people with preexisting right bundle branch block, development of the left bundle branch block during right heart catheterization may result in complete heart block. This can be avoided by minimal catheter manipulation in the right ventricular outflow tract.

• Clinical Significance

With the advent of the small catheters, increased use of the transradial approach, and improving technical skills of the operators, the risks and complications associated with cardiac catheterization have decreased significantly. Utmost care is necessary with each procedure to decrease the risk of complications of this commonly used life-saving procedure.

• Enhancing Healthcare Team Outcomes

Cardiac catheterization is usually done by an interprofessional cardiac care team that includes an interventional cardiologist with assistance from nurses and radiologic technologists. During the procedure, a nurse is dedicated to the monitoring of the vital signs. After the procedure, the nurse is also responsible for ensuring that the access site is not bleeding and the distal extremity pulses are intact. In addition, the nurse will monitor the urine output to ensure that there has been no adverse reaction of the dye to the kidney. Interprofessional collaboration and open communication will provide significant benefits when performing cardiac catheterization. [Level 5]

There is increasing evidence that the transradial approach for cardiac catheterization reduces associated complications and improves patient comfort compared to the transfemoral approach. Using ultrasound/fluoroscopy for access, small-sized catheters coupled with increasing operator experience will decrease the complications further. The technology associated with cardiac catheterization procedures is changing rapidly, and interventionalists should embrace new advances and work toward making these procedures as safe as possible for the patients.

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Disclosure: Yugandhar Manda declares no relevant financial relationships with ineligible companies.

Disclosure: Krishna Baradhi declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Manda YR, Baradhi KM. Cardiac Catheterization Risks and Complications. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Review Pediatric Catheterization Protocol. [Mymensingh Med J. 2015] Review Pediatric Catheterization Protocol. Sheikh N. Mymensingh Med J. 2015 Jul; 24(3):638-48.
• Invasive cardiovascular magnetic resonance (iCMR) for diagnostic right and left heart catheterization using an MR-conditional guidewire and passive visualization in congenital heart disease. [J Cardiovasc Magn Reson. 2020] Invasive cardiovascular magnetic resonance (iCMR) for diagnostic right and left heart catheterization using an MR-conditional guidewire and passive visualization in congenital heart disease. Veeram Reddy SR, Arar Y, Zahr RA, Gooty V, Hernandez J, Potersnak A, Douglas P, Blair Z, Greer JS, Roujol S, et al. J Cardiovasc Magn Reson. 2020 Mar 26; 22(1):20. Epub 2020 Mar 26.
• Core curriculum for the training of pediatric invasive/interventional cardiologists: report of the Society for Cardiac Angiography and Interventions Committee on Pediatric Cardiology Training Standards. [Cathet Cardiovasc Diagn. 1996] Core curriculum for the training of pediatric invasive/interventional cardiologists: report of the Society for Cardiac Angiography and Interventions Committee on Pediatric Cardiology Training Standards. Ruiz CE, Mullins CE, Rochini AP, Radtke WA, Hijazi ZM, O'Laughlin MP, Bouceck MM, Gillette PC, Hagler DJ. Cathet Cardiovasc Diagn. 1996 Apr; 37(4):409-24.
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• Review [Peripheral arterial complications after heart catheterization]. [Herz. 1998] Review [Peripheral arterial complications after heart catheterization]. Heintzen MP, Strauer BE. Herz. 1998 Feb; 23(1):4-20.

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Cardiac Catheterization Nursing Diagnosis and Nursing Care Plan

Last updated on January 28th, 2024 at 08:12 am

Cardiac Catheterization Nursing Care Plans Diagnosis and Interventions

Cardiac Catheterization NCLEX Review and Nursing Care Plans

Cardiac catheterization is a medical intervention frequently used to determine the existence of cardiovascular disorders such as coronary artery disease, congenital heart disease, and valvular heart disease.

A short, flexible tube is inserted into a blood vessel in the arm, neck, or leg during the procedure. Once the catheter is in place, additional tests such as coronary angiography, angioplasty, and stent insertion may be performed.

Types of Cardiac Catheterization

• Right-heart catheterization. Useful for assessing pulmonic valve function, right atrial & ventricular pressure, pulmonary artery pressure, and intracardiac shunts.
• Left-heart catheterization. Allows measurement and assessment of aortic and mitral valve function, aortic blood pressure, and systemic vascular resistance. 

Indications of Cardiac Catheterization

• Congenital heart defects
• Coronary artery disease
• Heart failure
• Heart valve disease
• Microvascular heart disease
• Atherosclerosis
• Cardiomyopathy
• Visualization. It allows for visual inspection of coronary arteries to rule out myocarditis or graft rejection.
• Differentiation. This procedure allows the differentiation of cardiac arrest from restrictive cardiomyopathy. It is also viable for determining various causes or unclear etiologies of shock and pulmonary edema.
• Monitoring. CC provides information on hemodynamic instability, multiorgan system failure, complicated acute myocardial infarction, and monitors response to treatment. 
• Screening. Besides cardiovascular diseases, it can aid with the diagnosis of respiratory disease and atypical chest pain. 
• Biopsy. Cardiomyopathy can be diagnosed through the evaluation of biopsy material for molecular anomalies.
• Therapeutic. This procedure may assist with the treatment of atherosclerosis via mechanical interventions.

Risks of Cardiac Catheterization

• Bruising or bleeding at the site of the catheter insertion
• Pain at the insertion site
• Formation of a blood clot at the site of the catheter

Complications of Cardiac Catheterization

• Clogged coronary arteries
• Cardiac arrest

Pre-Procedure Nursing Care: Preparing the Patient for Cardiac Catheterization

Before having a cardiac cath procedure, the patient should be prepared by the attending physician or healthcare provider. 

• Obtain informed consent and provide information about the procedure, its risks, complications, and outcomes
• Nothing by mouth ( NPO ) for at least six hours since having food or drinks in the stomach can increase the likelihood of developing complications from anesthesia. Provide a modest amount of water with each dose of medication the patient takes. Diabetic patients must be provided the correct information and instructions on taking their prescriptions and insulin. The dyes used in operation may exacerbate the side effects of certain diabetic drugs. Additionally, the patient may be asked to empty his or her bladder first.
• After the procedure, the patient can resume normal eating and drinking, but only in moderate amounts. Ascertain what medications or supplements the patient is taking and inform the handling physician about it.

What Happens During a Cardiac Catheterization

• Remove excess clothing and jewelry (e.g., scarf, necklaces) that may obscure cardiac imaging. Dentures and hearing aids are permitted.
• Before the procedure, the patient should empty their bladder and put on a hospital gown. Shaving is sometimes necessary.
• Before the procedure, an IV line will be inserted in the patient’s hand or arm to administer medication and fluids as necessary. Patients may be given anxiety and pain medication via intravenous administration during the surgery.
• Tests are carried out in a darkened and cool environment. Patients are instructed to lie on their backs on the X-ray table. They will then be connected to devices that track their heart rate, blood pressure, and oxygen saturation. Additionally, the patient will be linked to an electrocardiogram (ECG) monitor, which will record the heart’s electrical activity. Electrode patches are applied to the patient’s chest to monitor his or her heartbeat before and following the procedure. 
• If the neck vein is used during CC, the patient’s head must be shifted away from the insertion site. This measure is done to aid the physician in locating the most appropriate location for the catheter insertion. Usually, sterile cloths will be draped over the chest and neck. Placing sterilized towels on the groin area is an alternative if the vein in the groin is used.
• CC doesn’t typically necessitate sedation. The patient is prompted to cough or inhale deeply during the procedure. Inform him/her to report any unexpected symptoms immediately.
• A local anesthetic will be used to numb the skin around the insertion site. A very fine needle will be used to locate the vein, and then a thin tube will be inserted. Following anesthesia, the patient may experience a burning or stinging sensation and some pressure during the insertion.
• As soon as the local anesthetic sets in, the physician will put a sheath into the vein. The catheter is threaded into the blood vessel and progresses into the aorta. The doctor may reposition the patient or instruct them to hold their breath, cough, or tilt their head in a specific direction to get a clear vision.
• There may be some discomfort and noises heard after the biopsy catheter has been inserted for cardiac tissue biopsy. However, there should be no pain. If the arm is used for venous access, a small incision in the arm may be made to expose the blood vessel. When removing the tissue sample, patients may experience a pulling sensation. During a right heart cath procedure, a second catheter will be inserted into the patient’s right ventricle, right atrium, and pulmonary artery. Certain drugs may be delivered intravenously (IV) to monitor the heart’s response.
• After inserting the catheter, the doctor will administer contrast dye to enable visualization of the heart and coronary arteries. When the contrast dye is injected into the catheter, the patient may experience some sensations (e.g., flushing, warmth, salty or metallic taste in the mouth, and headache). Still, these effects typically persist for only a few moments.
• The healthcare provider will take a series of X-ray images of the heart and coronary arteries after the infusion of contrast dye. A few seconds of deep breathing might be requested of the patient at this period. 
• The physician will then withdraw the catheter and stitch up the incision. Sealing the artery with collagen, stitching it together with sutures, or attaching a clip will help prevent bleeding. Moreover, bleeding can be managed by applying direct pressure or a closure device. A sterile dressing will cover the wound if a vascular closure device is used. In case of bleeding, the physician (or an aide) will apply pressure to the area to induce clotting. After bleeding has subsided, pressure dressings are applied. 
• Patients undergo ongoing assessment and monitoring for cardiac tissue biopsy in the post-catheterization recovery area. They are transferred when a medical staff assists them off the table and onto a stretcher.

Post-Procedure Nursing Care for Cardiac Catheterization

• Following cardiac catheterization, the patient is sent to a recovery room or returned to their hospital or outpatient room. The patient’s condition will dictate the length of their stay. Moreover, they will not be able to bend their leg for a period if the catheter is inserted in the groin. If the insertion site is in the arm, they’ll be given an armguard or cushion to keep it straight and elevated. Another option is to use a plastic band to secure the area and prevent bleeding. 
• Bed rest is recommended, as is routine monitoring of vital signs and the insertion site to avoid any major bleeding and allow the artery to recover. Bedrest may last between four and twelve hours. If a closure device is implanted, bed rest may be reduced. Additionally, the nurse will inquire about any sensory changes in the affected limb or arm. The sheath or introducer may be left at the insertion site. If this is the case, maintain bed rest until the physician removes the sheath.
• After removing the sheath, it is recommended to consume light meals. The head of the bed should be angled no more than thirty degrees. If the patient experiences pain, chest tightness, feelings of warmth, bleeding, or pain at the insertion site, they should contact their healthcare professional immediately.
• The use of a urinary pan may be indicated to avoid flexion of the afflicted arm or leg. The increased urinary urge is frequently associated with contrast dye and increased fluid volume (from IV infusion).
• The patient may begin ambulating after a period of resting. Typically, he or she will require assistance from a healthcare professional due to dizziness caused by prolonged bed rest. Slowly rise from the bed and move around. Additionally, the nurse may periodically check the patient’s blood pressure when lying in bed, standing, or sitting.
• Pain medications may also be administered to ease discomfort or pain at the insertion site or during prolonged bed rest.
• It is recommended to consume plenty of water and other fluids to assist the body in flushing off the contrast dye.
• Returning to a normal diet is possible following the procedure unless the physician has contraindicated it.
• Hospital discharge may be scheduled following the recovery period unless the physician indicates otherwise. In most situations, the patient will spend the night in the hospital and will be observed.
• It is recommended that the patient be driven home by their guardian, particularly if it is an outpatient cardiac cath. 
• Continuously monitor the site for signs of bleeding, unusual skin discoloration, swelling, tenderness, and temperature change. Although a minor bruise is suspected, any bleeding that cannot be managed should immediately be reported to the physician. 
• Maintain cleanliness in the insertion site to avoid the risk of infection
• Avoid strenuous activities for at least two days.
• Include information on properly caring for the incision site if a closure device was used.

Nursing Diagnosis for Cardiac Catheterization

Cardiac catheterization nursing care plan 1.

Risk for Injury

Nursing Diagnosis: Risk for Injury related to trauma from percutaneous intervention, secondary to cardiac catheterization. 

Desired Outcome: The patient will maintain normal heart rate and blood pressure with absent bleeding.

Cardiac Catheterization Nursing Care Plan 2

Risk for Bleeding

Nursing Diagnosis: Risk for Bleeding related to potential hemorrhage from the catheter insertion, secondary to cardiac catheterization.

Desired Outcome: The patient will remain free from any symptoms of bleeding.

Cardiac Catheterization Nursing Care Plan 3

Hyperthermia

Nursing Diagnosis: Hyperthermia related to sensitivity to the radiopaque contrast dye, secondary to cardiac catheterization, as evidenced by weakness, warmth extremities, and postoperative increase in body temperature.

Desired Outcome: The patient will attain normothermia as evidenced by a normal temperature of 36°-38°C.

Cardiac Catheterization Nursing Care Plan 4

Ineffective Tissue Perfusion

Nursing Diagnosis: Ineffective Tissue Perfusion related to the formation of a clot at the puncture site, secondary to cardiac catheterization, as evidenced by weak or absent pulses, pain, and changes in sensation

Desired Outcome: The patient will exhibit an improved response to the external sensation, as shown by increased pulses and the absence of pain.

Cardiac Catheterization Nursing Care Plan 5

Nursing Diagnosis: Fear related to pain from the procedure, secondary to cardiac catheterization, as evidenced by apprehension, voiced worry or fear about the impending operation, verbal protests, and withdrawal. 

Desired Outcome: The patient will express a decrease in fear or worry regarding the operation.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020).  Nursing diagnoses handbook: An evidence-based guide to planning care . St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022).  Nursing care plans: Diagnoses, interventions, & outcomes . St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018).  Medical-surgical nursing: Concepts for interprofessional collaborative care . St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020).  Saunders comprehensive review for the NCLEX-RN examination . St. Louis, MO: Elsevier.  Buy on Amazon

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Nursing Care Plan & Diagnosis for Heart Cath Cardiac Catheterization

This nursing care plan for  Heart Cath or Cardiac Catheterization  includes a diagnosis and care plan for nurses with nursing interventions and outcomes for the following conditions: Acute Pain & Risk for Ineffective Therapeutic Regimen Management. Patients who have received a heart cath, also called a cardiac cath, may experience acute pain after the procedure. A cardiac cath is performed on patients to rule out coronary artery disease. Some of these patients have had a suspicious cardiac stress test and the cardiologist wants to make sure the patient does not have any blockages in the coronary arteries. If a blockage is found a stent is placed into the coronary artery to open the artery and allow the heart tissue to receive normal blood flow.

In order to do this the cardiologist inserts a needle and guides a wire up through the femoral artery in the groin which can be painful for the patient during the recovery period after numbing mediation and sedation wears off. A new technique being used to access the coronary arteries is the usage of the radial artery. However, if a stent has to be place the femoral artery is preferred.

Another issue patients who have had a heart cath may experience is ineffective therapeutic regimen management. Patients may have insufficient knowledge of site care, how to take medications properly to keep the cardiac stent open, or follow-up care.

Below is a case scenario that may be encountered as a nursing student or nurse in a hospital setting.

What are nursing care plans? How do you develop a nursing care plan? What nursing care plan book do you recommend helping you develop a nursing care plan?

This care plan is listed to give an example of how a Nurse (LPN or RN) may plan to treat a patient with those conditions.

Important Disclosure: Please keep in mind that these care plans are listed for Example/Educational purposes only, and some of these treatments may change over time. Do not treat a patient based on this care plan.

Care Plans are often developed in different formats. The formatting isn’t always important, and care plan formatting may vary among different nursing schools or medical jobs. Some hospitals may have the information displayed in digital format, or use pre-made templates. The most important part of the care plan is the content, as that is the foundation on which you will base your care.

Nursing Care Plan for: Acute Pain & Risk for Ineffective Therapeutic Regimen Management for Heart Cath Cardiac Catheterization

If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Otherwise, scroll down to view this completed care plan.

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Assessment of Nurse's knowledge and practice for patients undergoing Cardiac Catheterization

2019, Assessment of Nurse’s knowledge and practice for patients undergoing Cardiac Catheterization

Background: Cardiac catheterization is an invasive procedure indicated in a wide variety of circumstances. It is used for diagnostic evaluation and therapeutic intervention in the management of patients with cardiac diseases. Aim of the study: this study aimed to assess nurse's knowledge and practice regarding patients undergoing cardiac catheterization. Research design: descriptive research design was utilized in this study.Setting: the study was conducted in cardiac catheterization unit at Assiut University Hospital. Participants: A convenience sample including all nurses working (24) at cardiac catheter unit who are willing to participate in the study.Tools: A) Structured interview questionnaire sheet. b) Observation checklist sheet. Results: the results showed that; the highest percent of nurses (41.7%) their age was more than 30 years and have diploma degree; (62.5%). Their years of experience ranged from5 to 10years (41.7%). The majority of nurses (87.5%) had no in-service training courses related to cardiac catheterization and heart disease. Conclusion: nurses showed inadequacy of their knowledge and practice regarding care of patients undergoing cardiac catheterization. Recommendations: Nurses are need for in-service training programs and refreshing courses to improve their knowledge which will reflect into their knowledge and practice while working with patients.

Related Papers

Kurdistan Journal of Applied Research (KJAR)

Cardiac catheterization is a common word for a set of procedures that are implemented using this method, such as coronary angiography and left ventricle angiography. Coronary angiography is that invasive procedure which assumed as the golden standard for the diagnosis, estimation, and curing of heart diseases. There is a shortage of research of undergraduate students. The purpose of this descriptive cross-sectional study has been conducted to assess nurses' knowledge regarding cardiac catheterization and associated factors at General Hospital in Rania city. Data were collected from a stability sample of 60 nurses using demographic form instead of the section with the conductive questionnaire of Knowledge regarding cardiac catheterization. The majority of study participants were female (81.7%) Therefor, 70% of nurses were married. About 43.3% of study participants were Academic nurse while (40%) of them were Institute nurse, however level of knowledge form institute graduated nurses has a highest level and the majority of participants were not trained (95%). Results acquired have shown that there is no sufficient knowledge of nurses regarding cardiac catheterization, among all levels of nurses and there is a significant relationship between most socio-demographic data in true question but there are opposite result for false questions. We therefore recommend the training course by ministry of health for nurses to improve the knowledge and health awareness regarding cardiac catheterization.

https://www.ijrrjournal.com/IJRR_Vol.8_Issue.4_April2021/IJRR-Abstract029.html

International Journal of Research & Review (IJRR)

Background: Cardiac catheterization is an invasive procedure which is used in the diagnosis and treatment of several cardiac diseases. It may lead to several major and minor complications which may contribute to morbidity and mortality. Early recognition of complications and proper care is logically tied to taking action to receive prompt treatment and thus minimizing further complications. Objectives: (i) To find out the level of knowledge and practice level of cardiac nurses related to patient safety after cardiac catheterization. (ii) To find the association between selected demographic variables with level of knowledge and practice of cardiac nurses regarding patient safety after cardiac catheterization. Method: A survey was conducted in 30 convenient samples with a pre-validated questionnaire and an observational tool was also used in assessing the quality of care provided. The total period of the study was from January to February 2020. The study population was staff nurses from cardiology medical intensive care unit and cardiology medical ward. Result: The findings shows that in the level of knowledge among 30 samples the level of knowledge frequency and percentages. Adequate 22(73%), moderately adequate 06(20%), inadequate 02(7%). Mean 7.53, standard deviation 1.33. In the level of practice among 30 samples the level of practice frequency and percentages. Good 20(67%), average 08(27%), poor 02(6%). Mean 15.6, standard deviation 3.21. The findings shows that there is a significant association on knowledge level between demographic variables Additional qualification and Total year of experience at p<0.05. In practice there is a significant association on practice level between demographic total year of experience at p<0.05. Conclusion: The Study concluded that most of the Staff nurses has adequate knowledge and good practice regarding care of patients after cardiac catheterization and there is an association on level of knowledge with demographic variables like additional qualification and total year of experience and in practice there is association with total year of experience.

Faisal Y O U N U S Sameen

The present study aims to assess Nurse's Knowledge about Patient Safety after diagnostic Cardiac Catheterization at Azadi Teaching Hospital in Kirkuk City. A descriptive study survey approach was carried out from the period of 1 st March 2017 up to 1 st October 2017. A non-probability (purposive sampling) method was used to select the sample of the study. The study includes the (45) nurses who are working in medical ICU and cardiac medical ward at Azadi Teaching Hospital in Kirkuk City. The instrument of the study is Self structured questionnaire which is developed to assess the knowledge of nurses who are working in ICU and cardiac medical ward. The analysis of the data was used descriptive statistics (frequencies, percentages, mean, S.D), and inferential statistical (ANOVA and t-test). The results of the study showed that (48.9 %) of samples were in the age group between (23-27) year, and with a mean & SD of 2.13± 1.12.(64.4%) of study sample were female, (37.8 %) of the sample were graduate from Nursing institute, (75.6%) of them having (1-5) years of experience in the nursing profession, (95.6%) of the nurses had no training session in cardiac catheterization. The socio-demographic characteristic of the sample of the study has no significant relationship with knowledge at (P value < 0.05). The results of the questionnaire demonstrated that the nurses who are working in medical ICU and cardiac medical ward nurse's knowledge towards Patient Safety after diagnostic Cardiac Catheterization were far from optimal. The researcher recommends the establishment educational training programs for staff working in cardiac catheterization and establishes specialized centers for cardiac catheterization.

Journal of Vascular Nursing

Greta Koleva

harika sravs

Introduction: Catheterization is performed as a sterile, medical procedure by trained, qualified personnel, using equipment designed for this purpose, except in the case of intermittent self-catheterization, where patient have been trained to perform the procedure themselves. Urethral catheterization requires a physician's order. The nurse must use strict aseptic technique. Organizing equipment before the procedure prevents interruptions. Apply all the nursing measures to induce urination before the catheterization of bladder. The main complications of urinary catheterization are ascending urinary tract infection, tissue trauma during the insertion of the catheter. Nursing staff plays an important role in delivering quality patient care. Methods: A Non-Experimental descriptive research was adopted for this study. The study was conducted in selected hospital, Nellore district. 30 samples were selected by using non probability convenience sampling technique. Structured questionnaire were used to assess the knowledge regarding catheterization among staff Nurses and Nursing students. Results: The study results shows that with regard to knowledge regarding catheterization among staff nurses, 5(33.3%) had inadequate knowledge, 7(46.7%) had moderately adequate knowledge, 3 (20%) had adequate knowledge, whereas in nursing students, 5(33.3%) had inadequate knowledge, 9(60%) had moderately adequate knowledge, 1 (6.7%) had adequate knowledge. Conclusion: The study concluded that majority of staff nurses and nursing students had inadequate knowledge regarding catheterization So there is a need to improve knowledge both by the student nurses and as well as staff nurses.

Mosul Journal of Nursing

IOSR Journals

Background: Cardiac catheterization is an invasive procedure indicated in a wide variety of circumstances. It is used for diagnostic evaluation and therapeutic intervention in the management of patients with cardiac diseases. Aims of the study: this study aimed to, assess and develop nursing care standards for cardiac patients. And evaluate the effect of implementing nursing care standards on nurse's knowledge, practice and patient out come. Research design: Quasi-experimental research design was utilized. Setting: cardiac catheterization unit, Assiut University Hospital Subjects: Convenience sample including all nurses 24 working in cardiac catheter unit who are willing to participate in the study and 100 patients who had cardiac catheterization 50 patient pre and 50 post implementing the nursing care standards. Tools: Structured interview questionnaires sheet, An observation checklist sheet and Cardiac catheterization patient's assessment sheet. Results: good improvement in the mean knowledge and practice scores was found and post cardiac catheterization complications were reduced after implementation of the nursing care standards. Conclusion: cardiac catheterization patients are exposed to several complications, improving nurses' knowledge and practice can have favorable effect on the incidence of these complications. Recommendations: Nurses are need for in-service training programs and refreshing courses to improve their knowledge.

Mariam Feroze

Background: Cardiac Catheterization is a critical health status which requires standardized care policies, as well as it needs qualified and skilled health provider to obtain good outcome of management. This study aimed to assess the knowledge and practice of nurses regarding patient safety after cardiac catheterization. Material: This cross-sectional study was conducted in Punjab Institute of cardiology located in Lahore, Pakistan from 01 December 2016 to 31 March, 2017. 171 female nurses through using convenient sampling technique were included in the study. Questionnaire with multiple choice was used to collect data. Likert scale for multiple choose questionnaires regarding knowledge and practice of the nurses were used. Collected data were analyzed using SPSS version 21. Results: Out of 171 participants, all (N = 171) were female, most nurses had job experience of 2-5 years and 6-10 years, they were represented by 34.5% and 31.0% respectively. Mean of total knowledge was found g...

Erbil Journal of Nursing and Midwifery

yousif omer

Clinical Nursing Studies

Meftun Akgün

Objective: This study aimed to evaluate the catheter care given to patients with an inserted central venous catheter in the light of protocols and evidence-based applications.Methods: The universe of the study consisted of 300 nurses working in the surgical and internal medicine units of the Health Sciences University Sultan Abdülhamid Han Training and Research Hospital. Although we planned to reach the whole universe in the sample, a total of 202 nurses were included in the study because 60 nurses left the hospital due to appointment to other provinces, and 38 nurses did not want to participate in the study. Data were collected using the face-to-face interview method through a questionnaire form designed by the researcher.Results: Of the 202 nurses included in the study, 183 (90.6%) were female, and 146 (72.3%) had an undergraduate degree. Nurses who had received information about central venous catheter before and who were aware of the existence of a protocol/procedures/instructio...

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Case-Assignment: Cardiac Catheterization

Case-Assignment: Cardiac Catheterization Case-Assignment: Cardiac Catheterization Case-Assignment: Cardiac Catheterization ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT;Case-Assignment: Cardiac Catheterization Week 5 discussion DQ1 Demographic data are collected for every study. What is the purpose of describing the demographic data? DQ2 There is a tendency for novice researchers to develop their own instrument if they cannot readily find one. How might you respond to a peer or manager who asks you to help develop a new tool to collect patient data on anxiety prior to cardiac catheterization? Source: https://www.homeworkjoy.com/questions/health-care/573647-gcu-nur504-week-5-discussion-dq1dq2-latest-2017/ © homeworkjoy.comCardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. A common example of cardiac catheterization is coronary catheterization that involves catheterization of the coronary arteries for coronary artery disease and myocardial infarctions (“heart attacks”). Catheterization is most often performed in special laboratories with fluoroscopy and highly maneuverable tables. These “cath labs” are often equipped with cabinets of catheters, stents, balloons, etc. of various sizes to increase efficiency. Monitors show the fluoroscopy imaging, EKG, pressure waves, and more. Coronary angiography is a diagnostic procedure that allows visualization of the coronary vessels. Fluoroscopy is used to visualize the lumens of the arteries as a 2-D projection. Should these arteries show narrowing or blockage, then techniques exist to open these arteries. Percutaneous coronary intervention is a blanket term that involves the use of mechanical stents, balloons, etc. to increase blood flow to previously blocked (or occluded) vessels. Measuring pressures in the heart is also an important aspect to catheterization. The catheters are fluid filled conduits that can transmit pressures to outside the body to pressure transducers. This allows measuring pressure in any part of the heart that a catheter can be maneuvered into. Measuring blood flow is also possible through several methods. Most commonly, flows are estimated using the Fick principleand thermodilution. These methods have drawbacks, but give invasive estimations of the cardiac output, which can be used to make clinical decisions (e.g., cardiogenic shock, heart failure) to improve the person’s condition. Cardiac catheterization can be used as part of a therapeutic regimen to improve outcomes for survivors of out-of-hospital cardiac arrest.[1] Get a 10 % discount on an order above $ 50 :

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2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy

• Hypertrophic Cardiomyopathy (HCM) remains a common genetic heart disease in populations throughout the world.
• The prevalence of unexplained asymptomatic hypertrophy in young adults in the United States has been reported at about 1:500. Symptomatic hypertrophy based on medical claims data has been estimated at <1:3000 adults in the United States.
• This guideline updates the 2020 HCM Guideline with several revised and new recommendations for the diagnosis and treatment of HCM.

Video: 2024 Guideline for the Management of Hypertrophic Cardiomyopathy

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• Top Things to Know: 2024 Guideline for the Management of Hypertrophic Cardiomyopathy (HCM)

Related Resources

• Key Patient Messages Hypertrophic Cardiomyopathy 2024 Clinical Practice Guideline
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