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Caring For Patients Post Cardiac Catheterisation

Photo: Caring For Patients Post Cardiac Catheterisation
Cardiac catheterisation is when a catheter is inserted into a vein or artery and then led into the heart; usually the site of access will be from the groin, neck or throat. The purpose of this procedure is for diagnostic or interventional reasons. Diagnostic cardiac catheters are inserted so that blood flow and pressure in the chambers of the heart can be evaluated; interventional cardiac catheters are preferred as an alternative to open heart surgery. The procedures that can be carried out when a cardiac catheter is used include (1);

  • Closing septal defects; both ventricular and atrial
  • Opening new passageways
  • Narrow passageway expansion
  • Stent placement

Cardiac catheterisation is usually carried out under a general anaesthetic and can have complications despite recent advances in operative techniques. However statistics show that post cardiac catheterisation complications can still result in poor health and mortality in patients.
To reduce the risk of complications, it is advised that specific management and vigilant monitoring is in place for early identification of problems. Healthcare professionals, specifically nurses, are in the best position to be able to identify complications and offer prompt care to patients.

Nurses are the healthcare providers considered to be the most competent in reducing the mortality and morbidity rates for post-operative cardiac catheterisation recovering patients. (1).

Patient assessment

The healthcare provider needs to take in many factors when caring for patients who have had cardiac catheterisation.

Firstly, patient history should be assessed. A healthcare provider should be aware of (1);

  • Whether the patient had a diagnostic or interventional cardiac catheter inserted. This is because those who have had interventional cardiac catheter procedures will be at a higher risk of complications. The healthcare provider should also be fully aware of the findings of the procedure and whether there were any complications during theatre.
  • Whether the patient was taking anticoagulants regularly before the procedure. Although all patients will receive heparin during the procedure, those who are take blood thinning agents beforehand have a higher risk of bleeding. The healthcare provider should also determine which medications have now been prescribed for the patient.
  • What ‘normal’ cardiac rhythm for the patient was before the procedure took place. This can be found by referring to the pre-procedure ECG charts.
  • The access site of the catheter, including the position and whether the catheter was arterial or venous.
  • Age of the patient. Elderly patients and children under the age of one have a higher risk of complications.

Secondly, the healthcare provider should carry out a physical assessment of the patient in order to be aware of any potential complications. The puncture site itself should be routinely assessed to look for bleeding, haematomas, infection, and ecchymosis (1).

Potential complications and management of complications which can occur after a cardiac catheterisation

Bleeding

Bleeding should be monitored from the puncture site to assess patient recovery. If the patient suffers from a violent coughing fit or vomits, immediately check for bleeding. Aim to immediately apply pressure over the puncture site with gauze to achieve haemostasis; this will typically occur within five to ten minutes. Then the patient’s pressure bandage should be reinforced and the doctor should be notified.

Haematoma

The puncture site should be assessed for any swelling, redness, or pain. A haematoma can suggest internal bleeding; therefore again manual compression should be applied to prevent further bleeding. If the patient is being given any heparin infusions, they should be immediately stopped. The patient’s signs of intravascular volume depletion should be assessed. If any signs point towards insufficient cardiac output urgent medical help should be sought.

Arrhythmia

If the arrhythmia presents as something new for the patient, then a doctor should be notified. The healthcare provider should also make sure to assess the patient’s cardiac output, however even if the arrhythmia is already known yet cardiac output is insufficient, immediate medical help should be sought. The patient should also be placed on continuous cardiac monitoring once stable.

General patient care after the procedure

After the procedure takes place, the patient will generally require several hours for recovery. The patient should be taken to a recovery room to wait for the anaesthesia to wear off; typically this will take up to one hour. The plastic sheath which was inserted in the patient’s groin, neck, or arm will be removed soon after unless the patient requires specialised blood thinning medication.

After the recovery room, the patient should be transferred to a regular hospital or outpatient room. The length of the patient’s stay will be dependent on their condition. Some patients who have had a straightforward procedure may even be discharged on the same day, whereas others who have had an additional procedure such as an angioplasty or insertion of a stent will be required to stay overnight.

However guidelines require patient puncture sites to be assessed every thirty minutes for four hours minimum before the patient is allowed off of bed rest.

Patients should be kept lying flat for several hours after the procedure so that any serious bleeding can be avoided and that the artery can heal. It is advised that diagnostic catheterisation patients are kept on bed rest for four hours, and interventional catheterisation patients stay on bed rest for six hours. The patient is free to move side to side for their comfort. The head of the bed should be at a maximum thirty degree tilt. The patient should be allowed to eat and drink right after the procedure if they wish to (2).


Sources:

The Royal Children's Hospital Melbourne

Mayo Clinic


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