University of Kirkuk Second semester April - 2020
College of Nursing Adult nursing II 2nd year students
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Cardiac Catheterization
Cardiac catheterization involves passing a thin flexible tube
(catheter) into the right or left side of the heart, usually from the
groin or the arm.
Cardiac catheterization is a test to check the heart. This test can
include a coronary angiogram, which checks:
1. the coronary arteries.
2. blood flow in the coronary arteries.
3. blood flow and blood pressure in the chambers of the heart,
4. find out how well the heart valves work, and
5. defects in the way the wall of the heart moves.
6. In children, this test is used to check for heart problems that
have been present since birth (congenital heart defect).
1- Percutaneous Transluminal Coronary Angioplasty
(PTCA):
PTCA, also known as balloon angioplasty, involves use of a balloon-
tipped catheter that, when advanced through an atherosclerotic lesion, can
be inflated intermittently to dilate the stenotic area and improve blood
flow through the vessel, the high balloon inflation pressure stretches the
vessel wall, fractures the plaque, and enlarges the vessel lumen. A
successful PTCA reduces the stenosis to less than 50% of the vessel
lumen. Complications that can result in ischemia and possible severe left
ventricular dysfunction.
2- Atherectomy:
Atherectomy is the excision and removal of the atherosclerotic
plaque by cutting, shaving, grinding, using specialized coronary catheters,
Atherectomy devices include directional coronary atherectomy (DCA),
transluminal extraction catheter (TEC), or rotational ablation
(Rotablator). Potential complications of all Atherectomy devices include
Perforation of the coronary artery, abrupt closure, embolization distal to
the lesion site, and myocardial infarction, allergic, hypotension.
(Directional coronary atherectomy catheters)
3- Coronary Stents:
A stent is a self-expanding or balloon-expandable tube , the stent is
introduced into the coronary artery over a guidewire, usually in a vessel
area that has been previously dilated with angioplasty or had plaque
removed by atherectomy to debulk the atheroma. The
expansion/debulking is performed before stent insertion to obtain a larger
vascular lumen diameter. Stents are employed in 80% of PCIs because
they dramatically reduce the number of abrupt vessel closures within the
first 24hours, post procedure.
The risk include:
Cardiac tamponade
Heart attack
Injury to a coronary artery
Irregular heartbeat
Low blood pressure
Reaction to the contrast dye
Stroke
Possible complications of any type of catheterization include
the following:
Bleeding, infection, and pain at the IV or sheath insertion site
Damage to the blood vessels
Blood clots
Kidney damage due to the contrast dye (more common in patients
with diabetes or kidney problems)
Nursing Management After Percutaneous Coronary
Interventions:
1. After the bandage is removed, cover the area with a small adhesive
bandage. It is normal for the catheter insertion site to be black and
blue) for a couple of days. The site may also be slightly swollen
and pink, and there may be a small lump (about the size of a
quarter) at the site.
2. Palpating peripheral pulses usually monitored every 15m for first 1
to 2h after procedure, than hourly until the sheaths are removed.
3. Wash the catheter insertion site at least once daily with soap and
water. Place soapy water on the hand or wash- cloth and gently
wash the insertion site; do not rub.
4. Keep the area clean and dry. Do not use creams, lotions or
ointment on the wound site.
5. Do not take a bath, for one week after the procedure.
6. The patient usually feel tired and weak the day after the procedure.
Take walks around the house and plan to rest during the day.
7. Do not strain during bowel movements for the first 3 to 4 days after
the procedure to prevent bleeding from the catheter insertion site.
8. Avoid heavy lifting (more than 10 pounds) and pushing or pulling
heavy objects for the first 5 to 7 days after the procedure.
9. Do not participate in strenuous activities for 5 days after the
procedure. This includes most sports activities.
10.Gradually increase the activities until reach the normal activity
level within one week after the procedure.
11.After sheath removal, direct pressure is applied to the puncture site
for 15 to 30 minute. For stent or atherectomy which require a large
sheath size a C- clamp or femoral compression device may be used
to apply continued pressure for 1 to 2 h.
Indication for Cardiac Surgery:
1- Coronary Artery Disease
2- Valvular Disease
Coronary Artery Bypass Graft Surgery :
Result of three major randomized trials support the view that
coronary artery bypass grafting (CABG) to revascularize ischemia
myocardium affords dramatic improvement of symptoms and quality of
life. Myocardial revascularization uses a conduit (vein or artery) to
bypass an occluded coronary artery. Currently the two most common
conduits are the saphenous vein graft (SVG) and the internal mammary
artery (IMA).
Saphenous Vein Grafts SVG . Saphenous vein grafts are used to bypass
the obstruction in the coronary artery by anastomosing one end of the
vein to the aorta (proximal anastomosis) and the other end to the coronary
artery just past the obstruction (distal anastomosis). Although the
saphenous vein can be taken from above or below the knee, a vein from
below the knee is generally preferred because it is close in diameter to the
size of the coronary artery. To remove the vein, an incision is made along
the inner aspect of the leg. Alternatively, small incisions can be made in
the area of the vein. 50% of saphenous vein grafts are occluded after 10
years. The main processes account for saphenous vein failure: thrombosis
and atherosclerosis.
Internal Mammary Artery Grafts. The internal mammary artery is a
preferred alternative to the saphenous vein for surgical revascularization.
The internal mammary artery is used as a pedicle graft (i.e., the proximal
end remains attached to the subclavian artery) to bypass diseased
coronary arteries. Both the left and the right internal mammary artery can
be used. Because the left internal mammary artery is longer and larger
than the right, it is usually used to bypass the left anterior descending
coronary artery. The right internal mammary artery is anastomosed to the
right coronary artery.
Compared with saphenous vein grafts, internal mammary artery grafts
have superior graft patency rates; 90% were patent 10 years after surgery.
In addition, internal mammary artery grafts exhibit less atherosclerosis
over time, and they have been associated with lower long-term morbidity
and improved long-term survival
Surgical Treatment for Valvular Heart Disease:
Symptomatic aortic valve disease is surgically managed by aortic
valve replacement (AVR). Mitral valve disease can be repaired by valve
commissurotomy, valve repair, or valve replacement. Commissurotomy
is performed for mitral stenosis and involves incising fused leaflets to
increase valve mobility. Valve reconstructions or repair can sometimes
be performed for mitral regurgitation. If reconstruction of the valve is not
possible, Mitral valve replacement (MVR) is performed, Two major
types of prosthetic valves are available mechanical and biological.
Mechanical valves are made entirely of synthetic materials, whereas
biological valves combine synthetic materials with chemically treated
biological tissues.
Medtronic Hall Easy-Fit, aortic model Starr-Edwards Silastic
ball valve, aortic model.
SHEATH in anatomy the layer of connective tissue that envelops
structures such as nerves, arteries, tendon and muscle
During PCI, a cardiologist feeds a deflated balloon or other device on a
catheter from the inguinal femoral artery or radial artery up through blood
vessels until they reach the site of blockage in the heart. X-ray imaging is
used to guide the catheter threading.
