Routine Management On arrival to ward Assess and record patient observations - these should include: Neurological observations: Include assessment of behavior alertness, lethargy, irritability , limb strength and range of motion, facial symmetry, Glasgow Coma Score Maintain continuous cardiorespiratory monitoring to measure vital signs: HR, RR, BP, SpO2, Temperature Oxygen requirements Neurovascular observation Continue observations as per RPAO clinical guideline found here Neurovascular observations should be performed with every set of observations.
Assess puncture site 30 minutely for 4 hours than hourly until ambulation. Reassess site after first ambulation and then a minimum of 4 hourly prior to discharge. Note: the puncture site assessment commences from the time the patient enters the PACU, not when they are transferred to the inpatient unit.
The patient is required to remain on bed rest for: 4 hours for a diagnostic catheterisation. Note: The patient is permitted to move side to side while on bed rest to increase comfort. For younger patients it may be difficult to keep them supine for a period of hours; they can sit up in bed, sit on the parents lap or be carried, but they should not weight bare and ambulate Do not remove dressing prematurely unless ordered to by RMO. Dressing is to be removed prior to discharge for cardiac RMO to assess.
Note: if a patient remains in hospital for longer than 24 hours, the dressing should be removed 24 hours post procedure. Provide regular analgesia as ordered.
Maintain strict fluid balance chart. Particularly take note of urine output. The contrast dye used in cardiac catheter can be nephrotoxic and acute kidney injury has been associated with arterial access. Anticoagulation post cardiac catheterisation Aspirin may be ordered for device closures - be aware if medical team has requested such medications and when it should be commenced.
Heparin infusion post procedure is dependent on: If the patient was on anticoagulation eg: Warfarin pre procedure. A heparin infusion will commence to assist the patient returning to therapeutic coagulation levels. An issue has occurred during cardiac catheter that increases the risk of clots or concerns of limb compromise. Assessment and Management of Complications Complications: Varying acute haemodynamic complications associated with the general anaesthetic that is required with a cardiac catheter Vessel damage — can ultimately compromise the growth and function of the affected limb and complicate future catheter procedures Bleeding- including hematoma Arrhythmia Retroperitoneal bleeding Stroke — caused by a thrombus or hemorrhage Puncture site assessment Assess puncture site for: Bleeding- check pressure dressing for any oozing or bleeding from puncture site and mark the size of bleed if possible Note: check for bleeding immediately after vomiting or vigorous coughing.
Hematoma- assess site for swelling, redness and pain and mark the size of hematoma if possible Note: A hematoma can indicate internal bleeding into the thigh, pelvis or retroperitoneal space. Infection- assess site for heat, pain and redness. Also assess for other signs of infection including an increase in temperature, tachycardia, and rigors Ecchymosis- assess skin around site for purple discoloration Hematoma Apply manual compression over the hematoma, followed by a pressure dressing to prevent further bleeding.
If patient has a heparin infusion, stop infusion. Assess for signs of intravascular volume depletion- tachycardia, widening pulse pressure, hypotension, decreased peripheral perfusion, delayed CRT, agitation.
If insufficient cardiac output seek urgent medical assistance MET call 22 Auscultate hematoma for presence of pulse and a systolic bruit which indicates a pseudo aneurysm.
Notify physician Bleeding at site: Lie patient supine, elevate limb and apply pressure above puncture site with gauze to achieve hemostasis. Hemostasis should occur within minutes. Reinforce pressure bandage. Ensure patient is in sinus rhythm or is in a rhythm deemed normal for the patient If an arrhythmia is present clarify if this is a new arrhythmia for the patient.
If new arrhythmia notify physician. Note: regardless if the arrhythmia is new or deemed a normal occurrence for the patient, if cardiac output is insufficient you must seek urgent medical assistance.
Print rhythm strip or complete an ECG if patient is stable. Continuous cardiac monitoring. This policy, should be established by your institution. If conscious sedation is ordered the nurse should be familiar with the institutional policy for carrying for patients who have undergone conscious sedation.
As part of the preparation for cardiac catheterization the nurse should check anc document the status of peripheral pulses. All Documentation of Patient Teaching, and preop evaluation should be dead end of patient's clinical record. Each institution should have a precardiac catheterization checklist much as they do for patients going to surgery. This will include, but is not limited to, EKG, vital signs, oxygenation level, urine output, cardiac, respiratory, pulmonary, gastrointestinal, and gentle urinary assessment.
Particular attention must be paid to the peripheral vascular assessment of the lower extremities. Often the patient may return from the cardiac catheterization laboratory with a sheath in place. Some institutions, may allow the nurse to remove that sheath. Other institutions, require that the physician removes the sheath. In some institutions a ACT may be required to check the patients clotting time prior to sheath removal. During this time, you have to lie flat. Pressure will be applied to the puncture site to stop the bleeding.
You will be asked to keep your leg straight and will not be able to get out of bed. Your heartbeat and other vital signs pulse and blood pressure will be checked during your recovery. Report any swelling, pain or bleeding at the puncture site, or if you have chest pain. Before you leave the hospital, you will receive written instructions about what to do at home. What happens after I get home? Call your doctor if: Your leg with the puncture becomes numb or tingles, or your foot feels cold or turns blue.
The area around the puncture site looks more bruised. The puncture site swells or fluids drain from it. Call if: The puncture site swells up very fast. Bleeding from the puncture site does not slow down when you press on it firmly. How can I learn more about cardiac catheterization? Talk with your doctor. Here are some good questions to ask: What will you learn from the procedure? When will I get my results?
When can I resume my normal activities? What medicines will I need to take? Will I need another treatment? Last Reviewed: Jul 31, Subscribe today! Email required Email Required. Zip Code required Zip Code Required. Watch, Learn and Live See your cardiovascular system in action with our interactive illustrations and animations. Explore the Library.
Type: Extensible Order: Significant. TID Cath Procedure. Row 3 Procedure Number this admission is specified as a numeric text string, and shall be treated as the ordinal of this catheterization procedure within the admission i. Rows 8 and 12 Allow the recording of findings as either codes or as text; the same finding shall not be recorded as both.
Rows 15 and 16 Allow the recording of procedure results as either codes or as text, but not as both. Rows 3 and 4 Allow the recording of procedure description as either code or as text; the same description shall not be recorded as both. Rows 7 and 9 Allow the recording of findings as either codes or as text; the same finding shall not be recorded as both. TID Hemodynamic Findings. TID Ventricular Assessment. TID Common Findings. Rows 2, 3 and 4 Allow the recording of outcomes as either codes or as text; the same outcome shall not be recorded as both.
TID Summary, Cath. Type: Extensible Order: Non-Significant. TID Problem Properties. TID Procedure Properties. Up to three numeric characters. Allow the recording of procedure results as either codes or as text, but not as both. EV , NDR [2. IF Device is Primary for this Lesion. Title of composite object evidence document referenced.
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