the mysteries of the cardiac catheterization lab

THE MYSTERIES OF THE

CARDIAC CATHETERIZATION

LAB Cardiac Catheterization Lab

Rachelle Brink

Leanne Ritson

Presenter Disclosure

Rachelle Brink and Leanne Ritson

Relationships with commercial interests:

We have no conflict of interest or affiliations that have influenced this

presentation to disclose

Learning Objectives

At the conclusion of this activity, participants will be able to:

• Discuss the common procedures performed in the

TBRHSC Cardiac Catheterization Lab (Cath lab)

• Describe barriers and successes in the TBRHSC Cardiac

Catheterization Lab

• Pre op and Post-op care of patients

Welcome to the Cardiac Catheterization

Lab

What we do in the Cath Lab • Angiograms

• PCI (Percutaneous Coronary Intervention)

• Pacemaker Insertions

• TEE (Transesophageal echo)

• Cardioversions

• Our team consists of Registered Nurses, Medical Radiation

Technologists (MRT) and Cardiologists

Recovery Room Pre-Op

• Prior to procedure the flow sheet needs to be fully completed, this can take place before they arrive to the cath lab if time permits

• Special attention needs to be given to the patients most recent lab work especially the creatinine level and INR.

• IV access is preferred to be on the left side

• The right wrist should be shaved and Emla patch applied, along with the right femoral area

Medications Pre Angiogram/PCI

• All regular morning medications should be given to your

patient before coming to the cath lab

• Medications that should not be given the day of are

Metformin, lovenox and anticoagulation should be held

days prior depending on the physicians decision

ie..anticoagulants and novel oral anticoagulants (NOAC).

• ASA and Clopidogrel/Brilinta are the 2 very important

medications that must be given prior to coming and not be

held.

In The Lab

In The Lab

• The patient is monitored by ECG, O2 sat and Blood

pressure

• They are prepped on the table both wrist and groin

• Patients are given Midazolam and Fentanyl for sedation

• The procedure itself takes approximately 20 minutes and

if further intervention ie. Angioplasty, is needed then that

adds on more time depending on severity of the case

Sheath

Catheter

Stent

Coronary

Artery

Blockage

Coronary

Artery

Blockage:

Stent deploy

Coronary

Artery

Blockage:

Stent Placed

Recovery Room Post-Op

• Patient arrives back in Recovery room.

• Report is received about the Patient’s results

• Vitals are monitored

• Radial/Femoral sites are checked frequently

Post Care

Clamp TR Band

What to watch for….

Radial

• good CSM

• brachial pulse is palpable

• radial pulse is palpable

• hematoma (manual

pressure proximal to the site

needs to be held)

Femoral

• bruising, some is normal

• back pain could mean retro bleed

• hematoma (manual pressure needs to be held)

• numbness, discoloration could mean angioseal complication

Health Teaching

• Check groin site q30m x 2hours

• Hold fist over site when cough or sneeze

• No bath for 3 days, shower only

• No swimming or hot tubs for 2 weeks

• No creams or lotions

• Avoid strenuous activities for 7 days

• No heavy lifting

• Radial site- no bending or straining wrist for 7 days

• No driving for 2 days

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