Coronary Catheterization: Post-procedure Nursing Care

00:01 In this section, we're going to look at post-procedural care for a client who has had a cardiac cath. Now, the specific type of care is highly dependent on what procedure took place and what, if any, unexpected or changes from routine of care happen.

00:15 Patients are at risk of various complications and as nurses are, keen, observations and swift interventions can make a marked difference in their recovery.

00:23 So let's delve into our post procedural responsibilities using the nursing clinical judgment measurement model.

00:30 If you haven't heard the message yet, recognition of cues is vitally important in this situation.

00:37 Monitoring the puncture site for these things hematoma, swelling, bleeding or signs of infection is crucial.

00:47 That is a minimum standard of care.

00:50 So look at the puncture site.

00:52 Look for signs of a hematoma, which is bruising, which would indicate some oozing or bleeding swelling, which some is normal.

01:00 But you'll know what is abnormal signs of bleeding because we don't want the patient to be at risk for hemorrhaging or signs of infection, because any time you break the skin, you're at risk for infection.

01:11 Now, the nurse will continue to regularly assess vital signs, including pain.

01:15 Remember, that's the fifth vital sign.

01:17 And they'll do that per institutional protocol.

01:20 They'll also look for signs of decreased limb perfusion like pallor or coldness or absence of a pulse distal to the puncture site.

01:29 Okay, we've gone through a lot of information, but I want you to think about two specific things.

01:35 When you're assessing the puncture site.

01:37 I'm worried about the patient bleeding and I'm worried about perfusion.

01:42 Those are the two big categories that you're looking at.

01:45 So looking hematoma, swelling, bleeding.

01:48 Those are big deals.

01:49 Infection, if it's going to develop, is not usually immediately after the procedure.

01:54 Right? That will come later.

01:55 But limb perfusion is a big deal.

01:59 If that patient has developed a clot in that limb farther down the road from that clot, their skin color will look funny.

02:07 It'll look kind of pale.

02:08 They're also going to have coldness in that extremity and you won't be able to assess the pulses that they had before surgery.

02:15 In fact, often before a heart cath, nurses will take the trusty marker and they'll take the sharpie and mark a patient's pedal pulses or their pulses on their arms so they know exactly where to look after the procedure.

02:28 So keep that in mind.

02:30 Those are classic complications we're always on guard for.

02:36 If the nurse does see the cues of a, let's say, a growing hematoma, the analysis of those cues would indicate that we have a potential vascular complication.

02:46 Now, we might see other things like hypertension.

02:49 Now, if you have a drop in the patient's blood pressure and it's due to internal bleeding, there's a pretty significant bleed going on in there.

02:57 But it also could indicate there's just some internal bleeding that hasn't caused hypertension yet.

03:03 And hopefully we intervene before it does.

03:05 That might also be having some cardiac complications.

03:07 And that's why they have hypertension.

03:09 So you're constantly assessing and reassessing and putting those cues together.

03:13 So what could hematoma mean? We might have a vascular complication.

03:18 What could hypertension mean? Might we have internal bleeding or we might be having some cardiac complications? Heart's unable to pump effectively enough.

03:26 If we can't find pulses, that might mean that we have impaired perfusion and that artery might be occluded.

03:33 Now, if they have new onset chest pain, that could also indicate a problem with the newly placed stent or some other cardiac issue.

03:40 Wow. Do you see all that? That's why nurses are critically important to constantly assess and reassess after the procedure. Now let's take a look at some priority hypotheses based on what we analyzed previously. You can have a hematoma or bleeding that suggests a vessel injury or an inadequate hemostasis, meaning it wasn't enough that clot to stop the bleeding.

04:06 If you see a significant drop in blood pressure or other vital sign changes, this could show us that there could be re occlusion.

04:13 There could be internal bleeding or there could be cardiac complications.

04:17 If you have decreased limb perfusion that could indicate arterial occlusion, which means urgent and immediate attention chest pain.

04:25 Another hypothesis could tell us there might be a stent malfunction or possibly another cardiac issue.

04:30 So, wow, we have some problems to address.

04:34 We need to generate solutions.

04:36 So here are some things that we would do based on those hypotheses.

04:39 Here are some solutions we would likely generate.

04:42 We would look at caring for a patient after a percutaneous coronary catheterization.

04:46 We might consider the hematomas and bleeding more direct pressure along with assessing the need, the patient might need vascular repair for vital sign changes.

04:56 We've got to figure out what caused them.

04:58 Now, we talked about some examples, but I said your heart might be having a hard time.

05:01 You might have a lot of bleeding.

05:04 You have to figure out what the underlying cause of that hypertension is because that will help you determine what's the next best step.

05:11 Now for the poor perfusion, you might have to do some vascular imaging and in the worst case scenario, they might need to have some surgery.

05:18 Your patient is having chest pain.

05:20 You want to have an EKG, might give some medications, or it might be some additional interventions ordered by the health care provider.

05:28 Now, remember, if there's bleeding or a hematoma, the nurse must take action.

05:32 You've got to apply direct pressure to the bleeding site and alert the health care team, make sure that you give the medications for blood pressure, chest pain and other symptoms, and keep continuously reassessing and communicating with the patient about their symptoms and needs.

05:47 Evaluating these actions for effectiveness helps the nurse anticipate what needs to happen next. For example, if the bleeding or hematoma does not begin to resolve, the cardiologist may need to reassess the site, change the pressure device or suture, or use another stabilization device if vital signs are not stabilizing, The chest pain is not resolving or limb perfusion is not returning.

06:09 The patient may have to go back to the surgical area or be transferred from a post-surgical care unit to an intensive care area until they can return to baseline or stabilized. So remember, after a coronary catheterization with or without additional interventions such as angioplasty or stent placement, our main goal is to ensure the patient remains stable and free from complications.

06:32 Constant monitoring, quick decision making and prompt actions can greatly influence post-procedural outcomes.

06:39 After a coronary catheterization with or without additional interventions such as angioplasty or a stent placement, our main goal is to ensure the patient remains stable and free from complications.

06:51 That requires constant monitoring, quick decision making and prompt actions that can greatly influence the postprocedural outcomes.

06:59 Remember, while the procedure is vital, the nursing care before, during and after is what ensures patient safety and enhanced outcomes.

07:08 Always utilize your clinical judgment and collaborate with the interdisciplinary team.