Coronary Catheterization: Pre-procedure and Operative Nursing Care

00:01 Welcome to our video series on how to take care of a patient during a coronary catheterization procedure.

00:07 Now, these are really complex procedures.

00:09 These are done by specialists, but they require precise care at every stage from the entire team. Today, I'm going to review the specific nursing interventions required before, during and after the procedure that help us organize and remember these interventions. We're going to use the measurement model that you see on the screen.

00:28 Remember, that's the framework for the NCLEX and the way great nurses think.

00:32 So speaking of thinking, it's great to memorize nursing interventions, but it's also important to remember that patients are human beings and the care they receive needs to be individualized for that particular patient and that particular setting.

00:46 Now, as we move through the content, I'm going to share examples of how you might need to individualize your approach to meet each patient's unique needs.

00:53 Now, although the majority of these interventions are consistent between health care organizations, you may see some small differences in the order of how things are done or additional interventions with different populations, settings or physicians.

01:07 Before we review nursing responsibilities, let's revisit what coronary catheterization procedures are.

01:13 Sometimes the terminology coronary or cardiac catheterization, percutaneous catheterization or just caths are used interchangeably to refer to any procedure that accesses the heart's vessels via a catheter through the skin.

01:29 Okay, so you may hear any of those terms used in your clinical rotations, but let's be really precise.

01:35 To be clear, coronary catheterization allows for visualization of the coronary arteries of the heart and assessment for blockages or stenosis.

01:44 That's why we do a coronary catheterization.

01:47 We're going to get an up close and personal view of the blood supply to the heart muscle.

01:53 Now, they do this by injecting dye into the coronary arteries, and they capture these x-ray imaging to see the flow of the dye so they can identify any potential blockages.

02:03 So where the vessel is blocked, the dye will not be able to pass through and that'll be obvious on the imaging.

02:10 The procedure itself involves the introduction of a catheter percutaneously, that means through the skin.

02:16 Now it's usually via the femoral or the radial arteries.

02:19 Now once it enters in one of those places, either the groin or in the wrist, that is advanced to the heart's coronary artery.

02:28 So it enters in the groin and it is threaded up to where it enters the heart's coronary arteries. Same thing if it's percutaneously inserted in the radial artery.

02:40 When you see the term percutaneous catheterization, it's often more specific to an intervention done during the coronary catheterization.

02:48 So this refers to, yes, there's a heart cath, but there likely was an intervention done during that heart.

02:56 Cath Now it might be because the blockages are taken care of with angioplasty or with a stent placement. But keep in mind there are also other percutaneous catheterization procedures that treat other organs outside the heart.

03:08 So a cath just means you're going to be going through the skin and feeding through a catheter. When we're talking about the heart, that's when it's called a coronary catheterization. So to make sure you're clear, it can be helpful to consider coronary catheterization as a diagnostic tool and percutaneous catheterization as an intervention tool.

03:30 Understanding you may hear these used interchangeably.

03:34 Now we can focus on what the nurse needs to know.

03:36 And caring for patients undergoing a coronary cath procedure because we're going to be using the nursing clinical judgment measurement model.

03:43 Remember, that's the framework on the NCLEX and how great nurses think.

03:47 Now this is what's going to help us organize our discussion and give you the framework to think through what you will do as a nurse in each stage of the procedure.

03:56 Now before the procedure, there's pre-procedure responsibilities.

03:59 Now it's often the stage in which you are recognizing cuz these are what help us individualize the care plan to a specific patient's needs.

04:07 So you're going to get a thorough medical history.

04:10 You're going to make sure you understand any history of heart disease allergies, especially allergies to contrast or iodine any medications the patient's taking.

04:19 And you want to assess their understanding of the procedure as well as their emotional state, because it's understandable that anxiety is a common factor.

04:28 During the assessment, you're recognizing cues that, you know, to look for for a patient having this procedure.

04:34 Next step is you take those cues and that data and you analyze them and you're looking for any risks to the patient's safety.

04:42 For example, it could be if the patient had an allergy to shellfish.

04:45 We ask that because they might have an allergy to the contrast dye.

04:48 So of course, the health care provider, the specialist would need to know that.

04:53 What if they're taking medications such as anti-coagulants? And they took them the very same day as their procedure.

04:59 That could increase the risk of bleeding.

05:01 That's another thing that the health care provider would need to know.

05:05 Also be aware of emotional distress or anxiety because it's obviously not uncommon.

05:10 Let's consider the cues we received about this patient.

05:13 Now here are some priority hypotheses to consider based on the cues we collected and recognized. One hypothesis could be there's a risk of allergic reaction from contrast dye.

05:24 Another hypothesis could be medications may complicate the procedure or recovery.

05:30 Another one can be unaddressed.

05:32 Anxiety may cause procedural complications.

05:36 So what should a nurse do with this information? Well, the next step in the model is to generate solutions.

05:41 So thinking through the hypotheses that you proposed, this is where your academic and clinical training, combined with your critical thinking skills, are tested.

05:51 Now, an exam language.

05:53 You'll see things like what is most important for the nurse to follow up on? What should the nurse do first? Right. That indicates priorities.

06:01 Now, thinking through what we found out in our hypothesis, we would need to consult with the radiologist or the cardiologist about the potential allergies and medications interactions that we identified.

06:12 We would also consider pre-procedure anxiety medications or counseling.

06:17 Oftentimes, patients will have this as a routine order as needed for these types of procedures. You're also going to ensure that all emergency equipment and medications like epinephrine and things that we use to treat allergic reactions are available should the patient have an allergic reaction.

06:34 So obviously, it's great to have a plan for this patient's priorities, but we can't forget about the standard nursing responsibilities for all patients during the pre procedure period. Now you're going to take action on these types of items by doing things like this. You're going to provide education to the patient about the procedure, make sure they know what to expect and also know why it's important things that we're looking for, assessing and monitoring.

06:59 You want to make sure appropriate informed consent has been obtained.

07:02 You want to make sure the patient has been fasting if that is required, and initiate an IV line for Emergency Drug Administration.

07:09 Make sure you give any pre procedure medications as ordered by the health care provider. Now what's left is to evaluate the quality of your actions.

07:17 You may do this by ensuring the patient feels more informed and at ease after your education. You might confirm that all contraindications, allergies and medications have been communicated to the team.

07:28 You also might ensure all pre-procedure checks are complete and the patient is prepped and ready for the procedure.

07:35 Now, are you ready to think about what the nurse does during a coronary catheterization procedure? Well, you can probably guess that it begins with an assessment, right? During the procedure, the nurse is continuously assessing vital signs, especially heart rate, blood pressure, and oxygen saturation because these are cues, this could be signs that there could be impending coronary complications.

07:57 So in addition to that, the nurse observes the patient's level of consciousness and responsiveness to the anesthesia and looks for signs of bleeding or allergic reactions.

08:08 Now analysis of these parameters might reveal some fluctuations in the blood pressure or the heart rate that could signal cardiac instability.

08:15 Changes in consciousness can indicate potential complications, such as a reaction to the contrast dye or decreased perfusion.

08:23 Ekg changes can point toward cardiac complications.

08:26 So when you see and consider these cues, prioritization of hypotheses should begin.

08:31 Let's consider the following.

08:32 I'm going to look at three hypotheses.

08:34 So what if the blood pressure drops significantly? Well, it might be due to the contrast dye or to a vessel injury.

08:41 What if you notice irregular heart rhythms? Well, that might indicate the arrhythmia was provoked due to the catheters position.

08:48 Kind of irritating the heart muscle.

08:51 What about an allergic reaction to the contrast dye? Well, that might show up as a rash or swelling or altered consciousness.

08:58 So see why you want to keep all of these things in mind.

09:01 Because you need to know what can the nurse do with these hypotheses? Well, in the middle of a procedure, the nurse is both generating solutions and taking actions simultaneously.

09:10 So, for example, hemodynamic changes might trigger the need to have both emergency medications ready and you being prepared to administer them per hospital and ACLs or advanced cardiac life support guidelines.

09:23 Nobody wants that to happen, but there is a risk that it could if any of these possible complications do arise.

09:30 This is where the nurse has the opportunity to apply this measurement model.

09:33 You're going to take it all the way through to evaluation.

09:36 At this stage, the nurse evaluates the effectiveness of the actions by noting whether or not are the vital signs stabilizing.

09:44 Is the patient's consciousness level returning to baseline? Are the arrhythmias resolving post-intervention? How's the patient feeling? Are they experiencing any discomfort or distress? Remember during the procedure, while the cardiologist takes the lead in the intervention? Our role as nurses is to ensure that any potential complications are swiftly identified and managed.

10:04 Our diligence and clinical judgment can make a significant difference in patient outcomes.