PRE CATH PREPARATION : OR.... WHAT TO DO WHEN THE CATH LAB CALLS FOR THE PATIENT

1. CARE OF THE CARDIAC CATH PATIENTMeg Morris, RN, CCRN, Nurse Clinician IIZir Cardiac Cath LabJanuary 20, 2011

2. PRE CATH PREPARATION :OR....WHAT TO DO WHEN THE CATH LAB CALLS FOR THE PATIENT • GET THE PATIENT READY ! • HAVE PATIENT VOID • CLEAN JOHNNY • NO PANTS OR UNDERWEAR • CHART WITH MED SHEETS AND GREEN CARD

3. PRE CATH MEDS • ANY QUESTIONS CHECK WITH PHYSICIAN • ASA AND PLAVIX SHOULD BE GIVEN IF ORDERED AND NOT CONTRAINDICATED • LASIX: CHECK WITH PHYSICIAN • BETABLOCKERS AND ANTIHYPERTENSIVES ARE OK TO GIVE • ANTICOAGULANTS: CHECK WITH PHYSICIAN • INSULIN AND DIABETIC AGENTS: CHECK WITH PHYSICIAN

4. LEFT HEART CATH

5. Medications during the procedure • Moderate sedation • Versed • Fentanyl Patients are asleep and comfortable but able to converse with the staff.

6. Normal Coronary Anatomy

8. Closing the puncture site • Angioseal: A combination of stitches and collagen plug that sits between the artery and the insertion site. • Vasoseal: A collagen plug only, no stitches, that sits between the artery and the insertion site. • V pad: Coagulant pad held over the insertion site to promote hemostasis. • Manual hold Post-procedure care is the same for all closure devices.

9. Post cath care: See orders • Vital signs and groin checks • Pedal Pulses • IV Fluids • Activity: Bedrest HOB no higher than 30 degrees.

10. Groin care: What to do if the groin bleeds Minor bleeding: Remove dressing, apply pressure for 5-10 minutes. If still bleeding or oozing, call for help: cath lab (5559) during the day, Interns or residents at night. Check distal pulses

11. MAJOR BLEEDING OR HEMATOMAS • STAY WITH THE PATIENT !! • Call for help • Remove dressing and hold pressure • Monitor Heart rate and BP and distal pulses • IV access a must • Do not shut off Integrilin without checking with the Cardiologist.

12. Discharge Teaching • Groin care • Remove the dressing after 24 hours! • Keep site covered with a bandaid for one week, change it every day after showering. • Showering OK after 24 hours, no tub baths, swimming, or hot tubs for 1 week. • Activity: No heavy lifting (>10 lbs) for one week. • Reasons to call the doctor: Fever, bleeding, vomiting, chest pain.