CARDIAC CATHERIZATION

Prepare by Ak Mansoor Ahmad Subject :pediatric health nursing Facilitator :sir fath ur Raham

OBJECTIVE

1. Define Cardiac catherization 2. Enlist indication for cardiac catherization3. Demonstrate the procedure4. Discuses complication5. Discuses pre &postoperative nursing diagnosis6. Enlist nursing intervention

CARDIAC CATHERIZATION

Def: it is an invasive procedure used to identify cardiac anatomy; measure intracardiac pressure,shunt,and oxygen saturations:and calculate systemic and pulmonary vascular resistance. (also called cardiac cath or coronary angiogram) The procedure is performed in an area of the hospital called the catheterization laboratory, or “cath lab.”

INDICATIONTo confirm or establish the diagnosis.

To measure cardiac output. To measure pressure and oxygen saturations. To calculate intra cardiac shunting and pulmonary and systemic vascular resistance. To visualize coronary arteries.to assess for myocarditis or rejection following heart transplantation. To intervene in congential heart disease

PROCEDURE

Catheter insertion site include femoral vein or artery,umbilical vein or artery ,brachial vein or internal jugular vein. Under fluoroscopy , Catheter are guided through the heart collecting pressure measurements and oxygen saturation. Contrast dye is injected through the Catheter to visualize blood flow patterns an structural abnormalities.

COMPLICATION

Aysrthymias(usually catheter induce) Infection. Bleeding at catheter insertion site,large hematoma Allergic reaction to contrast material. Loss of pulse in the extremity used for cannulation. Perforation of heart or vessels . Stroke. Death.

NURSING DIAGNOSES

Preoperative Fear related to surgical procedure. Deficient knowledge regarding surgical procedure and associated nursing care . Postoperative Risk for injury related to complications of cardiac catheterization.

PRE-CATHETERIZATION NURSING INTERVENTIONS

Reducing fear in child and parents. provide specific instruction in nonthreatening manner. Day and time of the procedure Nothing –by-mouth- (NPO) guidelines. Sedation versus general anesthesia. Site of the planned arterial and venous puncture.

NURSING INTERVENTION

Provide appropriate teaching geared toward the child,s age and level of cognitive development.use diagrams models ,as appropriate. Give child opportunity to express fears and ask questions.

POST-CATHETERIZATION INTERVENTIONS: Before the patient returns to the unit, the nurse should ensure that all equipment is avialble to evaluate and maintain the patient once he arrives. These are things such as, intravenous pole with plump, blood pressure cuff, pulse oxmetry, telemetry if ordered, and sand bag. when the patient returns he may be placed on bed rest with the head of the bed no higher than 30 degrees. The patients affected extremity must be kept straight Insure the patient is fully awake, encourage the patient to drink at least two liters of fluid during the first 12 hours post cardiac cath. if his condition warrants and if it is not contraindicated.

POST-CATHETERIZATION INTERVENTIONS

 Maintain the patient on hourly intake and output.If the patient starts to bleed at the puncture site, hold pressure above the insertion site until the bleeding is stopped. Do not hold pressure directly on the departure site. Notify the physician.

EXPLAINING AND PROVIDING NURSING CARE

obtain baseline set of vital signs: heart rate ,BP respiratory rate, and oxygen saturation.

measure and record child,s height and weight.

note time of oral intake : solids and liquids.

identify known allergies.

list current medication and note time last taken.

help child change into a hospital gown.

start peripheral iv, as needed.

assess and mark the location of pulse (dorsalis peis,posterior tibial.)

OBSERVE FOR AND PREVENT COMPLICATION

Monitor and record routine vital sing ,extremity temperature ,color, and pulse, check with vital sings. Notify health care provider for: Heart rate ,respiratory rate , or BP Bleeding or increasing hematoma at puncture site. Changes in oxygen saturations. Fever. Cool , pulseless extremity.

FAMILY EDUCATION AND HEALTH MAINTENANCE

Provide discharge information: Care of incision or puncture site Activity restriction. Observe for and report late complications : redness , swelling ,drainage from puncture site. Follow up medical care.

Reference Lippincott manual of nursing practice(2010 edition)Collected data from online source website Web Med.