Cardiac Catheterisation. Cardiology

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1 Cardiac Catheterisation Cardiology Name: Cardiac catheterisation Version: 1 Page 1 of 7

2 Contents Page Number(s) 1. Introduction 3 2. Management pre operative 3 3. Management post operative 5 4. Discharge 6 5. References 7 1. Objectives To provide evidence- based guidelines for the management of patients undergoing diagnostic and interventional cardiac catheterisation. 2. Scope This guideline is intended for all healthcare professionals caring for infants and children undergoing elective diagnostic or interventional cardiac catheterisation. It does not include patients requiring insertion of reveal, implantable cardiac device or insertion of pacemaker. It should be utilised in the cardiac pre operative assessment clinic and on ward 1E at the Royal Hospital for Sick Children, Glasgow. 3. Roles and responsibilities All medical and nursing staff caring for patients requiring a cardiac catheter should be familiar with the guideline. 4. Evidence The guidelines have been created after consultation with standard textbooks, PubMed searches and local expert opinion from the fields of cardiology and nursing. The references are located at the end of this document. Name: Cardiac catheterisation Version: 1 Page 2 of 7

Scope This guideline is intended for all healthcare professionals caring for infants and children undergoing elective diagnostic or interventional cardiac catheterisation.

3 1. Introduction Diagnostic cardiac catheterisation is performed to obtain anatomical and hemodynamic information in patients with suspected or confirmed heart conditions. Interventional treatment is undertaken in the treatment of heart disease. At RHSC diagnostic cardiac catheters, electrophysiology studies and interventional procedures are performed. This guideline helps standardise care for patients. 2. Management pre operative Doctor and Cardiac Nurse Practitioner The patient will be assessed and clerked by a Doctor or Cardiac Nurse Practitioner (CNP) in the pre operative assessment (POA) clinic or ward 5A. They order and interpret investigations, ensure medications are prescribed and update details on Heart Suite. It is the responsibility of the CNP or Doctor to inform the cardiologist and anaesthetist as soon as possible if they believe the child may not be fit for procedure. Pre operative Investigations Chest X-ray Echo ECG Blood Tests: FBC, U&E, Group & Save The Echo and ECG do not need to be repeated if it has been performed within the last 3 months. Prolong Storage of blood sample A blood transfusion questionnaire and prolonged sample form must be completed if the patient attends the POA clinic. This is to ensure the blood sample can be safely prolonged. On admission to 5A the blood transfusion questionnaire must be updated by the Doctor or CNP. If blood is required a match to store plasma (MSP) request should be made on HISS. Staff Nurse and Nurse Support Commence the cardiac catheter pathway, assess patients and obtain and document baseline observations. Consent should be obtained and pregnancy test completed on all females aged 12 years and over or younger if they are menstruating. Name: Cardiac catheterisation Version: 1 Page 3 of 7

This guideline helps standardise care for patients. 2.

4 Baseline Observations Height and Weight (entered into Trakcare) Heart rate, Blood Pressure, Oxygen saturation (SpO2), Respiratory rate and Temperature. Check both radial and pedal pulses Dental Check It is important the child has been assessed as dentally fit prior to their catheter procedure. Parents are sent a dental assessment form when the child is listed for cardiac catheter. This should be signed by their dentist within 4 months of procedure. If the child has not been seen by a dentist the Yorkhill dental team should be contacted to review the child prior to their catheter procedure. Cannulation If children have had their bloods obtained at the POA clinic and they do not require IV fluids a cannula will be inserted in catheter lab. Patients should have topical anaesthetic applied to cannulation site at least 30 minutes prior to catheter lab. IV fluids Patients only require IV fluids overnight pre operatively if they fit the following criteria: Post stage 1 HLHS awaiting stage 2 repair BT shunt dependent SaO2 <75% Fasting Instructions Fast as per GG&C fasting guidelines Patients must receive written information on the fasting instructions at the POA clinic and are advised to call ward 1E the day prior to their procedure to clarify fasting times. These are confirmed with parents on admission to the ward on the day of the procedure. Anaesthetic Assessment The patient will be assessed by the cardiac anaesthetist either at the POA clinic or on ward 1E. Consent Consent must be obtained as per GG&C policy Name: Cardiac catheterisation Version: 1 Page 4 of 7

Parents are sent a dental assessment form when the child is listed for cardiac catheter. This should be signed by their dentist within 4 months of procedure.

5 3. Management Post operative A handover will be provided to the nurses on 1E by a member of the nursing team in cardiac catheter lab and information relating to the intra operative procedure will be contained in the cardiac catheter pathway. The cardiac consultant will document specific instructions on the patient s pink post operative form and will state if the child requires antibiotics. Monitoring Place patient on continuous ECG and saturation monitoring for a minimum of 4 hours Document observation in CEWS chart: On arrival to ward Assess level of consciousness, Record vital signs (HR, Spo2, BP, respiration rate and temperature). Record vital signs (HR, SpO2, BP, RR) as directed in table below. After 4 hours if child has been stable and fully awake, change to 4 hourly observations. Record temperature 4 hourly or more frequently if clinically indicated. Assess wound site for haematoma or bleeding, noting colour and temperature of limb. Palpate distal pulses when femoral artery has been accessed. If there are any complications refer to the guideline, Management of arterial complications after cardiac catheterisation. Timescales: On arrival Wound Observations Pulse Check First hour 15 mins 30 mins 30 mins Second hour 30 mins 30 mins 1 hourly Third hour 1 hourly 1 hourly 1 hourly Fourth hour 1 hourly 1 hourly 1 hourly Mobilisation If observations have been stable for the first 4 hours, the patient may be mobilised and monitoring may be discontinued. Patient will change to 4 hourly observations. Fluids Offer small amounts of clear fluids/ breast milk as tolerated when child is fully awake. Discontinue IV fluids after 4 hours if adequate oral intake and tolerating diet. Name: Cardiac catheterisation Version: 1 Page 5 of 7

Monitoring Place patient on continuous ECG and saturation monitoring for a minimum of 4 hours Document observation in CEWS chart: On arrival to ward Assess level of consciousness, Record vital signs

6 4. Discharge The following section provides general information on the discharge investigations and highlights the roles and responsibilities of the team. Please read the pink operational note form first as patient s may have individual plans. Some patients may be discharged on the same day as their procedure therefore prompt planning and coordination of the discharge is necessary. Nursing Team Perform a full set of vital signs including site and pulse check. Ensure parents know when to contact ward for advice Ensure cardiac catheter pathway is complete Provide relevant discharge nursing paper work and information on clinic appointment. Doctor/ Nurse Practitioner The patient should be assessed by a Doctor or CNP before discharge All relevant post operative investigations conducted Prescribe discharge medications Provide a copy of the discharge letter from Heart Suite and Trakcare Discharge Investigations Catheter closure of Atrial Septal Defect: Echo, ECG. Aspirin usually for 6 months Catheter closure of Ventricular Septal Defect: Echo, ECG. Aspirin usually for 6 months Catheter closure of Patent Ductus Arteriosus Echo, ECG. Aspirin: Not required Stents Echo, ECG. Aspirin: for a minimum of 6 months Diagnostic Cardiac Catheterisation Echo and ECG not required Aspirin: Not required Aortic/Pulmonary Valvuloplasty Echo, ECG. Aspirin: Not required Radio Frequency Ablation (RFA) Echo, ECG. Aspirin 75mg daily for 3 months following RFA if left sided pathway Name: Cardiac catheterisation Version: 1 Page 6 of 7

Some patients may be discharged on the same day as their procedure therefore prompt planning and coordination of the discharge is necessary.

7 References Agnoletti, G., et al (2005) Complications of paediatric interventional catheterisation: an analysis of risk factors. Cardiology in the Young. Vol. 15, pp Bennet, D. et al (2005) Incidents and complications during pediatric cardiac catheterization. Pediatric Anaesthesia. Vol. 15, pp Chair, S.Y, et al (2008) The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic catheterisation. International Journal of Evidence based healthcare. Vol. 6, pp Gianakos, S., et al (2004) Time in bed after electrophysiological procedures (TIBS IV): A pilot study. American journal of critical care. Vol. 13, pp Patient Safety Advisory (2007) Strategies to minimize vascular complications following a cardiac catheterization. Pennsylvania Patient Safety Advisory. Vol. 4 (2). Royal College of Nursing (RCN) (2007) Standards for assessing, measuring and monitoring vital signs in infants, children and young people. RCN. London. (p7) Vlasic, W. (2004) An evidence-based approach to reducing bed rest in the invasive cardiology patient population. Evidence based Nursing. Vol. 7 (4), pp Consultation documents Great Ormond Street (2005) Diagnostic Catheter Pathway Alder Hey (2009) Cardiac Catheterisation Pathway Membership of Guideline Development Group Natalie Robertson, Kathryn Cowie, Dr Benjamin Smith Reviewers: Mr MacArthur, SSN Anne Hamilton. Sister Louise Bell, Staff Nurse Liza McCubbin and Dr Lindsey Hunter, Dr Knight, Dr Richens, Dr Burns, Lead Nurse; Kay Maley. Audit and Review: This guideline will be audited on an annual basis and formally reviewed in 2016 Name: Cardiac catheterisation Version: 1 Page 7 of 7

Y, et al (2008) The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic catheterisation. International Journal of Evidence based healthcare. Vol. 6, pp.

Intro Who should read this document 2 Key Messages 2 Background 2

Intro Who should read this document 2 Key Messages 2 Background 2 Classification: Policy Lead Author: Nathan Griffiths, Consultant Nurse Paediatric Emergency Medicine Additional author(s): N/A Authors Division: Salford Healthcare Unique ID: DDCPan04(14) Issue number: