Nursing Care For Patient with CAG&PCI Sunisa Pongam RN, Cath Lab

Transcription

1 Nursing Care For Patient with CAG&PCI Sunisa Pongam RN, Cath Lab

2 What is atherosclerosis? Atherosclerosis is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restrict blood flow to the heart. 2

3 Atherosclerotic heart disease (Coronary Artery Disease: CAD) Is the narrowing or blockage of the coronary (heart) arteries. Your coronary arteries are shaped like hollow tubes through which blood can flow freely. Normally, the walls of the coronary arteries are smooth and elastic. 3

4 Atherosclerotic heart disease (Coronary Artery Disease: CAD Atherosclerosis occurs when the normal lining of the arteries deteriorates, the wall of the arteries thicken and deposits of fat and plaque build-up on the coronary artery walls, blocking or limiting the flow of oxygen-rich blood to the heart muscle. 4

5 Atherosclerotic heart disease (Coronary Artery Disease: CAD Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries are completely blocked. A heart attack (injury to the heart muscle) may occur. 5

6 What is Cardiac Catheterization? Is an invasive imaging procedure that allows your doctor to evaluate your heart function. Is a procedure used to diagnose or treat a blood vessel problem in your heart. 6

7 Cardiac Catheterization (CAG) is used to: -Check blood flow and blood pressure in the chambers of the heart. -Check blood flow in the coronary arteries. -Find out how well the heart valves work. -Check the pumping action of the heart. (Evaluate heart muscle function) 7

8 Cardiac Catheterization (CAG) is used to: -Find out if a congenital heart defect is present and how severe it is. (especially in children) -Help determine whether treatment with medicines, an interventional procedure or coronary artery bypass graft (CABG) may be effective. 8

9 Cardiac Catheterization (CAG) is used to: -If the patient have atherosclerosis, this test can pinpoint the size and location of fat and calcium deposits (Plaque) that are narrowing coronary arteries. 9

10 Cardiac Catheterization (Cath.) Laboratory: A special room in the hospital with testing equipment and staff for the procedure. It is cool, darkened room. The patient will lie on a special procedure table where X-ray can be taken, either by repositioning the table or by moving the X-ray machine around them. The patient will be attached to equipment (Electrode) for continuous cardiac, Blood pressure (BP), and pulse oximetry monitoring. 10

11 Cardiac Catheterization (Cath.) Laboratory: An X-ray machine (Fluoroscope) provides images of heart during the procedure to help the doctor accurately position each catheter. A special kind of dye (X-ray contrast) is injected into the coronary arteries

12 During a CAG: 1. A long, narrow tube called a Catheter is inserted through a plastic introducer sheath (a short, hollow tube that is inserted into a blood vessel in your arm or leg). The catheter is guided through the blood vessel to the coronary arteries with the aid of a special X-ray machine. 12

13 During a CAG: 2. Contrast Media (CM) is injected through the catheter and move through the heart s chamber, valves and major vessels. (under Fluoroscope) The digital photographs of the CM are used to identify the site of the narrowing or blockage in the coronary artery. 13

14 Extra Additional imaging procedures called Intravascular Ultrasound (IVUS) and Fractional Flow Reserve (FFR), may be performed (along with CAG) in some cases to obtain detailed images of the walls of the blood vessels. Both IVUS & FFR are currently only available in specialized hospitals and research centers. 14

15 Extra IVUS Procedures: an accurate picture of the location and extent of plaque. FFR: a special wire is threaded through the artery and a vasodilation medication is given. This test is functionally performing a very high quality stress test for a short segment of the artery. 15

16 What is an interventional procedure? An interventional procedure: is a nonsurgical treatment used to open narrowed coronary arteries to improve blood flow to the heart. 16

17 What is an interventional procedure? An interventional procedure Balloon Angioplasty Stent Placement Rotablation or Cutting Balloon 17

18 Angioplasty is used to: 1 Restore blood flow to the affected area at the heart by treating narrowed coronary 2 Provide prompt relief of chest pain and/or shortness of breath after procedure. arteries. 18

19 Angioplasty is used to: 3 Potentially reduce the risk of heart attack and prolong life compared to no treatment. 4 Chest pain during exertion if medication has failed or is not selected 19

20 5 6 Continual or increasing chest pain and/or shortness of breath. Patients who are not candidates for CABG 20

21 PTCA/PCI -A procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery. -When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart. - This procedure is sometimes complicated by vessel recoil and restenosis 21

22 PCI with Stenting: In most cases, PTCA is performed in combination with the stenting procedure. -A Stent is a small, metal mesh tube that acts a scaffold to provide support inside the coronary artery. -A Balloon Catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. 22

23 PCI with Stenting: -Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. -The balloon is deflated and removed, and the stent stays place permanently. -During a period of several weeks, the artery heals around the stent. In this way, restenosis is somewhat diminished 23

24 Two kinds of Coronary Artery Stents 1.Bare-Metal Stent (BMS): -Help to prevent the artery from re-narrowing. -Supporting the artery wall after angioplasty. 24

25 Two kinds of Coronary Artery Stents 2.Drug Eluting Stent (DES): -Are BMS with a special drug coating. -Have the same support benefits as BMS for keeping the artery open after angioplasty. -The stent releases a drug over time to further reduce the chance of re-blockage. ***Arteries commonly become blocked again about 7% of the time with DES, compared to 25% for BMS*** 25

26 Percutaneous Transluminal Coronary Rotablator Angioplasty (PTCRA): -A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of the narrowing in the coronary artery. -The tip spins around at a high speed and grids away the plaque on the arterial walls. 26

27 Percutaneous Transluminal Coronary Rotablator Angioplasty (PTCRA): -This process is repeated as needed to treat the blockage and improve blood flow. -The microscopic particles are washed safety away in your blood stream and filtered out by your liver and spleen. 27

28 Cutting Balloon Catheter: -Has a balloon tip with small blades. -When the balloon is inflated, the blades are activated. -The small blades score the plaque, then the balloon compresses the fatty matter into the arterial wall. -It may be used to treat the buildup of plaque with a previously placed stent (restenosis) or other types of blockage. 28

29 What are the possible risks of the procedures? The doctor will discuss the specific risks and potential benefits of the recommended procedure. 1.Irregular heart rhythm / severe bradycardia (vagal nerve stimulation) 2.Bleeding at the catheter insertion site / Hematoma 3.Continued chest pain or angina 4.Mild to moderate skin reactions from X-ray exposure (like Sun burn) 5. Kidney failure (Contrast Media Induce Nephropathy:CIN) 29

30 What are the possible risks of the procedures? 6. Stroke 7. Death 8. Emergency CABG 9.Infection 10.Perforation of a blood vessel 11.Air embolism 12.Blood clots (can occur in the venous and arteries vascular system) 30

31 What are the possible risks of the procedures? 13.Heart Attack (happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain. 31

32 How long do the procedure take to perform? The test may last minutes. If you also need special procedures, the test may take longer. (If you have a blockage, you may have angioplasty and a stent placed during the procedure.) 32

33 How long do the procedure take to perform? Does an Interventional procedure cure CAD? For most people, Interventional procedure increase blood flow to the heart, diminish chest pain and decrease risk of a heart attack. The patient will still need to reduce your risk factors & make certain lifestyle changes to prevent future disease development or progression. 33

34 To achieve the best results: 1.Change Lifestyle 2.Take your medications as prescribed 3.Make dietary changes 4.Quit smoking 5.Exercise regularly 6.Keep your follow-up appointments 34

35 Preparing for the procedure 1.The doctor will explain the risks and benefits associated with the procedure.****** 2.Consent form 3.Medication 3.1 Anticoagulant (Coumadin, warfarin) 3.2 Aspirin 3.3 Diabetes 4.Complete Electrocardiogram (ECG), Chest X-ray and Blood Examination. 35

36 Preparing for the procedure 5. Infuse Intravenous (IV) fluids as ordered to prevent dehydration. 6. The patient may be instructed to fast for 6-8 hours before the test 7. Take routine medicine to your doctor. The doctor will tell you which medicines to stop before you test and which medicines you can take safety. 36

37 Preparing for the procedure 8. Tell the doctor if you: 8.1 Are allergic to iodine dye used in the CM. 8.2 Are allergic to any medicines. 8.3 Have any bleeding problem. 8.4 Are allergic to seafood 8.5 Might be pregnant 37

38 Preparing for the procedure 9. If the patients have a history of kidney problems, blood tests (Creatinine, Blood Urea Nitrogen) may be done before and after the test to confirm that your kidneys are functioning properly. Because of CM can cause kidney damage in people who have poor kidney function. 7. Have the patient void. 38

39 During procedure (The patient will be awake and able to follow instructions during the test) 1. The nurse will clean skin (and possibly shave) the site when the catheter will be inserted (arm or groin). 2. The doctor will use a local anesthetic to numb the catheter insertion site. (Femoral, Brachial or Radial approach) 3. The patient will be given a mild sedative to help relax. 39

40 During procedure 4. When the CM is injected into the heart. The patient may feel hot or flushed for several seconds. (normal) 5. Instruction the patient tell if feel itching or tightness in the throat, nausea, chest discomfort, or any other symptoms. 40

41 After procedure (Move the patient to Recovery Room) 1. The introducer sheath will be removed and the incision will be closed with stiches, a collagen seal, or applied pressure. <A collagen seal is a protein material that works with your body s natural healing processes to form a clot in the artery.>***** 2. The patient will need to lay flat and keep the leg straight for two to six hours to prevent bleeding. Your head can be raised about 30 degrees. 41

42 After procedure 4. The nurse will check Vital sign (HR, RR, BP, O2sat & Assessment pain score) every 15 minutes X 4 times, every 30 minutes X 2 times then every hour until stable. 5. The nurse will check your bandage regularly. Please tell her if you think you are bleeding (have a wet, warm sensation) or if your toes begin to tingle or feel numb. 42

43 After procedure 6. The patient will need assistance getting out of bed. 7. The patient will need to drink plenty of liquids to clear the CM from body. 43

44 The Nurse s Role in the Cardiac Cath. Lab 1.Pre-procedural assessment of vitals along with post-care evaluation. 1.1Monitor VS, EKG, Pulse oximetry 1.2Access and mark pulses on the extremity that will be used. (such as the DorsalisPedis and Posterior Tibial Pulses) 44

45 The Nurse s Role in the Cardiac Cath. Lab 2.Pre-procedural paperwork 2.1Post-procedural care 2.2 Instruct the patient to follow up & recommendation. 45

46 Reference -Brindis, R.G., & Dehmer, G.J.(2006). Continuous quality improvement in the cardiac cathteterization laboratory. Circulation, 113, center.com 46

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