4. Interventional Cardiology

Question 1

Cardiac Catheterization Lab Procedures

Answer 1

1. Diagnostic Cardiac Catheterization
2. Percutaneous Coronary Intervention (PCI)
   a. Intracoronary stenting: most common PCI procedure
   b. Balloon angioplasty w/out stent (PTCA): seldom used, high reocclusion rates.
3. Percutaneous balloon valvotomy
4. Pacemaker implementation
5. Electrophysiology (EP) studies
   a. Implantable cardioverter defibrillator (ICD)
   b. Cardiac ablation therapy

Question 2

Goal of PCI with Stent

Answer 2

Restoration of blood flow distal to a coronary artery lesion with partial or total occlusion

Question 3

Complications of PCI

Answer 3

-In-hospital death is rare, ~1.8%
-In-hospital MI ~ 0.4%
-Coronary artery perforation
-Distal coronary artery embolization
-Intramural hematoma
-Failure of stent deployment
-Stent Thrombosis
a) Most incidents occur acutely (w/in 24 hrs of stent placement) or subacutely (w/in first 30 days)
-Stroke of TIA: greater risk if with aortic stenosis
-Arrhythmias
-Renal Failure
-Retroperitoneal bleed

Question 4

Patient Care during Sheath Removal

Answer 4

-Record baseline peripheral pulses and vitals
-Provide comfort (i.e. morphine 2 - 4 mg IV) before removal
-Monitor BP q 5 - 10 min during sheath removal.
-Monitor for VASOVAGAL RESPONSE .
-Vasovagal management
-Achieve hemostasis.

Question 5

Patient Care during Sheath Removal: when checking for vasovagal response, look for

Answer 5

Hypotension < 90 systolic with or w/out bradycardia, absence of compensatory tachycardia and associated symptoms of pallor, nausea, yawning, diaphoresis

Question 6

Patient Care during Sheath Removal: Vasovagal management includes

Answer 6

-Holding nitrates
-Atropine 0.5 mg IV (even in absence of bradycardia if other signs occur)
-IV bolus of 250 mL 0.9 NSS if patient is not immediately responsive to atropine
-Assess for anxiety/pain as contributing factors

Question 7

Patient Care during Sheath Removal: Achieve hemostasis

Answer 7

-Manual pressure for 20 - 30 min
-Mechanical clamp compression using FemoStop or C-clamp
-Closure Device

Question 8

Manage Complications of Cardiac Catheterization Procedures

Answer 8

-Monitor for signs of coronary artery reocclusion (if PCI): chest pain, ST elevation –>Contact MD.
-Monitor for vasovagal reaction during sheath removal –>give fluids, atropine.
-Monitor for bleeding: sheath site.
1. Immediately apply manual pressure 2 fingerbreadths above the puncture site.
2. Continue manual pressure for a minimum of 20 min (30 min if still on GP IIb/IIIainhibitors) to achieve hemostasis.
-Monitor for bleeding: retroperitoneal
–>give fluids, blood products
1. Sudden hypotension
2. Severe low back pain
-Monitor for vascular complications: pulse assessments
-Monitor for hematoma at sheath insertion site: assess sheath insertion site for swelling.