7.2 Pediatric Cardiovascular Diagnostic Procedures

Question 1

Electrocardiogram (EKG)

Answer 1

• Multiple leads are placed on the chest to give an idea of rhythm and conduction of the heart

Question 2

Echocardiogram (ECHO)

Answer 2

• Ultrasound of heart that gives information about structure, cardiac output and ejection fraction of the heart

Question 3

Cardiac Catheterization

Answer 3

• Catheter is inserted into the right femoral vein or artery and snaked to the right side of the heart. Information is provided through imaging

Diagnostic Abilities
- Radiopaque catheter combined with angiography (look at structures of heart)
- This can tell us o2 saturation in the heart chambers, pressure measurements in the heart, cardiac output, stroke volume, indicators of anatomic abnormalities or obstructions.
- Helpful in diagnosing of congenital heart defects

Intervention Abilities
- Can be used to place a stent, balloon angioplasties, and electrophysiological studies (treat dysrhythmias with radiofrequency ablation)

Question 4

Cardiac Catheter Risk

Answer 4

• They may undergo general anesthesia
• They may have allergic reactions to the contrast used
• Can the child excrete the contrast? Renal insufficiency
• Most common risk is risk of hemorrhage
• Vascular Injury (perforation of heart or valve damage)
• Stroke or CNS injury

Question 5

Nursing Prep for Cardiac Cath

Answer 5

• Will need to be NPO except clear liquids for 6-8 hours before procedure then completely NPO 2 hours before procedure
• Complete physical exam and allergy assessment
• Accurate height and weight especially for medication administration
• ASSESS PULSES PRIOR TO CARDIAC CATH TO GET A BASELINE
• Mark placement of peripheral pulses as well
• Baseline O2 Saturation
• Educate patient and family about the procedure and be there for informed consent.

Question 6

Post-Op Care Cardiac Cath

Answer 6

• Children need to lie flat up to 8-12 hours and keep their leg immobilized to reduce the risk of hemorrhage.
• Pulses and neuro checks are one of the most important assessment tools (make sure pulses are still present and strong)
• Check extremities for signs of infection or poor perfusion
• Check signs of hemorrhage
• Monitor I&O’s very carefully especially because contrast materials are being used

Question 7

Pressure Dressing

Answer 7

• Dressing that provides pressure to an area of the body
• Cardiac Cath is going through a major vessel so we want to prevent bleeding around the insertion site. These dressings can help prevent hemorrhage
• Usually kept on for the first 18-24 hours and then they are replaced with gauze and band-aid for discharge

Question 8

If Bleeding Occurs

Answer 8

• Provide direct continuous pressure 1 inch above the insertion site.
• HOLD FIRM PRESSURE FOR SEVERAL MINUTES TO STOP THE BLEED
• Call for help

Question 9

Discharge Education

Answer 9

• Remove dressing the next day
• Change band-aids once a day for 2 days
• Avoid a tub bath for 3 days but they can shower
• Observe for redness, swelling, drainage, bleeding
• Observe extremities for temperature or color differences
• Child may go back to school but no exercise for the 1st week

Question 10

EKG VS EHCO

Answer 10

EKG
- Shows electrical activity of the heart

ECHO
- Uses sound waves to see image of heart structures