Cardiac Catheterization

Question 1

Assessment Before the Procedure

Answer 1

1. Establish a baseline (vital signs, fever, s/sx of infection)
2. Obtain child’s height and weight
3. Assess for any allergies (especially iodine and shellfish; some contrast contains iodine)
4. Review medication
   > if on anticoagulants, hold for several days to reduce risk of bleeding
5. Check labs (hemoglobin, hematocrit)
6. Perform complete physical examination
   > focus closely on peripheral pulses
   > use pen to mark location of child’s pedal pulses to easily assess after procedure

Question 2

Educating the Child and Family Before the Procedure

Answer 2

1. Teach all aspects to decrease anxiety
2. Procedure is typically outpatient but some may require an overnight stay for observation
3. Include:
   > information about what the procedure involves
   > how long it will take
   > any special instruction from physician
4. Introduce equipment to younger children through play therapy
5. Offer tour of catheterization lab for school-age and adolescence
6. Mention sounds and sights they may experience during the procedure
7. Teach simple relaxation measures
8. Teach child that they may feel a sensation of the heart racing when the catheter is inserted
9. Warn older children that they may experience a feeling of warmth or stinging when contrast material is injected
10. Withhold food and fluids for 4-6 hours before procedure
11. Administer meds with a sip of water
12. INFORMED CONSENT
13. Ask child to void before procedure
14. Allow parents to accompany the child to the catheterization area
15. Teach what to expect after the procedure
16. Inform parents about potential complications
    > bleeding
    > fever
    > loss of pulse in extremity
    > development of arrhythmias
17. Explain to child that a dressing will be over the catheter site and need to keep the leg straight for several hours after the procedure
18. Frequent monitoring will be required after the procedure

Question 3

Assessment after the Procedure

Answer 3

1. Monitor for complications
   > bleeding
   > arrhythmias
   > hematomas
   > thrombus formation
   > infection
2. Examine q15 mins:
   > vital signs
   > neuromuscular status of lower extremities
   > pressure dressing
3. Monitor cardiac rhythm and O2 sats via pulse ox
4. Assess distal pulses bilaterally (pulse of affected extremity may be slightly less than the other extremity but should gradually return to baseline)
5. Assess color and temperature of extremity
6. Check capillary refill and sensation to evaluate blood flow to the area

Question 4

Nursing Interventions Following Cardiac Catheterization

Answer 4

1. Maintain bedrest
2. Child maintain extremity in straight position for 4-8 hours
3. Inspect dressing frequently
4. Monitor intake and output
5. Assess for dehydration due to contrast having diuretic effect
6. Begin with sip of clear liquids and progress to their pre procedure diet
7. Continue IV fluid and encourage oral intake to promote elimination of the contrast material
8. Allow child to talk about the experience and how they felt

Question 5

Providing Care After a Cardiac Catheterization

Answer 5

1. Change the pressure dressing on the day after the procedure; keep dressing dry and covered
2. When changing the dressing, inspect the insertion site for redness, irritation, swelling, drainage and bleeding. Report any of these to physician
3. Check temp, color sensation, and pulses on the child extremities and compare
4. Resume child’s diet after the procedure; report N/V
5. Check temperature at least once a day for approximately 3 days; Report temp of 100.4 or greater
6. Avoid giving child a tub bath; use sponge baths or showers instead
7. Discourage strenuous exercise or activity
8. Watch for changes in child’s appearance
   > skin color
   > reports of the heart flutter or skipping a beat
   > fever
   > difficulty breathing
9. Give acetaminophen or ibuprofen for pain
10. Schedule follow-up appointment with physician