DIVISION OF SPECIALISED SERVICES - CARDIAC SERVICES

STANDARD OPERATING PROCEDURE

TITLE:
CHEST PAIN MANAGEMENT
Code:

CL8

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INDICATIONS FOR PRACTICE

Patients admitted to the cardiology catheter labs may experience chest pain due to
myocardial ischaemia pre, post and during their procedure. Patients should be
appropriately assessed and treated to maximise myocardial perfusion and relieve their pain.

2.

AUTHORISED PERSONNEL/TRAINING REQUIRED

Registered Nurses
All medical staff
Allied Health Professionals (AHPs) working within the cardiology department

To ensure patients are assessed and treated immediately following University Hospitals
Bristol Acute Coronary Syndrome (ACS), and NICE guidelines.

3.

PROCEDURE
Assessment
- Assess pain for type, severity, radiation, duration and associated symptoms.
Document on observation chart and care plan.
- Palpate the patients pulse and measure blood pressure and observe for signs of
shock. Continue to monitor and document every 30 minutes until patient pain free.
- Record and document the patients respiratory rate and oxygen saturations,
(continuously monitor oxygen saturations until pain free and early warning score
(EWS) less than 2.
- Apply oxygen if oxygen saturations are less than 94%, ensure this is prescribed on
the patients drug chart.
Perform 12 lead ECG and ensure this is reviewed by the operator or cardiologist on
call. Continue to perform serial ECGs every 15 minutes until pain free. Ensure an
ECG is also recorded when patient is pain free.

Attach patient to cardiac monitor.

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DIVISION OF SPECIALISED SERVICES - CARDIAC SERVICES

STANDARD OPERATING PROCEDURE
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Administer analgesia such as GTN spray and consider the need for opiates, Intra
Venous (IV) nitrates and anti emetics, these should be prescribed on the patients
drug chart, and be given as per IV guidelines

Gain IV Access preferably in the left arm allowing the right radial artery to be used for
cardiac intervention.

Inform the co-ordinator at the earliest opportunity on extension 22649.

Patients with chest pain in daycase should be moved to the recovery area.

Patients undergoing cardiac intervention should be prepared as swiftly and safely as

possible. The emergency checklist should be completed by the circulating nurse,
and the patient placed in a hospital gown.

Patients with acute chest pain, arrhythmias or with a EWS greater than 2 should
have external defibrillator pads applied by the cardiac physiologist prior to their
procedure.

Patients having cardiac intervention should have a long line attached to their venflon
to allow pain relief and emergency drugs to be given during their procedure.

Emergency patients entering the department should have a full set of bloods taken
by the end of their procedure including: U&Es, CRP, LFTS, Lipids Hb and clotting
screen.

APPROVED BY:

NAME

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DATE

CLINICAL LEAD
Effective
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4.

Review
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Obsolete
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FURTHER INFORMATION/EXCEPTIONS

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DIVISION OF SPECIALISED SERVICES - CARDIAC SERVICES

STANDARD OPERATING PROCEDURE
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See attached Acute Coronary Syndromes Protocol for further guidance.

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