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Left Heart Catheterization

Left heart catheterization is performed to evaluate the
 Cardiac catheterization is an invasive diagnostic patency of the coronary arteries and the function of the
procedure in which radiopaque arterial and left ventricle and the mitral and aortic valves
venous catheters are introduced into selected
blood vessels of the right and left sides of the Nursing Interventions
heart. Nursing responsibilities before cardiac catheterization
 Catheter advancement is guided by fluoroscopy. include the following:
PURPOSES • The patient is instructed to fast (NPO), usually for 8 to
 Cardiac catheterization is most frequently used 12 hours, before the procedure. If catheterization is to
to diagnose CAD. be performed as an outpatient procedure, a friend,
 Assess coronary artery patency. family member, or other responsible person must
 Determine the extent of atherosclerosis. transport the patient home.
 Determine revascularization. • The patient is informed of the procedure and advised
 Procedures, including PCI or coronary artery that it will involve lying on a hard table for less than 2
bypass surgery. hours.
 Diagnose pulmonary arterial hypertension • The patient is reassured that IV medications are given
 Treat stenotic heart valves via percutaneous to maintain comfort.
balloon valvuloplasty. • The patient is informed about sensations that will be
experienced during the catheterization. Knowing what
Angiography to expect can help the patient cope with the
Cardiac catheterization is usually performed with experience. The nurse explains that an occasional
angiography, a technique in which a contrast agent is pounding sensation (palpitation) may be felt in the
injected into the vascular system to outline the heart chest.
and blood vessels. • The patient is encouraged to express fears and
anxieties. The nurse provides teaching and reassurance
Aortography to reduce apprehension.
An aortogram is a form of angiography that outlines the • The nurse will make sure to secure a written consent.
lumen of the aorta and the major arteries arising from it • The patient is advised to remove any metals or
jewellery before the procedure.
Coronary Arteriography
Coronary arteriography involves the introduction of a Nursing responsibilities after cardiac catheterization
catheter into the right or left brachial or femoral artery, may include the following:
which is then passed into the ascending aorta and • The catheter access site is observed for bleeding or
manipulated into the right and left coronary arteries. hematoma formation.
• Peripheral pulses are assessed in the affected
Angiographic extremity every 15 minutes for 1 hour, and then every
Techniques are used to evaluate the degree of 1 to 2 hours until the pulses are stable.
atherosclerosis and to determine treatment. They are • Temperature, color, and capillary refill of the affected
also used to study suspected congenital anomalies of extremity are frequently evaluated, per local nursing
the coronary arteries. standards.
• The patient is assessed for affected extremity pain,
Right Heart Catheterization numbness, or tingling sensations that may indicate
Right heart catheterization usually precedes left heart arterial insufficiency. Any changes are reported
catheterization. It involves the passage of a catheter promptly.
from an antecubital or femoral vein into the right • Dysrhythmias are carefully screened by observing the
atrium, right ventricle, pulmonary artery, and cardiac monitor or by assessing the apical and
pulmonary arterioles. peripheral pulses for changes in rate and rhythm.

• Bed rest is maintained for 2 to 6 hours after the
procedure. If manual or mechanical pressure is used,
the patient must remain on bed rest for up to 6 hours
with the affected leg straight and the head of the bed
elevated no greater than 30 degrees. For comfort, the
patient may be turned from side to side with the
affected extremity straight. If the cardiologist deployed
a percutaneous vascular closure device or patch,
• The nurse checks local nursing care standards and
anticipates that the patient will have fewer activity
restrictions. The patient may be permitted to ambulate
within 2 hours. Analgesic medication is administered as
prescribed for discomfort.
• The patient is instructed to report chest pain and
bleeding or sudden discomfort from the catheter
insertion sites promptly.