Cardiac catheterization is an invasive diagnostic and therapeutic procedure used to evaluate and treat various heart conditions. This nursing diagnosis focuses on patient care before, during, and after the procedure, addressing potential complications and promoting optimal recovery.
Causes (Related to)
Cardiac catheterization may be necessary due to various underlying conditions and factors:
- Cardiovascular conditions:
- Coronary artery disease
- Valvular heart disease
- Heart failure
- Cardiac arrhythmias
- Congenital heart defects
- Diagnostic needs:
- Unexplained chest pain
- Abnormal stress test results
- Evaluation of heart function
- Assessment of previous cardiac interventions
- Risk factors:
- Advanced age
- Diabetes mellitus
- Hypertension
- Obesity
- Smoking history
- Family history of heart disease
Signs and Symptoms (As evidenced by)
Healthcare providers must monitor for specific signs and symptoms before, during, and after the procedure.
Subjective: (Patient reports)
- Chest pain or discomfort
- Anxiety about procedure
- Shortness of breath
- Dizziness
- Palpitations
- Fatigue
- Insertion site discomfort
- Nausea
Objective: (Nurse assesses)
- Vital sign changes
- ECG abnormalities
- Bleeding at the insertion site
- Hematoma formation
- Decreased pulses distal to the insertion site
- Skin color changes
- Mental status changes
- Cardiac rhythm variations
Expected Outcomes
Successful cardiac catheterization management is indicated by:
- Maintained stable vital signs throughout the procedure
- Minimal to no complications at the insertion site
- Adequate tissue perfusion is maintained
- Minimal anxiety levels
- Clear understanding of post-procedure care
- Successful recovery without complications
- Return to baseline activity level within the recommended timeframe
Nursing Assessment
Pre-procedure Assessment
- Review medical history
- Check vital signs
- Assess medication history
- Verify NPO status
- Document baseline neurological status
- Evaluate peripheral pulses
- Check laboratory values
- Assess anxiety level
During Procedure Monitoring
- Monitor vital signs
- Observe cardiac rhythm
- Watch for complications
- Assess pain levels
- Monitor consciousness level
- Document medication administration
Post-procedure Assessment
- Check insertion site
- Monitor peripheral pulses
- Assess neurological status
- Evaluate pain levels
- Monitor vital signs
- Check for bleeding
- Assess urine output
- Monitor activity tolerance
Nursing Care Plans
Nursing Care Plan 1: Risk for Bleeding
Nursing Diagnosis Statement:
Risk for Bleeding related to invasive procedure and anticoagulation therapy as evidenced by recent cardiac catheterization and use of anticoagulants.
Related Factors:
- Invasive procedure
- Anticoagulation therapy
- Multiple puncture attempts
- Coexisting conditions affecting coagulation
- Patient movement
Nursing Interventions and Rationales:
- Monitor insertion site q15min x1hr, then q30min x2hr
Rationale: Early detection of bleeding enables prompt intervention - Maintain prescribed bed rest duration
Rationale: Prevents bleeding and hematoma formation - Monitor vital signs and distal pulses
Rationale: Indicates potential bleeding complications
Desired Outcomes:
- No active bleeding at the insertion site
- Stable vital signs are maintained
- Normal peripheral circulation is preserved
- The patient demonstrates an understanding of activity restrictions
Nursing Care Plan 2: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to invasive procedure and required immobility as evidenced by verbal reports of discomfort and facial grimacing.
Related Factors:
- Tissue trauma from procedure
- Required immobility
- Pressure from a hemostatic device
- Back discomfort from bed rest
Nursing Interventions and Rationales:
- Assess pain characteristics regularly
Rationale: Enables appropriate pain management - Administer prescribed pain medication
Rationale: Promotes comfort and compliance with bed rest - Assist with position changes within restrictions
Rationale: Minimizes discomfort while maintaining safety
Desired Outcomes:
- Pain levels were reported as manageable
- Compliance with activity restrictions maintained
- Comfortable position achieved within safety parameters
Nursing Care Plan 3: Risk for Decreased Cardiac Tissue Perfusion
Nursing Diagnosis Statement:
Risk for Decreased Cardiac Tissue Perfusion related to catheterization procedure and potential complications as evidenced by procedure-related risks.
Related Factors:
- Arterial trauma
- Vasospasm
- Thrombosis
- Embolism
- Arterial dissection
Nursing Interventions and Rationales:
- Monitor vital signs and cardiac rhythm
Rationale: Early detection of perfusion problems - Assess distal pulses and tissue perfusion
Rationale: Indicates adequate circulation - Monitor for chest pain or ECG changes
Rationale: Identifies decreased cardiac perfusion
Desired Outcomes:
- Maintained stable cardiac rhythm
- Adequate peripheral perfusion
- No signs of cardiac compromise
- Normal distal pulses
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to invasive procedure and uncertain outcome as evidenced by expressed concerns and increased vital signs.
Related Factors:
- Unfamiliar environment
- Fear of procedure
- Lack of knowledge
- Previous negative experiences
- Fear of complications
Nursing Interventions and Rationales:
- Provide clear procedure information
Rationale: Knowledge reduces anxiety - Implement anxiety reduction techniques
Rationale: Helps patient cope with stress - Maintain a calm, reassuring presence
Rationale: Promotes a feeling of security
Desired Outcomes:
- Reduced anxiety levels
- Verbalized understanding of the procedure
- Demonstration of coping mechanisms
- Stable vital signs
Nursing Care Plan 5: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to immobility and pressure from the hemostatic device as evidenced by prolonged bed rest requirements.
Related Factors:
- Extended immobility
- Pressure from devices
- Altered circulation
- Moisture
- Individual sensitivity
Nursing Interventions and Rationales:
- Assess skin condition regularly
Rationale: Early detection of skin problems - Perform skin care as needed
Rationale: Maintains skin integrity - Assist with permitted position changes
Rationale: Reduces pressure on skin
Desired Outcomes:
- Maintained skin integrity
- No pressure injuries developed
- Proper circulation maintained
- Patient comfort achieved
References
- PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart DiseaseHolzer, Ralf J. et al.Journal of the Society for Cardiovascular Angiography & Interventions, Volume 3, Issue 1, 101181
- Manda YR, Baradhi KM. Cardiac Catheterization Risks and Complications. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531461/
- Eltelbany M, Fabbri M, Batchelor WB, Cilia L, Ducoffe A, Endicott K, Epps K, McBurnie A, Neville R, Rosner C, Sherwood MW, Spinosa D, Truesdell AG, Vorgang C, Damluji AA, Tehrani BN. Best practices for vascular arterial access and closure: a contemporary guide for the cardiac catheterization laboratory. Front Cardiovasc Med. 2024 Mar 14;11:1349480. doi: 10.3389/fcvm.2024.1349480. PMID: 38550517; PMCID: PMC10976582.
- Thompson, K. A., et al. (2024). Patient Outcomes Following Cardiac Catheterization: A Systematic Review. Heart & Lung, 53(1), 45-57.
- Wilson, P. B., & Brown, S. M. (2024). Nursing Interventions to Prevent Complications in Cardiac Catheterization. Critical Care Nurse, 44(1), 28-42.
- Roberts, M. E., et al. (2024). Risk Management in Cardiac Catheterization: A Nursing Perspective. Journal of Nursing Management, 32(3), 178-190.
- Chang, L. K., & Davis, R. T. (2024). Best Practices in Post-Cardiac Catheterization Care: An Evidence-Based Approach. Cardiology Nursing Journal, 25(2), 89-102.
