Cardiac Catheterization Nursing Diagnosis and Nursing Care Plan

Cardiac Catheterization Nursing Care Plans Diagnosis and Interventions

Cardiac Catheterization NCLEX Review and Nursing Care Plans

Cardiac catheterization is a medical intervention frequently used to determine the existence of cardiovascular disorders such as coronary artery disease, congenital heart disease, and valvular heart disease.

A short, flexible tube is inserted into a blood vessel in the arm, neck, or leg during the procedure. Once the catheter is in place, additional tests such as coronary angiography, angioplasty, and stent insertion may be performed.

Types of Cardiac Catheterization

  • Right-heart catheterization. Useful for assessing pulmonic valve function, right atrial & ventricular pressure, pulmonary artery pressure, and intracardiac shunts.
  • Left-heart catheterization. Allows measurement and assessment of aortic and mitral valve function, aortic blood pressure, and systemic vascular resistance. 

Indications of Cardiac Catheterization

  • Evaluation. This procedure evaluates chamber pressure, valvular insufficiencies, and myocardial function. Additionally, it is a useful diagnostic tool for assessing the viability of cardiac transplantation, determination of cardiac output, oxygen saturation levels, and pressure. Diagnostic catheterization is indicated for patients with:
    • Congenital heart defects
    • Heart valve disease
    • Microvascular heart disease
  • Visualization. It allows for visual inspection of coronary arteries to rule out myocarditis or graft rejection.
  • Differentiation. This procedure allows the differentiation of cardiac arrest from restrictive cardiomyopathy. It is also viable for determining various causes or unclear etiologies of shock and pulmonary edema.
  • Monitoring. CC provides information on hemodynamic instability, multiorgan system failure, complicated acute myocardial infarction, and monitors response to treatment. 
  • Screening. Besides cardiovascular diseases, it can aid with the diagnosis of respiratory disease and atypical chest pain. 
  • Biopsy. Cardiomyopathy can be diagnosed through the evaluation of biopsy material for molecular anomalies.
  • Therapeutic. This procedure may assist with the treatment of atherosclerosis via mechanical interventions.

Risks of Cardiac Catheterization

  • Bruising or bleeding at the site of the catheter insertion
  • Pain at the insertion site
  • Formation of a blood clot at the site of the catheter

Complications of Cardiac Catheterization

  • Clogged coronary arteries
  • Stroke
  • Ischemia
  • Cardiac arrest

Pre-Procedure Nursing Care: Preparing the Patient for Cardiac Catheterization

Before having a cardiac cath procedure, the patient should be prepared by the attending physician or healthcare provider. 

  • Obtain informed consent and provide information about the procedure, its risks, complications, and outcomes
  • Nothing by mouth (NPO) for at least six hours since having food or drinks in the stomach can increase the likelihood of developing complications from anesthesia. Provide a modest amount of water with each dose of medication the patient takes. Diabetic patients must be provided the correct information and instructions on taking their prescriptions and insulin. The dyes used in operation may exacerbate the side effects of certain diabetic drugs. Additionally, the patient may be asked to empty his or her bladder first.
  • After the procedure, the patient can resume normal eating and drinking, but only in moderate amounts. Ascertain what medications or supplements the patient is taking and inform the handling physician about it.

What Happens During a Cardiac Catheterization

  • Remove excess clothing and jewelry (e.g., scarf, necklaces) that may obscure cardiac imaging. Dentures and hearing aids are permitted.
  • Before the procedure, the patient should empty their bladder and put on a hospital gown. Shaving is sometimes necessary.
  • Before the procedure, an IV line will be inserted in the patient’s hand or arm to administer medication and fluids as necessary. Patients may be given anxiety and pain medication via intravenous administration during the surgery.
  • Tests are carried out in a darkened and cool environment. Patients are instructed to lie on their backs on the X-ray table. They will then be connected to devices that track their heart rate, blood pressure, and oxygen saturation. Additionally, the patient will be linked to an electrocardiogram (ECG) monitor, which will record the heart’s electrical activity. Electrode patches are applied to the patient’s chest to monitor his or her heartbeat before and following the procedure. 
  • If the neck vein is used during CC, the patient’s head must be shifted away from the insertion site. This measure is done to aid the physician in locating the most appropriate location for the catheter insertion. Usually, sterile cloths will be draped over the chest and neck. Placing sterilized towels on the groin area is an alternative if the vein in the groin is used.
  • CC doesn’t typically necessitate sedation. The patient is prompted to cough or inhale deeply during the procedure. Inform him/her to report any unexpected symptoms immediately.
  • A local anesthetic will be used to numb the skin around the insertion site. A very fine needle will be used to locate the vein, and then a thin tube will be inserted. Following anesthesia, the patient may experience a burning or stinging sensation and some pressure during the insertion.
  • As soon as the local anesthetic sets in, the physician will put a sheath into the vein. The catheter is threaded into the blood vessel and progresses into the aorta. The doctor may reposition the patient or instruct them to hold their breath, cough, or tilt their head in a specific direction to get a clear vision.
  • There may be some discomfort and noises heard after the biopsy catheter has been inserted for cardiac tissue biopsy. However, there should be no pain. If the arm is used for venous access, a small incision in the arm may be made to expose the blood vessel. When removing the tissue sample, patients may experience a pulling sensation. During a right heart cath procedure, a second catheter will be inserted into the patient’s right ventricle, right atrium, and pulmonary artery. Certain drugs may be delivered intravenously (IV) to monitor the heart’s response.
  • After inserting the catheter, the doctor will administer contrast dye to enable visualization of the heart and coronary arteries. When the contrast dye is injected into the catheter, the patient may experience some sensations (e.g., flushing, warmth, salty or metallic taste in the mouth, and headache). Still, these effects typically persist for only a few moments.
  • The healthcare provider will take a series of X-ray images of the heart and coronary arteries after the infusion of contrast dye. A few seconds of deep breathing might be requested of the patient at this period. 
  • The physician will then withdraw the catheter and stitch up the incision. Sealing the artery with collagen, stitching it together with sutures, or attaching a clip will help prevent bleeding. Moreover, bleeding can be managed by applying direct pressure or a closure device. A sterile dressing will cover the wound if a vascular closure device is used. In case of bleeding, the physician (or an aide) will apply pressure to the area to induce clotting. After bleeding has subsided, pressure dressings are applied. 
  • Patients undergo ongoing assessment and monitoring for cardiac tissue biopsy in the post-catheterization recovery area. They are transferred when a medical staff assists them off the table and onto a stretcher.

Post-Procedure Nursing Care for Cardiac Catheterization

  • Following cardiac catheterization, the patient is sent to a recovery room or returned to their hospital or outpatient room. The patient’s condition will dictate the length of their stay. Moreover, they will not be able to bend their leg for a period if the catheter is inserted in the groin. If the insertion site is in the arm, they’ll be given an armguard or cushion to keep it straight and elevated. Another option is to use a plastic band to secure the area and prevent bleeding. 
  • Bed rest is recommended, as is routine monitoring of vital signs and the insertion site to avoid any major bleeding and allow the artery to recover. Bedrest may last between four and twelve hours. If a closure device is implanted, bed rest may be reduced. Additionally, the nurse will inquire about any sensory changes in the affected limb or arm. The sheath or introducer may be left at the insertion site. If this is the case, maintain bed rest until the physician removes the sheath.
  • After removing the sheath, it is recommended to consume light meals. The head of the bed should be angled no more than thirty degrees. If the patient experiences pain, chest tightness, feelings of warmth, bleeding, or pain at the insertion site, they should contact their healthcare professional immediately.
  • The use of a urinary pan may be indicated to avoid flexion of the afflicted arm or leg. The increased urinary urge is frequently associated with contrast dye and increased fluid volume (from IV infusion).
  • The patient may begin ambulating after a period of resting. Typically, he or she will require assistance from a healthcare professional due to dizziness caused by prolonged bed rest. Slowly rise from the bed and move around. Additionally, the nurse may periodically check the patient’s blood pressure when lying in bed, standing, or sitting.
  • Pain medications may also be administered to ease discomfort or pain at the insertion site or during prolonged bed rest.
  • It is recommended to consume plenty of water and other fluids to assist the body in flushing off the contrast dye.
  • Returning to a normal diet is possible following the procedure unless the physician has contraindicated it.
  • Hospital discharge may be scheduled following the recovery period unless the physician indicates otherwise. In most situations, the patient will spend the night in the hospital and will be observed.
  • It is recommended that the patient be driven home by their guardian, particularly if it is an outpatient cardiac cath. 

Home Care

  • Continuously monitor the site for signs of bleeding, unusual skin discoloration, swelling, tenderness, and temperature change. Although a minor bruise is suspected, any bleeding that cannot be managed should immediately be reported to the physician. 
  • Maintain cleanliness in the insertion site to avoid the risk of infection
  • Avoid strenuous activities for at least two days.
  • Include information on properly caring for the incision site if a closure device was used.

Nursing Diagnosis for Cardiac Catheterization

Cardiac Catheterization Nursing Care Plan 1

Risk for Injury

Nursing Diagnosis: Risk for Injury related to trauma from percutaneous intervention, secondary to cardiac catheterization. 

Desired Outcome: The patient will maintain normal heart rate and blood pressure with absent bleeding.

Cardiac Catheterization Nursing InterventionsRationale
Routinely monitor the patient’s blood pressure, temperature, and vital signs. Although blood pressure is not a vital sign, it is frequently monitored in conjunction since hypotension can result in fatigue and increase the risk of injury/falls. On the other hand, an unusually high or low body temperature should be monitored and controlled until normothermia is attained.
Review laboratory studies from pre-catheterization assessment.This measure will provide data to compare with post-catheterization assessment. Prothrombin time (PT), ECG, and a chest X-ray are all part of the initial evaluation that every cardiac cath patient receives as part of the standard of care.
Cover the catheterization site with a pressure dressing and monitor for pain, hematoma, and bleeding. If mild bleeding occurs, maintain steady pressure 1 inch above the puncture site and contact the physician immediately.Cardiovascular cath and PCI have a higher risk of vascular bleeding since the femoral artery is typically used to get vascular access. The management of bleeding demands the application of direct, constant pressure on the afflicted area.
Maintain bed rest for at least 6 hours following catheterization and limit movement as much as possible.Postoperative bed rest can help prevent various complications such as bleeding and hematoma formation, but it can also cause discomfort in the back.
Raise the head of the bed (HOB) to 45 degrees. Raising the head of the bed is a nonpharmacologic intervention that lessens supine hypertension.
Suggest calming activities such as listening to music and storytelling. Avoid strenuous exercises and activities.Distracts from one’s discomfort while providing an outlet for communication and interaction.
For pediatric patients: 
Encourage parents to safely hold their infant or young children and mobilize them out of bed.This measure helps reduce the child’s agitation and promotes more peaceful sleep.  
Instruct parents to observe and notify any sign of bleeding immediately.Promotes closer monitoring

Cardiac Catheterization Nursing Care Plan 2

Risk for Bleeding

Nursing Diagnosis: Risk for Bleeding related to potential hemorrhage from the catheter insertion, secondary to cardiac catheterization.

Desired Outcome: The patient will remain free from any symptoms of bleeding.

Cardiac Catheterization Nursing InterventionsRationale
Monitor the patient’s vital signs every 15 minutes for four hours. Bleeding causes hypotension and tachycardia, which are common compensating responses
Monitor laboratory studies (e.g., hematocrit, hemoglobin).Hgb and Hct levels may be an excellent indication of bleeding when hemorrhage is not notable.
Inform the patient about the risk factors and preventive measures (e.g., pressure dressing, bed rest) to control bleeding.Complications of bleeding are particularly prevalent in the elderly, women, infants, and those taking anticoagulants. By holding educational sessions during the implementation phase, patients can better understand the risk factors contributing to vascular bleeding and its complications.
Monitor the patient’s skin for any signs of bleeding such as bruising, hematoma, and petechiae.Repeated attempts of arterial puncture can result in a hematoma. Local hematomas must be identified and treated promptly to avoid serious complications such as compartment syndrome (which can lead to tissue necrosis). A petechial rash may also arise as a result of compromised collagen integrity. If bleeding from the incision site occurs for an extended period, it may potentiate coagulation issues. 
Support the patient emotionally and psychologically.This assists in reassuring and relaxing the patient.
Avoid flexion of the hip or elbow more than 30 degrees. These limitations reduce the likelihood of bleeding and disruption of vascular circulation.
Educate the patient and family members of any bleeding symptoms that should be reported to a medical professional.The likelihood of developing complications from blood loss can be reduced if bleeding is diagnosed and treated early by a healthcare professional.

Cardiac Catheterization Nursing Care Plan 3

Hyperthermia

Nursing Diagnosis: Hyperthermia related to sensitivity to the radiopaque contrast dye, secondary to cardiac catheterization, as evidenced by weakness, warmth extremities, and postoperative increase in body temperature.

Desired Outcome: The patient will attain normothermia as evidenced by a normal temperature of 36°-38°C.

Cardiac Catheterization Nursing InterventionsRationale
Monitor the patient’s vital signs (e.g., body temperature, BP) every 15 minutes for 4 hours.This measure will indicate whether the body is exhibiting signs of hyperthermia. Vital signs are indicators of the body’s most fundamental functions. Although blood pressure is not a vital sign, it is frequently monitored in conjunction. On the other hand, an unusually high or low body temperature should be monitored and controlled until normothermia is attained.
Record and monitor the patient’s intake and output ratio. If the output is insufficient, restrict fluids. Provide intravenous hydration (post-catheterization) for patients unable to drink or eat, including pediatric patients. Fluid overload (hypervolemia) and increased intraventricular pressure result in coronary hypoperfusion and ischemia, impairing heart function and increasing cellular injury. Moreover, this measure aids in diluting radiographic contrast material in the blood and tubular filtrate.
Educate parents on the importance of maintaining a sufficient fluid intake.Involving the patient’s parents increases the likelihood of success.
Instruct parents to monitor their child’s temperature at home and to report any significant temperature changes upon discharge.Helps monitor hyperthermia  

Cardiac Catheterization Nursing Care Plan 4

Ineffective Tissue Perfusion

Nursing Diagnosis: Ineffective Tissue Perfusion related to the formation of a clot at the puncture site, secondary to cardiac catheterization, as evidenced by weak or absent pulses, pain, and changes in sensation

Desired Outcome: The patient will exhibit an improved response to the external sensation, as shown by increased pulses and the absence of pain.

Cardiac Catheterization Nursing InterventionsRationale
Assess the quality of peripheral pulses, the color of skin, capillary refill, sensation, and range of motion of the affected extremity.This measure indicates the presence of decreased peripheral perfusion. This examination identifies clot formation at the puncture site and the potential hazard of hypoxemia to the extremities. Moreover, early recognition of blood clots allows for more prompt intervention and reduces the likelihood of cellular death or damage.
Encourage adequate fluid consumption post-catheterization. Provide intravenous hydration for patients unable to drink or eat (including pediatric patients).Dehydration can result from osmotic diuresis brought by the radiographic contrast dye. Moreover, it aids in diluting radiographic contrast material in the blood and tubular filtrate. However, drinking fluids pre-catheterization is contraindicated.
Avoid strenuous activities throughout the recovery time.Lack of mobility and bed rest allow the puncture site to stabilize, preventing bleeding.
Elevate and maintain the position of the involved extremity. Instruct the patient not to avoid flexion of more than 10 degrees; anything below is acceptable. In addition to improving circulation, bed rest and avoidance of arm bending reduce the risk of injury or trauma and the formation of blood clots. 

Cardiac Catheterization Nursing Care Plan 5

Fear 

Nursing Diagnosis: Fear related to pain from the procedure, secondary to cardiac catheterization, as evidenced by apprehension, voiced worry or fear about the impending operation, verbal protests, and withdrawal. 

Desired Outcome: The patient will express a decrease in fear or worry regarding the operation.

Cardiac Catheterization Nursing InterventionsRationale
Assess the patient’s comprehension of the procedure and encourage him/her to communicate their concerns to their healthcare provider.This examination documents the patient’s fears and concerns that may worsen distress, anxiety, and fear. The nurse can avoid any misconceptions resulting in patient outbursts and rage by promoting open communication. Moreover, this intervention allows the nurse to anticipate and meet the patient’s needs. Separation from the parent, fear of death, mutilation, trauma, and suffering contribute to pediatric patients’ fear.
For pediatric patients:
Provide the parents with information about the child’s sensory experiences. Ascertain that the material provided is age-appropriate and simple to comprehend.Children use all of their senses to take in information; therefore, how they interpret the procedure and diagnosis should be considered. Moreover, they need to know what to expect to cope well. Giving the patient age-appropriate information promotes comprehension and reassurance. Likewise, parents can benefit from the information, and their involvement creates a support system for the child.
Encourage parental presence during and after surgery.Children respond effectively to their parents’ presence during stressful situations.
Explain the rationale behind the steps taken before and after the catheterization.The process is better understood and accepted if the patient understands why it was administered.
Advise parents that their child may act differently at home for a period of time (e.g., stirring in sleep, clinginess, less self-sufficiency). Encourage parents to stay with the child and provide them comfort and support emotionally and psychologically.A child can experience a temporary regression in development due to anxiety-inducing conditions in their lives (e.g., past trauma, chronic conditions). Assisting children in need enables them to cope with setbacks.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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