Cath Lab Pre- & Post-Procedure Care – Key Vocabulary

Overview

• Focus: Pre- and Post-procedure care for cardiac catheterization (cath-lab) patients.

• Emphasis on adhering to national standards so every lab delivers uniform, high-quality, safe care.

• Many items sound like “common sense,” yet each is tied to published standards/accreditation metrics.

Pre-Procedure Responsibilities

1. Environment & Equipment Readiness (Start-of-Shift)

• Before the first patient (after coffee!):

  • Verify emergency equipment: code carts, defibrillator, Ambu-bag, intra-aortic balloon pump, contrast injectors, X-ray system.

  • Perform daily QC/I-STAT or other analyzers’ quality controls.

  • Rationale: Any cath can devolve into an emergency; unchecked gear = unsafe care.

2. Patient Pick-Up Checklist (Holding, Floor, or ED)

• Use two identifiers (name and DOB; confirm spelling).

• Confirm informed consent present and correctly worded (see next heading).

• Verify IV access:

  • Patent line, fluids available, no infiltration.

  • Hard to start a new IV “in the dark under the drape” when a crisis hits.

• Ask & document:

  • NPO status – “When did you last eat or drink?”

  • Procedure understanding – “Do you know what we’re doing today?”

  • Outstanding questions – address or page MD.

Informed Consent Essentials

• Staff may physically “take in the form,” but MD is legally responsible for obtaining consent.

• Must include BOTH potential benefits and risks/complications.

• Consent wording must match intended procedure exactly:

  • Example: “Right- and Left-Heart Cath with Possible Angioplasty” ≠ license for renal or peripheral work.

• If patient uncertainty persists: delay, clarify, or re-page MD before cath.

Sterile Technique Principles (Quick Reminders)

• Open sterile packages away from your body first.

• Drape closest side of patient first; prevents leaning over un-draped field.

• Palpate access pulse (radial or femoral) before prepping; drapes arranged around landmark.

Vascular Access Anatomy & Landmarks

A. Femoral (Groin) Anatomy – “NAVeL” Mnemonic (lateral → medial)

• Nerve | Artery | Vein | Ligament (inguinal ligament) near navel.

• Clinical pearl:

  • Right-groin stick causing leg pain → needle likely on nerve; move medially to reach artery.

B. Optimal Femoral Puncture Zone

• Above arterial bifurcation (superficial femoral & profunda) but below \text{inguinal ligament}.

• Medial to femoral head (fluoro landmark).

• Avoid “too low” (pseudoaneurysm risk) and “too high” (retroperitoneal bleed risk).

C. Radial / Brachial Considerations

• Absolute contraindication for radial approach: occluded ulnar artery (insufficient collateral).

• Anatomy recap: radial feeds thumb–middle finger; ulnar feeds ring–pinky.

• Allen’s Test (subjective)

  1. Occlude radial & ulnar arteries.

  2. Have patient clench/unclench until hand blanches.

  3. Release ulnar pressure → entire hand must reperfuse promptly.

• Barbeau (Modified Allen’s, objective)

  • Pulse-ox probe on thumb. Occlude both vessels → waveform & SpO₂ disappear.

  • Release ulnar; return of crisp waveform/SpO₂ \approx 98\% = adequate collateral flow.

D. Jugular Venous Access

• Right Internal Jugular: used for endomyocardial biopsies, temporary pacemakers, etc. Know surface landmarks & prep.

E. Transseptal Approach Awareness

• Venous access → transseptal puncture required for:

  • ASD/PFO closure, WATCHMAN implantation, mitral valvuloplasty, MitraClip, many AFib ablations.

• Always identify whether case is arterial or venous to prep correctly.

Hemostasis & Manual Pressure Techniques

• Femoral sites

  • Finger placement: 2\text{–}3\,\text{cm} (≈ two-three fingerbreadths) above skin puncture (matches track angle).

  • General rule: 3\,\text{min} per French size → e.g., 6\,\text{F} \times 3 = 18\,\text{min}.

• Radial sites

  • Little subcutaneous tissue → compress directly over arteriotomy.

  • TR-Band: adjust air volume delicately for patent hemostasis.

Patient Education — Post-Cath Instructions

• Head of bed ≤ 30^{\circ} once hemostasis confirmed.

• Encourage PO fluids to clear contrast.

• “If you feel anything warm or wet at the site, press firmly and call the nurse.”

• Cough/sneeze → support site with fingers.

• Use simple language; omit frightening technical jargon.

Common Post-Procedure Complications & Recognition

1. Hematoma (blood outside vessel)

• Signs: swelling/lump, expanding bruise, pain (nerve compression), possible external ooze.

• High-risk groups: anticoagulated, elderly (friable vessels), obese, large sheaths (≥ 8\,\text{F}), multiple sticks, premature ambulation, PVD, uncontrolled HTN.

2. Pseudoaneurysm (low stick)

• Blood trapped between arterial layers; may be pulsatile mass.

• Management: prolonged pressure; if persistent ⇒ thrombin injection or surgical repair.

3. Retroperitoneal Bleed (high stick/back-wall injury)

• Early: low back or flank pain.

• Progressive: ↓H&H, hypotension, tachycardia.

• Requires rapid imaging, volume resuscitation, possible intervention.

Post-Procedure Handoff & Monitoring

• Verbal report to receiving RN: highlights, meds given, sheath status, hemostasis method, complications.

• Confirm patient awake/stable; remember floor RN may have ≥5 other patients.

• Sharps off tray first when breaking down.

• Vital-sign schedule: q15\,\text{min}\times4 \rightarrow q30\,\text{min}\times2 \rightarrow q1\,\text{h} until discharge/transfer.

TIMI Flow Grading (Angioplasty Documentation)

• 0 = No antegrade flow.

• 1 = Penetration without perfusion.

• 2 = Partial (sluggish) perfusion.

• 3 = Complete, normal perfusion (goal).

• Example: STEMI LAD occlusion “pre =0 / post =3.”

Post-Sedation Recovery Scoring (Aldrete)

• Grades Activity, Respiration, Circulation, Consciousness, SpO₂.

• Patient must reach institutional threshold (e.g., ≥8/10) before transfer from high-acuity area.

Heart-Failure Functional Classification (NYHA)

• Class I: No limitation; ordinary activity ⇒ no undue fatigue/SOB.

• Class II: Slight limitation; ordinary activity ⇒ fatigue, palpitations, dyspnea.

• Class III: Marked limitation; < ordinary activity produces symptoms; comfortable at rest.

• Class IV: Symptoms at rest; unable to carry out any physical activity; may require ventilator or balloon pump.

Vascular Closure Devices

• Complication profile mirrors manual sites: hematoma, pseudoaneurysm, limb ischemia if device malfunctions.

Study Tips

• Two blue-tinted sections in textbook are tear-out/ fold-over flash-cards (Q on top, A underneath).

• Practice with review questions following this lecture to solidify recall.

End of comprehensive notes – good luck on your exam and in providing consistently safe, high-quality cath-lab care!