The cardiac catheterization and electrophysiology (EP) laboratory is a combination of cardiac telemetry, critical care, and outpatient care. Most patients come from home to have a routine diagnostic catheterization, EP study, or cardiac ablation. Patients are also admitted from the emergency or cardiac departments for emergent percutaneous intervention (PCI) in the event of a possible heart attack. The EP lab is always available to emergently take patients to ablate cardiac arrhythmias or implant a pacemaker or an automatic implantable cardioverter defibrillator (AICD) if needed, but most cases are scheduled. Patients without significant coronary artery disease (CAD) are usually discharged home the same day.
The post-procedure care is primarily focused on the patient’s recovery from moderate sedation and the vascular assessment of the femoral or radial arterial sheath site if the patient had a diagnostic procedure. For the PCI patient, monitoring for dysrhythmias, new onset ischemia, or infarct and initiation of post-procedure fibrinolytics are all-important nursing tasks. The removal of the arterial and/or venous sheaths is also done in the post-procedure period, when the patient’s activated clotting time (ACT) or partial thromboplastin time (PTT) has returned to baseline. A nursing background in cardiac surgery, telemetry, or intensive care nursing is recommended, but is not a prerequisite. Most units have an orientation program and require each nurse to be current in basic life support (BLS) and advance cardiac life support (ACLS). Key skills are recognition of possibly fatal dysrhythmias, prompt correction of vasovagal reactions or allergic reactions, clinical assessment of the heart and lungs, and coordination with the cardiology attending on local procedures based on American Heart Association (AHA) protocols. This chapter is written to address the questions a nurse may have upon taking a job in the cardiac catheterization and electrophysiology laboratory in a hospital setting.
1.What is coronary artery disease?
2.What happens when a patient is actively having chest pain?
3.What are the major types of myocardial infarction?
4.The AHA provides algorithms for the care of acute coronary syndromes. What is the standard for detection of coronary thrombosis (critical lesions)?
5.What is angioplasty or percutaneous coronary intervention?
6.What can be assessed by a cardiac catheterization?
7.What interventions (PCI) are performed to reduce the ischemia and injury of a coronary occlusion by the interventional cardiologist?
8.What types of interventional procedures might be done during angioplasty?
9.Which drugs can be given through the catheter directly into the coronary arteries by the interventional cardiologist?
10.Which patients should have cardiac artery bypass surgery rather than a stent placement?
11.What should the pre-procedural assessment for a cardiac catheterization include?
12.How is the determination made to use the radial versus the femoral artery for catheterization?
13.What medications do patients receive for a cardiac catheterization or PCI?
14.What is given for a known allergy to contrast dye?
15.How often should the cardiac patient be assessed in the PACU?
16.What are the potential complications of femoral artery cannulation?
17.Can a nurse remove the femoral sheath?
18.What devices can be used to seal the artery after removal?
19.Why use manual compression when a device is available? What does manual technique look like?
20.After the procedure, how long should the patient be monitored?
21.Is a sandbag or IV bag appropriate to provide pressure on the groin site after a sheath removal?
22.What kind of dressing should be applied to the site?
23.Many patients have a vasovagal response to the sheath removal. How should the bradycardia be treated if the patient is symptomatic?
24.What injuries should be assessed for?
25.What conditions should be reported to the provider?
26.What is the post-treatment procedure for radial cardiac catheterization?
27.What medications may be given in the postprocedure catheterization lab?
28.What complications of an acute myocardial infarction might occur in the first 24 hours?
29.What discharge instructions should the nurse emphasize?
30.What are the complications to watch for in the PACU?
31.What discharge instructions should post-catheterization patients receive?
32.What is electrophysiology and its purpose?
33.What is arrhythmia ablation?
34.What type of arrhythmias require ablation therapy?
35.What are the advantages of ablation therapy?
36.What is a modified maze procedure?
37.A patient received pulmonary artery catheters under fluoroscopy for both diagnosis and treatment of cardiac conditions. What are the normal pressures you should observe for pulmonary artery or right heart catheter?
38.Why would the femoral vein be cannulated during a cardiac catheter or pacemaker insertion?
39.What are the indications for placement of a permanent pacer?
40.What is cardiac resynchronization therapy?
41.How is the pacemaker assessed just after insertion?
42.What instructions should be given to a patient who has a pacemaker and/or automated internal cardiac defibrillator?
43.What is the indication for a ventricular assist device, and how would the patient be monitored?
44.What additional skills are recommended for post-cardiac catheterization recovery nurses who may not be included in perianesthesia competencies?
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