Cardiac Catheterization (Angiocardiography, Cardioangiography, and Coronary Angiography)

Norm of Cardiac Catheterization (Angiocardiography, Cardioangiography, and Coronary Angiography)

Normal heart anatomy with normal chamber volumes and pressures, normal wall and valve motion, and patent coronary arteries. Normal cardiac output and chamber pressures are listed below:

	Normal Pressures
Cardiac output (CO)	4–8 L/min
Right-Sided Heart Catheterization
Right atrial (RA)	3–11 mm Hg
Right atrial mean	6 mm Hg
Right ventricular systolic	20–30 mm Hg
Right ventricular end-diastolic	<5 mm Hg
Pulmonary artery systolic (PAS)	20–30 mm Hg
Pulmonary artery end-diastolic pressure (PAEDP)	8–15 mm Hg
Pulmonary artery mean (PAM)	<20 mm Hg
Pulmonary artery wedge pressure (PAWP) or pulmonary capillary wedge pressure (PCWP)	4–12 mm Hg
Left-Sided Heart Catheterization
Ascending aorta systolic	140 mm Hg
Ascending aorta diastolic	90 mm Hg
Ascending aorta mean	105 mm Hg
Left ventricle (LV) systolic	140 mm Hg
Left ventricular end-diastolic pressure (LVEDP)	8–12 mm Hg
Left atrium mean (LAM)	12 mm Hg

 

Usage of Cardiac Catheterization (Angiocardiography, Cardioangiography, and Coronary Angiography)

Identification, documentation, and quantitation of congenital disorders of the heart and diseases and disorders of the greater vessels of the heart; evaluation of cardiac muscle function; evaluation of coronary artery patency; identification of ventricular aneurysms; and identification and quantitation of the severity of acquired or congenital cardiac valve disease. This procedure is safe in morbidly obese clients.

 

Description of Cardiac Catheterization (Angiocardiography, Cardioangiography, and Coronary Angiography)

Cardiac catheterization involves passing a catheter through the brachial or femoral artery or antecubital or femoral vein into the left or right side of the heart through the aorta or vena cava, respectively. Angiographic films can be taken after radiopaque dye is injected from the catheter tip. The dye makes it possible to visualize chamber function, valve function, and chamber size. Measurements of oxygen content and pressure and flow rate of blood can be obtained in each chamber, along with the cardiac output and perfusion of the coronary arteries.

 

Professional Considerations of Cardiac Catheterization (Angiocardiography, Cardioangiography, and Coronary Angiography)

Consent form IS required.

Risks
Air embolism, allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), asystole, cardiac tamponade, cerebrovascular accident (left-sided heart catheterization), congestive heart failure, cerebrovascular accident, dysrhythmias, embolus (left-sided heart catheterization), endocarditis, hematoma, hemorrhage, hemothorax, hypovolemia, infection, myocardial infarction, pneumothorax, pulmonary edema, pulmonary embolism (right-sided heart catheterization), renal toxicity, retroperitoneal bleed, thrombophlebitis (right-sided heart catheterization with antecubital site), thrombus (left-sided heart catheterization), and vagal response (right-sided heart catheterization). This invasive procedure poses a 2% risk of complications.
Contraindications and Precautions
Pregnancy (because of radioactive iodine crossing the blood-placental barrier), severe cardiomyopathy, severe dysrhythmias, uncontrolled congestive heart failure. This procedure should be performed with extreme caution on clients allergic to local anesthetics, iodine, shellfish, or radiopaque contrast material. Steroids and diphenhydramine should be given before the procedure to these clients.

 

Preparation

1. See Client and Family Teaching.
2. Routine cardiac medications may be given with a small sip of water.
3. Record the baseline height and weight for the calculation of dye dosage.
4. Sedation is usually prescribed for relaxation, but the client remains awake.
5. Assess peripheral pulses and mark them for easy location.
6. Assess baseline ECG and arterial blood pressure and monitor continuously because of the potential for occurrence of cardiac dysrhythmias during the procedure.
7. Have emergency cardiac medications and emergency equipment readily available.
8. Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.

 

Procedure

1. Left-sided heart catheterization: In a cardiac catheterization laboratory under fluoroscopy, a long catheter is inserted through a percutaneously inserted sheath into the brachial or femoral artery retrograde through the aorta into the left ventricle or to the beginning of the coronary arteries. Radiopaque dye is then injected from the catheter tip, and the patency of the coronary arteries (coronary angiography, coronary arteriography, cineangiography, or angiocardiography), left ventricular function (contrast ventriculography), and bicuspid and aortic valve function are assessed and recorded radiographically.
2. Right-sided heart catheterization: In a cardiac catheterization laboratory under fluoroscopy, a long catheter is inserted through a percutaneously inserted sheath into an antecubital or femoral vein through the vena cava, right atrium, and right ventricle and into the pulmonary artery. Heart chamber and pulmonary artery pressures may be measured as well as cardiac output, tricuspid and pulmonary valve function, and right ventricular function. Radiographic films of the procedure are made.

 

Postprocedure Care

1. Maintain bed rest for 4–6 hours.
2. Apply a pressure dressing to the arterial catheter insertion site and immobilize the extremity for 4–6 hours. A sandbag may be placed over an arterial site. Check the dressing and site for bleeding and hematoma formation along with vital sign and pulse checks. Bed rest and extremity immobilization may be extended in clients receiving heparin.
3. Check vital signs and peripheral pulses, color, skin temperature, and sensation of the procedural extremity every 15 minutes × 4, then every 30 minutes × 2, and then hourly for 8–12 hours. Also check for low back or flank pain, which may indicate a retroperitoneal bleed.
4. Assess for dysrhythmias, chest pain, or symptoms of cardiac tamponade.
5. An analgesic may be prescribed for catheterization site discomfort.
6. Encourage the oral intake of fluids if not contraindicated.
7. Resume diet.

 

Client and Family Teaching

1. Fast from food for 8 hours and from fluids for 3 hours before the procedure.
2. The procedure lasts 1–3 hours.
3. A momentary warm flush and metallic taste or racing pulse may be experienced when the dye is injected. It is also normal to feel a few skipped beats when the catheter is in the ventricle.
4. If coronary angiography will be performed, you might experience momentary chest pain while the dye is injected into the arteries, but no damage will result.
5. It is important to lie motionless throughout the procedure. Symptoms of more than momentary chest pain should be verbalized immediately.
6. Vital signs, pulse checks, and assessments for pain will be taken after the procedure at frequent intervals.
7. Report any difficulty breathing during and after the procedure.

 

Factors That Affect Results

1. Atherosclerosis of peripheral vessels prohibits easy passage of the catheter.

 

Other Data

1. The procedure should be stopped for severe chest pain, neurologic symptoms of a cerebrovascular accident, cardiac dysrhythmias, or hemodynamic changes.
2. Because of the risk of complete coronary artery occlusion from plaque disruption or coronary artery perforation, it is advisable (and legally required in many states) to have backup cardiothoracic surgery availability whenever a cardiac catheterization is performed.
3. African-Americans and females are less likely to be referred for cardiac catheterization (Shire, 2002).