Images have been removed from the PowerPoint slides in this handout due to copyright restrictions.

Size: px

Start display at page:

Download "Images have been removed from the PowerPoint slides in this handout due to copyright restrictions."

Damon Whitehead
5 years ago
Views:

1 Percutaneous Coronary Intervention Types of PCI Procedures Balloon Angioplasty Rotational Atherectomy Coronary Stent Balloon Inflation Rotational Atherectomy Coronary Stents Stent Placement Bare metal Drug eluding Radioactive 1

2 PCI Pre Procedure Care Coronary Artery Access NPO after MN Pre-meds for dye allergy benadryl and steroids IV hydration or mucomyst especially if creatinine is elevated Give AM meds and ASA 18g PIV, AM labs Stop heparin drip on call to cath lab Treatment during PCI Arteriotomy Closure Devices O2 per nasal cannula Moderate sedation- fentanyl and versed Lidocaine to numb incision site Anticoagulation: Heparin or Bivalirudin AIIb/111a agent: Integrilin or Reopro Perclose A surgical procedure to suture the arterial vessel puncture site closed Angio-Seal A bio-absorbable anchor is deployed inside the artery and a collagen sponge outside the vessel creating a seal and providing hemostasis Post PCI Assessment Complications Bedrest from 4-6 hours depending on closure device used HOB<30 degrees Head-to-toe assessment emphasis on neuro changes Monitor vital signs, puncture site and neurovascular status (CMS, pulses, temperature, capillary refill) of lower extremities q15min x4, q30min x2 and q1h until off bedrest 12 Lead EKG Encourage PO fluids to facilitate clearance of contrast dye Myocardial infarction - distal fragmentation or abrupt closure (3-5%) Stroke (<1%) Bleeding external, hematoma, retroperitoneal Serious arrhythmias VF, VT, heart block, asystole Renal failure Vascular injury pseudoanerysm, thrombosis, embolus, dissection Emergency CABG surgery 2

3 New Minimally Invasive Angiography Procedures TAVR MitraClip Watchman Coronary Artery Bypass Grafting CABG Indications Significant left main occlusion (>50%) 3 vessel disease LVEF less than 35% Diabetics with multi-vessel disease Coronary Artery Bypass Surgery Median sternotomy Placed on CBP heparin to achieve ACT > 400 Arterial cannula placed in ascending aorta Venous cannula placed in vena cava or right atrium Aorta is cross-clamped Cardioplegia solution is given to arrest the heart for minutes Grafts harvested SVG and/or LIMA Cross-clamp removed defibrillation may be required to restart normal electrical activity CBP is discontinued, protamine sulfate given and cannulas removed Atrial and ventricular pacing wires and mediastinal/pleural chest tubes are placed, sternum wired shut and incision closed Newer Bypass Techniques Post Operative Management Off Bypass CABG (OPCAB) 20-30% of cases Most beneficial for patients with significant comorbidities Sternotomy Minimally Invasive Direct CABG (MIDCAB) Left thoracotomy 5-10 cm incision LIMA is harvested and anastomosed to the LAD Maintain hemodynamic stability Maintain ventilation and oxygenation Prevent post-op complications Bleeding from graft anastomosis sites Cardiac tamponade Infection Cardiac arrhythmias Pain and anxiety Sternal precautions 3

4 Cardiac Tamponade Cardiogenic Shock A true emergency! Cardiogenic Shock Pathophysiology Signs and Symptoms Decrease stroke volume Decrease cardiac output Increase heart rate Vasoconstriction Pulmonary congestion Decreased CI/CO, SBP, MAP Weak and thready pulses Arrhythmias Dyspnea, wheezing, crackles Cold, clammy skin Decreased UOP Restless, agitated, confused Cardiogenic Shock Treatment Intra Aortic Balloon Pump Treat the cause! Diuretics for preload reduction Inotropes to increase contractility Vasodilators for afterload reduction IABP to decrease myocardial workload 4

5 IABP Nursing Considerations Dysrhythmias Peripheral circulation Balloon perforation Balloon migration References Burns, S. (2014). AACN Essentials of Critical Care Nursing (3 rd ed.). New York, NY: McGraw Hill Education. Stanke, S. (2013). Percutaneous Coronary Intervention Instructional, Urden, L., Stacy, K., & Lough, M. (2010). Critical Care Nursing: Diagnosis and Management (6th ed.). St. Louis, MO: Mosby Elsevier. White, K. (2016). Fast Facts for Critical Care. Mobile, AL: Gwin s Printing. 5

University of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives

University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty