Patient Education Cardiac Catheterization Lab Procedures This booklet describes cardiac catheterization. It also details how to prepare for the procedure and the care needed after it is done. Before You Come to the Hospital To make your hospital stay as comfortable as possible, it helps to come prepared for your appointment. These tips will help make your stay easier: Call the Cardiac Intake Center at 206-598-3400 for detailed directions if needed. The Catheterization Lab is on the second floor in Room NN243. Pack an overnight bag in the event you have to stay overnight. Generally, patients who undergo a diagnostic catheterization (also known as coronary angiogram) are discharged after 6 hours. Patients who require an intervention procedure will stay 24 hours. Make hotel/motel reservations or lodging plans in the area if you are from out of town. Please bring these items with you: - A list of medications you are currently taking, along with a list of medication you have taken in the past two days. Please include the dose amount. - The name and phone number of a contact person. - If you have had a prior catheterization and received pictures from the procedure, bring them in to give to the Cath Lab team.
Page 2 Reasons for Your Visit Cardiac catheterization is used as a tool to answer specific clinical questions about your heart and its circulation. Diagnosis Your doctor has referred you for this test to assess your heart and its circulation. This test is called cardiac catheterization or coronary angiogram. During the test, X-ray images and pressure measurements are recorded and studied to view the chambers, valves, and blood vessels of your heart. Treatment (Intervention) The cardiologist performing the procedure will discuss with your doctor whether treatment is needed. If it is safe to proceed with a treatment or intervention and that is your wish, the intervention will be performed during the same procedure. In some cases, the diagnosis reveals that no intervention is needed. Coronary Arteries Coronary arteries are blood vessels that lie on the heart surface. As blood leaves the heart, a small amount is sent through these arteries to supply the heart s need for blood and oxygen. All cells in the body require a constant blood supply, including the cells of the heart. There are two major coronary arteries, the right and the left. Right coronary artery system Left coronary artery system The heart, including the coronary arteries.
Page 3 The coronary arteries may be affected by the disease process known as arteriosclerosis. This is a build-up of fat and cholesterol deposits within the artery, which can cause obstruction of normal blood flow. When an obstruction is severe, the blood flow to the heart muscle can be reduced. This may result in chest discomfort, called angina. When an artery is completely blocked, damage to the heart muscle may occur. This is a myocardial infarction, or heart attack. During the cardiac catheterization, images are created to show how blood flows through your arteries and to what extent there are obstructions or limited blood flow. How to Prepare Fasting Do not eat or drink anything after midnight the day of your procedure. Do take your usual morning medications unless otherwise directed by our cardiac intake nurse. After the procedure, your regular diet will be resumed. Day of Admission If you are not already a patient in the hospital system, you will need to register at the Clinic Registration desk on the third floor in the lobby. From Registration, go to Outpatient Blood Draw on the third floor behind the Outpatient Pharmacy. Then proceed to the Special Procedures Unit (off the Pacific elevators) on 4-South. Before you go to the Catheterization Lab, you will be prepared for the procedure on the nursing unit: You will change into a hospital gown. Your blood pressure and temperature will be taken. A nurse will ask questions about your medical history. An electrocardiogram will be performed. An IV will be started. From the Special Procedures Unit, you will be transported to the Cardiac Catheterization Lab. During your catheterization, your family may wait on the nursing unit or in the second-floor waiting room.
Page 4 In the Catheterization Lab: You will be asked to sign consent forms. There is a small element of risk from the procedure, and some patients have side effects from the dye or medications used. While the risks and side effects are not common, you should be aware of them. The doctor or nurse practitioner (ARNP) will discuss them with you prior to asking for your consent. You will be helped onto a special table that slides back and forth and there will be a camera above you. This will enable the doctor to visualize the blood vessels around your heart from different angles. Electrodes will be attached to monitor your heart rhythms. You will be draped in sterile paper sheets. A nurse will give you a sedative through your IV prior to the procedure. Your groin and/or neck will be scrubbed with antiseptic solution and shaved to avoid infection. Always ask your doctor or nurse if you have any questions or do not understand part of the catheterization process. Diagnosis Performing a Coronary Angiogram (Catheterization) Once you have signed the consent forms and have been prepared for the catheterization, the procedure will begin. 1. Your groin or arm will be numbed with an anesthetic called Lidocaine. 2. A short tube called a sheath will be inserted into the femoral artery, a major artery of the leg. In some cases, the sheath may be inserted into an artery in your arm. You may feel pressure, but you should not feel pain. If you have any pain, please tell your doctor. 3. A catheter (a long, flexible hollow tube) will be guided through the sheath and up to the coronary arteries of the heart. You will not feel the catheter as it moves. 4. The doctor will inject contrast dye through the catheter and into the arteries of your heart to assess whether there are any blockages in the vessels. You will not feel these injections, although parts of the test may cause you to feel a warm flushing sensation. This sensation is normal.
Page 5 5. If the doctor finds arteries that have narrowed or become blocked, she or he may choose to intervene to open the blockages. Femoral artery catheterization sites. Keep in Mind The procedure is not painful, but you may feel pressure in your groin and/or arm. You will be told what is happening during each step of the procedure, and there will be a nurse with you to help keep you comfortable. You may feel a fluttering sensation in your chest, which is normal for this procedure. If you have any discomfort during the catheterization procedure, please let the doctor or nurse know.
Page 6 Percutaneous transluminal coronary angioplasty (PCTA). Interventions As mentioned, if the doctor finds a narrowing in your coronary arteries, she or he may decide to intervene to improve the blood flow to your heart muscle. The two most common types of intervention are: Percutaneous Transluminal Coronary Angioplasty (PCTA) The doctor will place a small guide wire in the artery through the catheter already in place. A balloon catheter is then placed over the wire and moved to the narrowing. At the artery narrowing, the balloon is inflated for 20 to 60 seconds to push any plaque build-up on the artery wall out of the way. This allows increased blood flow to the heart. Stent Most often, your doctor will choose to open the artery with a device called a stent. A stent is a small mesh tube, which can be expanded by a balloon. The balloon is removed and the stent is left inside the artery to hold open the area of the narrowing or blockage. The newest stents are now coated with a medication that prevents scar tissue from developing and thus causing another obstruction. These are called drug-eluting stents.
Page 7 Stent placement in coronary artery. After the Procedure Catheterization Only After the information is gathered, the catheters are removed. The sheath is also removed, and pressure is applied to the site to prevent bleeding. A sterile dressing is then placed over the site to keep the area clean. The site will be monitored. If an artery in your leg is used, you must keep your leg straight for 6 hours during the recovery time. If an artery in your arm is used, an arm board will be placed on your arm to help keep it still during the recovery time. You must keep your arm straight for 3 hours. After the catheterization, you will be transported back to the Special Procedures Unit on the fourth floor. If you have an angiogram with no intervention procedure, you can expect a hospital stay of at least 6 hours after the procedure. During recovery, you will be required to lie flat. The nurse taking care of you will assist you with comfort measures. Your regular diet will be
Page 8 resumed. You may be given pain medications if you have any discomfort from lying flat. Your pulse, blood pressure, and dressing will be checked often during the first 3 to 6 hours after the procedure. Catheterization with an Intervention If an intervention is performed, you can expect to stay in the hospital overnight. Because you may not know ahead of time whether or not you will have an intervention, make arrangements to stay in the hospital for at least 24 hours. Discharge Prior to discharge from the hospital, you will be examined by a doctor or nurse practitioner. They will discuss the results of the procedure with you. If your medications or diet need to be adjusted, this will be done prior to discharge. Your nurse will instruct you about these changes and discuss follow-up care. These instructions should be followed after you go home from the hospital: Activity Avoid lifting more than 5 pounds the day of the catheterization, and more than 10 pounds for the next week. You may not drive on the day of your procedure. On the day after your procedure, you may return to light activity and you may drive. Do not resume your regular exercise routine for 2 days after the catheterization. Pain It is common to be sore at the site where the catheter was placed for 1 or 2 days. You may take Tylenol for pain relief. Avoid ibuprofen products for 24 hours. If you have severe pain or swelling at the catheter site, call your doctor.
Page 9 Site Care You may remove the dressing or bandage the day after the procedure. Keep the site clean and dry. You may shower the next day, but avoid baths, hot tubs, or swimming for 1 week. Inspect the site for redness or drainage over the next 3 days. You will have a bruise at the site that could spread down your leg over the next day, and may take 2 to 3 weeks to resolve. Symptoms to Report Call 911 if you have: Heavy bleeding or sudden swelling at the site. - Apply pressure above the area until help arrives. Call your doctor if you have: Swelling or oozing at the site. - Apply pressure with your fingers just above the bandage for 10 minutes. - If the swelling or oozing has not stopped, continue to apply pressure to the site. Drainage from the site or intense redness around it. Follow-up Follow the discharge instructions that are given to you. Call your cardiologist s office when you get home to schedule a follow-up visit within the next week or two. Continue your prescribed medications unless told otherwise by your provider. If you have any questions or concerns after you go home, please contact your doctor or nurse.
Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC clinic staff members are also available to help at any time. 206-598-3400 After hours and on weekends, call: UWMC Paging Operator 206-598-6190 Ask for the Interventional Cardiologist on call Notes Box 356422 1959 N.E. Pacific St. Seattle, WA 98195 206-598-3400 University of Washington Medical Center 06/2001 Rev. 09/2004