Under supervision of: Dr/

Saadya Amin.
Dr/ Mahmoud Fekry
Critical nursing department.
Division (2)
Faculty of nursing.
 Cairo university.
2024
Students’ name:
• Asmaa Mahmoud Abdelrehiem
• Anas Abdullah Qarmout
• Asmaa Salah Orabi
• Afnan Ahmed Abdelsalam
• Amgad Magdy Mohamed Mabrouk
• Eman Awadahalla Saad
• Esraa Magdey Ashour
• Esraa megahed Ibrahim
• Amir Ahmed Salah
• Amira Tarek Abdalla
• Esraa Khaled Mohamed
Objectives:
By the end of the presentation, the students will be able to:
• Define the cardiac catheterization accurately.
• Explain briefly the anatomy of the coronary arteries.
• Enlist the most common indications of cardiac catheterization.
• Enumerate the most common contraindications of cardiac catheterization.
• Differentiate between diagnostic and therapeutic cardiac catheterization.
• Mention all the sites of insertion correctly.
• Discuss advantages and disadvantages for each site of insertion.
• Describe explicitly the cardiac catheterization procedure.
• Appoint the most common complications of cardiac catheterization.
• Demonstrate the proper patient preparation pre-procedure.
• Exhibit the proper care for patient post catheterization.
• Display a complete health education for patient with cardiac catheterization.
Outlines:
• Introduction & Definition of Cardiac Catheterization.
• Anatomy of Coronary arteries.
• Indications.
• Contraindication.
• Diagnostic Cardiac Catheterization.
• Therapeutic Cardiac Catheterization.
• Sites of Insertion (Advantages and Disadvantages).
• Catheterization Procedure.
• Complications of Cardiac Catheterization.
• Pre procedural care (Patient's preparation).
• Post procedural care (Post Catheterization).
• Patient Education.
Introduction.
• Millions of people are living with heart disease, and some of em don't even realize they have
it.
• Heart disease is a number one cause of death above cancer diabetes and injuries that's why
it's important to get it diagnosed and treated quickly and there are a lot of tests and
treatments to heart disease and there is one procedure that is both test and treatment is called
cardiac catheterization it can show how healthy the heart and blood vessels are.
Definition of cardiac catheterization.
• It is one of the invasive procedures used to visualize the heart chambers, valves and great
vessel in order to diagnose and treat abnormalities of the coronary arteries
• Before the procedure, the patient may need to diagnostic tests, such as blood tests, heart
imaging tests, or a stress test, to determine how well the heart is working and to help guide
the procedure. During the procedure, doctor may:
o Check the pressure in each chamber of the heart. o
Take blood samples to measure oxygen levels.
o Evaluate how well the pumping chambers in the heart
contract. o Locate any defects in the valves and chambers.
Anatomy of Coronary arteries.
• The coronary arteries are a vital part of the circulatory system that supply oxygenated blood
to the heart muscle itself. They are responsible for delivering nutrients and oxygen to the
heart, ensuring its proper functioning. Let's explore the anatomy of the coronary arteries:
1. Coronary Circulation: The coronary arteries are part of the systemic circulation, which
means they branch off from the aorta, the main artery of the body, to supply the heart. The
coronary circulation consists of two main arteries: the left coronary artery (LCA) and the
right coronary artery (RCA).
2. Left Coronary Artery (LCA): The left coronary artery arises from the left side of the aorta,
just above the aortic valve. It further divides into two main branches:
a. Left Anterior Descending Artery (LAD): The LAD artery, also known as the anterior
interventricular artery, travels down the front of the heart, in the anterior interventricular
groove. It supplies blood to the front and sides of the left ventricle and the front part of the
interventricular septum.
b. Left Circumflex Artery (LCx): The LCx artery wraps around the left side of the heart in
the atrioventricular groove. It supplies blood to the left atrium, the lateral and posterior walls
 of the left ventricle, and may give rise to the posterior descending artery (PDA) in some
individuals.
3. Right Coronary Artery (RCA): The right coronary artery originates from the right side of
the aorta, just above the aortic valve. It runs along the right atrioventricular groove, supplying
blood to the right atrium, right ventricle, and the inferior part of the left ventricle. The RCA
may also give rise to the posterior descending artery (PDA) in some individuals.
4. Collateral Circulation: The coronary arteries form an interconnected network of smaller
vessels known as collateral arteries. These vessels provide alternative pathways for blood flow
in case of a blockage or narrowing of the main coronary arteries. Collateral circulation helps
maintain blood supply to the heart muscle and can reduce the severity of myocardial infarctions
(heart attacks).
Understanding the anatomy of the coronary arteries is crucial for diagnosing and treating.
Various cardiovascular conditions. Medical professionals, such as cardiologists and cardiac
Surgeons, utilize this knowledge to assess blood flow, identify blockages, and perform
intervention like
angioplasty or coronary artery bypass grafting (CABG) to
restore or Improve blood supply to the heart muscle

Indications.
• Cardiac catheterization can be either a
diagnostic or a therapeutic procedure. The
procedure is done in the evaluation and the
treatment of the following conditions:
o Coronary artery disease. o
Measuring the hemodynamics in the
right and left side of the heart.
o Evaluate the left ventricular
function. o Evaluation and treatment
of cardiac arrhythmias.
o Evaluation and treatment of valvular
heart disease.
o Assessment pericardial and
myocardial diseases. o Assessment of the congenital heart diseases. o Evaluation of
heart failure.
Contraindications.
• Contraindications for cardiac catheterization are:
o Allergy to contrast (dye) medium. o Uncontrolled Blood Pressure
(Hypertension). o Severe aortic stenosis.
o Problems with blood coagulation (Coagulopathy).
o Kidney failure or dysfunction.
o Severe anemia.
o Electrolyte imbalance. o Fever. o Active systemic infection /sepsis.
o Uncontrolled rhythm disturbances (arrhythmias). o Uncompensated
heart failure.
Diagnostic cardiac catherization.
• Cardiac catheterization is a non-surgical procedure usually performed to diagnose coronary
artery disease. The patient is given a mild sedative to aid in relaxation, but remains awake
during the procedure so that questions relating to comfort, chest pain or shortness of breath
can be addressed.
• The catheter (a long, thin, flexible tube) is inserted through the femoral artery in the groin
(or an artery in the arm). A colorless dye is injected through the catheter, and x-ray pictures
are taken of the heart and coronary arteries. The test takes about one hour, and most patients
are discharged the same day.
• This test will help the doctor evaluate the patient's cardiac condition relating to:
1. How well the heart muscle and valves are working?
2. The extent of damage to the heart after a heart attack?
3. Which coronary arteries are narrowed?
4. What treatment, if ny, is required - medical management, angioplasty or surgery?
Therapeutic cardiac catheterization.
Cardiac catheterization is useful in the treatment of heart problems. As with diagnostic
catheterization.
Therapeutic catheterizations are used to relieve blockages in the coronary arteries with
angioplasty (widening the arteries), to remove obstructive material, and for stent placement (a
tube that remains in place to keep the artery open)
BALLOON ANGIOPLASTY: A
specially designed catheter with a tiny
balloon is carefully guided. through
the artery to the blockage, then inflated
to widen the opening and increase
blood flow to the heart. A stent is often
placed during the procedure, to keep
the artery open after the balloon is
deflated and removed. It's used to open
blocked coronary arteries caused by
coronary artery disease. It restores
blood flow to the heart muscle without open- heart surgery. Angioplasty can be done in an
emergency setting such as a heart attack. Or it can be done as elective surgery if your
healthcare provider strongly suspects you have heart disease. Angioplasty is also called
percutaneous coronary intervention (PCI).
ANGIOPLASTY WITH STENT: Coronary stents are now used in nearly all angioplasty
procedures. A stent is a tiny, expandable metal mesh coil. It is put into the newly opened area of
the artery to help keep the artery from
narrowing or closing again. Once the stent has
been placed, tissue will start to coat the stent
like a layer of skin. The stent will be fully lined
with tissue within 3 to 12 months, depending
on if the stent has a medicine coating or not.
Most stents are coated with medicine to prevent
scar tissue from forming inside the stent. These
stents are called drug-eluting stents (DES).
They release medicine within the blood vessel
that slows the overgrowth of tissue within the
stent. This helps prevent the blood vessel from becoming narrow again. Some stents don't have
this medicine coating and are called bare metal stents (BMS). They may have higher rates of
stenosis.
ROTABLATION (PRECUTANEOUS TRANSLUMINAL ROTATIONAL
ATHERECTOMY) – PTRA: A special catheter, with an acorn-shaped, diamond-coated tip, is
guided to the point of narrowing in the coronary artery. The tip spins around at a high speed and
grinds away the plaque on the arterial walls. This process is repeated as needed to treat the
blockage and improve blood flow. The microscopic particles are washed safely away in your
blood stream and filtered out by your liver and spleen.
CUTTING BALLOON: The cutting balloon catheter has a balloon tip with small blades.
When the balloon is inflated, the blades are activated. The small blades score the plaque, then,
the balloon compresses the fatty matter into the arterial wall. This type of balloon may be used
to treat the buildup of plaque within a previously placed stent (restenosis) or other types of
blockages
Sites of Insertion (Advantages and Disadvantages).
CORONARY ARTERIOGRAPHY
. In coronary arteriography, the catheter is introduced into the right or left
Femoral, brachial, or radial arteries, then passed into the ascending aorta
And manipulated into the appropriate coronary artery

➔ Arterial Access
◆Right or Left Common Femoral Arteries (main site)
◆Right or Left Brachial Arteries (alternative site)
◆Right or Left Radial Arteries (alternative site)
CORONARY ARTERIOGRAPHy:-
ADVANTAGES
○Coronary arteriography is used to evaluate the degree of atherosclerosis and to guide the
Selection of treatment. It is also used to study congenital anomalies of the coronary arteries.

★ DISADVANTAGES
○Potential risks and complications include
Heart attack, Stroke, Injury to the catheterized artery, Irregular heart
Rhythms (arrhythmias), Allergic reactions to the dye or medications used
During the procedure, Kidney damage, Excessive bleeding, Infection
LEFT HEART CATHETERIZATION

★Catheterization of the left ventricle. In this approach, the physician usually inserts the
Catheter into the right brachial artery or a femoral artery and advances it
Into the aorta and left ventricle.

★ Arterial access:
○ Right Brachial Artery
○ Right or Left Femoral Artery
LEFT HEART CATHETERIZATION

★ ADVANTAGES
○Left heart catheterization is performed to evaluate the patency of the coronary
arteries and the function of the left ventricle and the mitral
and aortic valves.

★ DISADVANTAGES
○Potential complications include dysrhythmias, MI, perforation of the heart or great vessels,
and
Systemic embolization.
○After the procedure, the catheter is carefully withdrawn and arterial hemostasis is achieved
Using manual pressure or other techniques. If the physician performed an arterial or venous cut
down the site is sutured and a sterile dress.
Femoral artery:-
Advantge
Femoral artery:-
Advantage:--Larger caliber artery
(permitting Larger Size catheters)
-Less prone to spasm-Most common mode Of vascular access For Coronary Angioplasty
Disadvantage:-
-Ecchymosis. -Bleeding. -Aneurysm. -Thrombus Formation
-Vessel perforation. -Limb ischemia.
_Brachial artery:-
Advantage:--Easy access -Larger caliber artery
(permitting larger size Catheters). -Alternative vascular Access for coronary Angiography.
Disadvantage:-
-Uncomfortable for Patient. -Median nerve Damage.
RIGHT HEART CATHETERIZATION

★It involves the passage of a catheter from an antecubital or femoral vein into the right Atrium,
right ventricle, pulmonary artery, and pulmonary arterioles.

★ Venous access:
○ Right or Left Femoral Vein
○ Right or Left Antecubital Vein (i.e Basilic vein)
○ Internal Jugular Vein
ADVANTAGES
○Saturations from each of these areas are obtained and recorded. Although right heart
Catheterization is considered a relatively safe procedure.
○Right heart catheterization allows for the determination of multiple prognostic such as Right
atrial pressure, cardiac output, cardiac power output, pulmonary artery pressure, Pulmonary
artery pulsatility
★ DISADVANTAGES
○Potential complications include cardiac dysrhythmias, venous spasm, infection of the Insertion
site, cardiac perforation, and, rarely, cardiac arrest.
Femoral vein:-
Advantages
-Easy to find vein. -No risk of Pneumothorax
-Preferred site for Emergencies and CPR. -Fewer complications
DISADVANTGES
-Highest risk of infection. -Risk for DVT.
_Not good for ambulatory Patients.
Basilic vein:-
Advantage:- -Largest, straight Pathway in upper arm
Disadvantage:- -Located too far medially or Posteriorly
-Difficult insertion and care
-Close proximity to brachial Artery and some branches of Internal cutaneous nerves.
Internal jugular vein:-
ADVANTGES
-Large vessel size. -Easy to locate -Easy access for Catheter
-Short, straight Pathway To superior vena cava -Low complication .
Disadvantage:--Close Proximity to Carotid Artery
-Higher Infection rate. -Uncomfortable To patient.
Catheterization procedure.
1. Shave and sterilize the catheter site.
2. Tell the patient that he will feel pain.
3. Prepare the femoral artery site using antiseptic solution and dry it using a dry gauge 4. Cover
the site with a sterile drape, with an opening at the site of the femoral access site
5. Infiltrate the lateral groin with local anesthesia.
6. After the injection wait for 2-3 minutes.
7. Locate the femoral artery insertion site.
8.Insert Selinger needle at a 30°45° angle into femoral artery and push very gradually until shaft
the needle comes into lumen in artery sheath femoral artery.
9. Avoid too low and too high puncture.
10. Expect bright red blood to scope through the needle.
11.Insert small guide wire through needle with a rotating movement and pushing.
12. Remove Selinger needle.
13.Insert catheter sheath with dilator along guide wire.
14. Remove guide wire and dilator together.
15. Check the sheath is in the artery through: Blood backflow / Flush / Check pressure.
16. Insert long wire above level aortic valve.
17. Insert the catheter.
18. Withdraw guide wire
19. Important rules during procedure:
▪ Aspirate catheter from now and then.
▪ Keep an eye on pressure and rhythm.
▪ Don't push against resistance.
20. Wire resistance:
▪ Blocked needle pull the wire out confirm pulsatite blood
▪ Needle malposition post wall penet (good blood return but no wire advancement)
withdraw needle 1-2mm
21. Once catheter into aorta:
▪ Blood backflow
▪ Flush
▪ Check pressure by manometer
22. If no back flow:
 ▪ Catheter blocked clot or kink
▪ Catheter tip against wall
▪ Catheter engaged osteal lesion or catheter induced spasm
23. Give a test dose of dye.
Complications for cardiac catheterization.
Local Vascular Complications.
• Hematoma/Retroperitoneal Bleeding
• Thrombosis and Embolism
• Arteriovenous Fistula
• Dissection aneurysm
• Pseudoaneurysm
Vascular Complications after Transradial
Access.
• Radial artery occlusion
• Radial artery spasm.
Other major Complications
• Dissection and Perforation of the Great Vessels
• Stroke
• Atheroembolism.
• Allergy’s reaction
• Infection
• Acute renal failed
• Arrhythmia
• Death

Pre procedural care (Patient's preparation).

1. Ensure that a written informed consent is obtained prior to the procedure.
2. Explain the procedure to the patient.
3. Instruct patient not to eat or drink anything for at least six hours before test, or as directed by
their doctor.
4. Ask patient to remove dentures and any jewelry, especially necklaces that could interfere
with pictures of the heart.
5. Shave the hair from the site where the catheter will be inserted.
6. Have the patient to void just before the procedure.
7.Before a cardiac catheterization, check patient blood
pressure and pulse.
8. Discontinue any anticoagulant therapy as order early
such as warfarin, asprin.
9. Ask patient if they take diabetes medications.
10. Check the patient history for hypersensitivity to
shellfish, iodine, or contrast media used in other diagnostic tests.
11. Inform patient that sticky patches (electrodes) will be placed on their chest to monitor their
heartbeat before, during and after the procedure.
12. Inform the patient that the test takes 1 to 2 hours.
13. An IV line will be started to give fluids and medications.
14. Tell the patient that they may receive a mild sedative but will remain
conscious during the procedure.
15.Give patient antithrombotic medication to prevent thrombosis.
Post procedural care (Post Catheterization).
Care for patient after catheterization….
1-The patient will go to a recovery room for a few hours from 4 to 6 hours.
2- put patient in flat position.
3- Pressure will be applied to the puncture site to stop the bleeding.
4-Nurse will be asked to keep the site of puncture straight and not out of bed
5-Assess heart beat and other vital signs (pulse and blood pressure) will be
Checked during patient recovery
6- Assess the sit of puncture for bleeding, swelling .
7- administration pain relive medication.
8-Report any swelling, pain , or bleeding at the puncture site, or if the patient have chest
Pain.
9-ECG measurement and compared to the previous measurement pre procedure
10-take IV free fluid post procedure to remove secretion
11. Before patient leave the hospital, Nurse will receive written instructions about
what to do at home.
Patient Education.
• The patient must lie flat and supine for a minimum of two hours to ensure the artery does not
reopen.
• After two hours, the patient can be released to person driving the patient home.
• For the next 24 hours, patient should not bent at the waist (to lift anything), strain, or lift
heavy objects (no lifting over 4.5 kilograms for three days). Dressing must remain dry.
• Inform patient to not take a bath or swim for the first week. he may take showers, but make
sure the area where the catheter was inserted does not get wet for the first 24 to 48 hours.
• Teach patient to Avoid tub baths, but shower as desired.
• Teach patient to drink plenty of fluids.
• If severe pain, redness, drainage from puncture site, swelling or discoloration of limb occurs,
temperature of 38.6 C, doctor must be notified immediately.
• The general recommendation is to hold oral hypoglycemic medication on the day of the
procedure and 48 hours after finishing the procedure.
• Resume oral anticoagulant the day after the procedure, after at least 24 hours have elapsed
and when hemostasis is secured.
• Tell the patient the he should be able to return to work in 2 to 3 days if he does not do heavy
work.
• If test results showed coronary artery disease, teach the patient about treatment and
rehabilitation programs.
• Teach patient in case of bleeding:
• Remove dressing, apply pressure for 5-10 minutes. If still bleeding or oozing, call for help.
References:
• https://www.ncbi.nlm.nih.gov/books/NBK531461/
• https://healthtimes.com.au/hub/catheterisation/18/guidance/nc1/caring-for-
patientspost-
cardiaccatheterisation/1921/#:~:text=General%20patient%20care%20after%20the%2
0proce
dure&text=A%20nurse%20will%20monitor%20vital,requires%20specialised%20bloo
d%20thinning%20medication
• https://www.ahajournals.org/doi/full/10.1161/CIR.0b013e31821b1f10#
• https://www.ahajournals.org/doi/10.1161/01.CIR.100.5.566