Percutaneous Transluminal Coronary Angioplasty (PTCA)

What to Expect

During the Procedure

• Description of the room, monitoring devices, positions, and equipment that will be used - From the preparation area, you will be taken to the cath lab, the room where the PTCA procedure is performed, on a stretcher. The room will be cool due to the equipment in use.
  
  You will be assisted onto a cushioned table. The nurses and technicians will connect you to various types of monitoring equipment in order to assess your heart rate and rhythm, blood pressure, and oxygen levels during the procedure. You are encouraged to ask questions if you have them. You will lie flat on your back during the entire procedure. There will be several monitor screens in the room, showing your vital signs (EKG, heart rate, blood pressure, breathing rate, and oxygen level), the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected.
  
  The cath lab is a sterile area, so everyone in the room will wear gowns, masks, and caps. The physician and assistants actually performing the procedure will wear sterile gloves. A large x-ray camera will be above the table to make pictures of the procedure.
  
  
• Anesthesia - As stated above, you will be given a sedative medication in your IV prior to the procedure to help you relax. However, you will remain awake during the procedure.

(Client may insert pictures of cath lab and/or diagram of catheter insertion sites and path of catheter into heart here if available)

• Basic description of the procedure:
  
  
  • Once the monitoring equipment has been connected, the cath site (groin or arm) will again be cleaned with antiseptic soap.
    
    
  • The insertion area will be covered with sterile towels and a sheet.
    
    
  • A numbing medication (lidocaine or xylocaine) will be injected into the skin at the cath site. You may feel some stinging at the site for a few seconds after the numbing medication is injected.
    
    
  • Once the numbing medication has taken effect, a sheath, or introducer, is inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced into the heart. If the arm is used, a small incision (cut) is made to expose the blood vessel for insertion of the sheath.
    
    
  • It will be very important for you to remain still during the procedure so that the catheter placement is not disturbed and to prevent damage to the cath insertion site.
    
    
  • The angioplasty catheters are inserted through the sheath into the blood vessel. The physician advances the catheter through the blood vessels into the heart. This is done by watching the catheter on the monitor and guiding it into the proper structures. The room will be dim, so that the monitors can be seen by the physician and staff.
    
    
  • The catheter is advanced into the coronary arteries. Once the catheter is in place, dye is injected through the catheter into your coronary arteries in order to see the narrowed area(s). It is possible that you may feel a brief sensation of warmness just after the dye is injected, but this sensation is temporary and will soon pass.
    
    
  • Your physician will observe the coronary arteries after the x-ray dye injection on an x-ray monitor that resembles a TV screen. You may also be able to watch the monitor screen at this time. During this time, you may be instructed to take in a deep breath and hold it for a few seconds.
    
    
  • When the physician locates the narrowed artery, the PTCA catheter will be advanced to that location and the balloon will be inflated to open the artery. It is possible to experience some chest pain or discomfort at this point as a result of blood flow being temporarily blocked by the inflated balloon. Any chest discomfort or pain should go away when the balloon is deflated. However, if you notice any continued discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty, let your physician know immediately.
    
    
  • The physician may inflate and deflate the balloon several times. The decision may be made at this point to insert a stent in order to maintain the artery's opening.
    
    
  • The physician will take measurements after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter is removed. However, the sheath, or introducer, will be left in for several more hours.
    
    
  • The physician (or an assistant) will hold pressure on the cath site for about 15 to 20 minutes, so that the blood can begin to form a clot at the site and stop bleeding. Once the physician (or assistant) is satisfied that bleeding has stopped, a very tight bandage will be placed on the site. A sandbag may be placed on top of the bandage for additional pressure on the site, especially if the site is the groin.
    
    
  • You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: You will not be allowed to bend your leg nearest the cath site, if the insertion was done in the groin, for several hours. To help you remember to keep your leg straight, the knee of the affected leg will be covered with a sheet and the ends will be tucked under the mattress on both sides of the bed to form a type of loose restraint.

(Client may insert photos of normal and abnormal coronary arteries from cath film here)

• Procedure time - The PTCA procedure itself will last about one to two hours, depending on how long it takes to obtain adequate blood flow in the artery being treated.

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