Cardiac Catheterization

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 cardiac catheterization 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 procedure area, so many hospital personnel 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 may be given a sedative medication in your IV prior to the procedure to help you relax. However, you will likely remain awake during the procedure.

(Client may insert pictures of cath lab and/or diagram of catheter insertion sites and path of catheter into the heart, 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) may be 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 site.
    
    
  • 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.
    
    
  • Once the catheter is in place, dye is injected through the catheter to visualize the heart and the coronary arteries. 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.
    
    
  • After the x-rays are taken of the heart and coronary arteries, the catheter is removed.
    
    
  • 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.
    
    
• Procedure time - The cath procedure itself will last about an hour, depending on how long it takes to obtain adequate diagnostic information. If the physician decides to do an additional procedure to open one or more clogged coronary arteries (percutaneous transluminal coronary angioplasty, or PTCA), the procedure will last longer than two hours.

After the Procedure

• Recovery process - After the cath procedure has been completed, you will be taken on a stretcher to a recovery area.

  You will be closely monitored by a nurse during the recovery period. Your blood pressure, heart rate and rhythm, and breathing will be assessed frequently. The nurse will also check the blood circulation in the leg or arm used for the catheter insertion, and assess the dressing on the cath site for bleeding. You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain. You should also tell your nurse about any feelings of warmth, bleeding, or pain at the cath site in your leg or arm.

  The sheath, or introducer, is in an artery and thus will need to remain in the cath site for approximately four to six hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off. You will need to lie flat during this time. If you become uncomfortable in this position, your nurse may give you medication to make you more comfortable.
  
  At the appropriate time, the sheath will be removed from the groin or arm. After the sheath is removed, pressure will be applied directly on the site either manually or with a clamp-type device for about 20 minutes. After bleeding has stopped completely with the pressure application, a tight dressing will be applied on the site. You will continue to lie in bed for a specified period, at least two hours or longer. It is very important that you keep your leg or arm with the catheter site straight during this period.

  After the sheath has been removed, you may be given a light meal, such as a sandwich and fruit. You will be encouraged to drink fluids as much as possible to help flush the x-ray dye from your system. The effects of increased fluid intake and the x-ray dye will cause you to urinate frequently; however, you will need to use a bedpan or urinal during this time so that your affected leg or arm will not be bent. You may require assistance from your nurse, so do not hesitate to ask for help.

  After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying, sitting, and standing.
  

• Length of stay - If the procedure is done on an outpatient basis, you will be allowed to leave after you have completed the recovery process - usually about six to eight hours after the procedure is finished. If an angioplasty is done during the procedure, or if complications occur during or after the procedure, you will spend the night in the hospital.
  
  
• Average recuperation time - You will most likely feel tired for a day or so after the procedure. The catheter site in your leg or arm may be sore for a few days. You may have other pain or discomfort for a day or so due to lying still for a long period of time during the procedure and the recovery period.

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