Details of the procedure

Angiography
Cardiac catheterization is usually performed with angiography, a technique in which a contrast agent is
injected into the vascular system to outline the heart and blood vessels. When a specific heart chamber or
blood vessel is singled out for study, the procedure is known as selective angiography. Angiography
makes use of cineangiograms, a series of rapidly changing films on an intensified fluoroscopic screen that
record the passage of the contrast agent through the vascular site or sites. The recorded information
allows for comparison of data over time.

Common Sites
Common sites for selective angiography are the aorta, the coronary arteries, and the right and left sides of
the heart.

Aortography
An aortogram is a form of angiography that outlines the lumen of the aorta and the major arteries arising
from it. In thoracic aortography, a contrast agent is used to study the aortic arch and its major branches.
The catheter may be introduced into the aorta using the trans lumbar or retrograde brachial or femoral
artery approach.

Coronary Arteriography
In coronary arteriography, the catheter is introduced into the right or left brachial or femoral artery, then
passed into the ascending aorta and manipulated into the right and left coronary arteries. Coronary
arteriography is used to evaluate the degree of atherosclerosis and to determine treatment. It is also used
to study suspected congenital anomalies of the coronary arteries.

Right Heart Catheterization

Right heart catheterization usually precedes left 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. Pressures and oxygen saturation levels from each of these areas are obtained and
recorded.
Although right heart catheterization is considered relatively safe, potential complications include cardiac
dysrhythmias, venous spasm, infection of the insertion site, cardiac perforation, and, rarely, cardiac arrest.

Left Heart Catheterization

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. Potential complications include dysrhythmias, MI,
perforation of the heart or great vessels, and systemic embolization. Left heart catheterization is
performed by retrograde 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.
After the procedure, the catheter is carefully withdrawn and arterial hemostasis is achieved using manual
pressure or other techniques previously described. If the physician performed an arterial or venous
cutdown, the site is sutured and a sterile dressing is applied.

Immediately before the procedure, you will be taken to the cardiac catheterization lab.

 You will be given medication to help you relax, but you will be awake during the procedure so
that you can follow instructions from the doctor and nurses.
 The doctor will administer freezing to your groin or your wrist.
 A small catheter will be threaded through an artery in your wrist or groin and guided up to the
heart.
 X-ray pictures will be taken and a special dye will be injected through the catheter to highlight
your coronary arteries and identify if there are any narrowed sections or blockages.

o Most patients experience a sensation of body warmth as the dye is injected or the urge to
empty their bladder.
 During the procedure, you may be asked to take a deep breath and hold it for a few
seconds, or to cough.
 It is not unusual to experience some chest pain. Inform the nurse if you experience any
discomfort or have concerns.
 The time for the procedure in the lab is usually 30 to 90 minutes.

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Patient preparation

Nursing Interventions Nursing responsibilities before cardiac catheterization include the following:
The patient is instructed to fast, usually for 8 to 12 hours, before the procedure. If catheterization is to be
performed as an outpatient procedure, a friend, family member, or other responsible person must transport
the patient home.
The patient is informed of the expected duration of the procedure and advised that it will involve lying on
a hard table for less than 2 hours.
The patient is reassured that mild sedatives or moderate sedation will be given IV.
The patient is informed about certain sensations that will be experienced during the catheterization.
Knowing what to expect can help the patient cope with the experience. The nurse explains that an
occasional pounding sensation (palpitation) may be felt in the chest because of extrasystoles that almost
always occur, particularly when the catheter tip touches the myocardium.
The patient may be asked to cough and to breathe deeply, especially after the injection of contrast agent.
Coughing may help disrupt a dysrhythmia and clear the contrast agent from the arteries. Breathing deeply
and holding the breath help lower the diaphragm for better visualization of heart structures. The injection
of a contrast agent into either side of the heart may produce a flushed feeling throughout the body and a
sensation similar to the need to void, which subsides in 1 minute or less.

How you prepare

Cardiac catheterization is usually performed in the hospital. The test requires some preparations. Before
your test:

 Don't eat or drink anything for at least 6 hours before your test, or as directed by your
doctor. Having food or drink in your stomach can increase your risk of complications from
anesthesia. Ask your doctor or nurse if you should take your medications with a small amount of
water.
If you have diabetes, ask for instructions about diabetes medications and insulin. You will usually
be able to have something to eat and drink soon after your test.

 Your doctor may recommend you stop medications that may thin your blood, such as warfarin,
aspirin, apixaban, dabigatran and rivaroxaban.

 Take all your medications and supplements with you to the test. It's best if you take the original
bottles so that your doctor will know the exact dose you take.
Before the procedure

You'll have your blood pressure and pulse checked. You'll also be asked to use the toilet to empty your
bladder.

You'll need to remove dentures and may need to remove jewelry, especially necklaces that could interfere
with pictures of your heart. You'll wait in a preop room until it's time for your procedure — you can often
have someone wait there with you.

During the procedure

Cardiac catheterization is done in a procedure room with special X-ray and imaging machines. Like an
operating room, the cardiac catheterization lab is a sterile area.

Cardiac catheterization is usually performed while you're awake but sedated. However, certain
procedures, such as ablation, valve repair or valve replacement, may be performed while you're under
general anesthesia.

An IV line will be inserted in your hand or arm and will be used to give you any additional medications
you might need during your procedure. You will also have monitors (electrodes) placed on your chest to
check your heartbeat during the test.

Just before the procedure, a nurse or technician may shave the hair from the site where the catheter will
be inserted. Before the catheter is inserted in your artery, you'll be given a shot of an anesthetic to numb
the area. You may feel a quick, stinging pain before the numbness sets in.

After you feel numb, the catheter will be inserted. A small cut is made to access an artery. A plastic
sheath will be inserted in the cut to allow your doctor to insert the catheter.

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