What position should a patient be in after cardiac catheterization?

During the first 6 hours, increase in back pain intensity was lower in the intervention group than in the usual care group (p<0.001), with the intervention group reporting lower levels of back pain at all the 5 pain assessment times. The groups did not differ for incidence of significant bleeding (1 v 4 patients, p = 0.37).

In patients who have had non-emergency coronary angiography, changing their position in bed reduced back pain without increasing the incidence of bleeding from the catheter insertion site.

Conventional care after CATH involving the femoral artery site routinely includes manual or mechanical site compression, keeping the affected extremity straight, and bed rest for 6–24 hours, to prevent bleeding from the insertion site. This care, guided largely by physician discretion or hospital standards, has not been based on empirical studies.

Back discomfort associated with restricted movement and prolonged immobilisation after CATH is a common patient complaint.1 The optimal length of time for bed rest is unknown, and until recently, little was known about the effect of positional change on outcomes. However, Chair et al have extended the findings of a previous study,2 which found that side lying was as safe as the supine position and more comfortable for patients. This result is also consistent with research that shows that elevating the head of the bed by 15–45° after CATH reduced back pain and promoted wellbeing without an increase in vascular complications.1

The combined findings of studies on the effect of positional change will enable nurses to increase patient comfort safely. Altering a patient’s position by 15–45° head elevation and side to side positioning will enhance patient comfort, reduce back pain, and enable them to meet self care needs such as eating, drinking, and voiding. However, early ambulation may be the best strategy to offset back discomfort after CATH. Studies have shown that earlier ambulation (2–4 v 5–6 h after CATH) resulted in greater patient satisfaction with care and no difference in incidence of bleeding complications.3,4,5

Cardiac catheterization (also called cardiac cath or coronary angiogram) is an invasive imaging procedure that allows your doctor to look at your coronary arteries to diagnose coronary artery disease. It can also be used to measure pressures in your chambers, and evaluate the function of your heart.

Instructions for going home after Cardiac Catheterization

Care for the Catheter Insertion Site

Procedures may be performed in the femoral artery in the groin (in the area at the top of your thigh) or in the radial artery in your arm. When you go home, there will be a bandage (dressing) over the catheter insertion site (also called the wound site).

• The morning after your procedure, you may take the dressing off. The easiest way to do this is when you are showering, get the tape and dressing wet and remove it.
• After the bandage is removed, cover the area with a small adhesive bandage. It is normal for the catheter insertion site to be black and blue for a couple of days. The site may also be slightly swollen and pink, and there may be a small lump (about the size of a quarter) at the site.
• Wash the catheter insertion site at least once daily with soap and water. Place soapy water on your hand or washcloth and gently wash the insertion site; do not rub.
• Keep the area clean and dry when you are not showering.
• Do not use creams, lotions or ointment on the wound site.
• Wear loose clothes and loose underwear.
• Do not take a bath, tub soak, go in a Jacuzzi, or swim in a pool or lake for one week after the procedure.

Activity Guidelines

Your doctor will tell you when you can resume activities. In general, you will need to take it easy for the first two days after you get home. You can expect to feel tired and weak the day after the procedure. Take walks around your house and plan to rest during the day.

For femoral cardiac cath

• Do not strain during bowel movements for the first 3 to 4 days after the procedure to prevent bleeding from the catheter insertion site.
• Avoid heavy lifting (more than 10 pounds) and pushing or pulling heavy objects for the first 5 to 7 days after the procedure.
• Do not participate in strenuous activities for 5 days after the procedure. This includes most sports - jogging, golfing, play tennis, and bowling.
• You may climb stairs if needed, but walk up and down the stairs more slowly than usual.
• Gradually increase your activities until you reach your normal activity level within one week after the procedure.

For radial cardiac cath

• Do not participate in strenuous activities for 2 days after the procedure. This includes most sports - jogging, golfing, play tennis, and bowling.
• Gradually increase your activities until you reach your normal activity level within two days after the procedure.

Ask your doctor when it is safe to

• Return to work.
• Resume sexual activity.
• Resume driving. Most people are able to resume driving within 24 hours after going home.

Medications

• Please review your medications with your doctor before you go home. Ask your doctor if you should continue taking the medications you were taking before the procedure.
• If you have diabetes, your doctor may adjust your diabetes medications for one to two days after your procedure. Please be sure to ask for specific directions about taking your diabetes medication after the procedure.
• Depending on the results of your procedure, your doctor may prescribe new medication. Please make sure you understand what medications you should be taking after the procedure and how often to take them.

Fluid Guidelines

Be sure to drink eight to ten glasses of clear fluids (water is preferred) to flush the contrast material from your system.

Importance of a Heart-Healthy Lifestyle

It is important for you to be committed to leading a heart-healthy lifestyle. Your health care team can help you achieve your goals, but it is up to you to take your medications as prescribed, make dietary changes, quit smoking, exercise regularly, keep your follow-up appointments and be an active member of the treatment team.

Follow Up

Your Cleveland Clinic cardiologist will contact your referring or primary care doctor by phone or fax to report the results of your catheterization. Your doctor also will receive a written report from Cleveland Clinic in the mail that will include a general summary of your medical condition including the procedure you underwent, your prescribed medications and care plan. Ask your primary care doctor when you should return for follow-up testing.

Please ask your doctor if you have any questions about cardiac catheterization, angioplasty or stenting.

Learn more about:

Cardiovascular diseases (CVDs) are the leading cause of death globally. An estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. Over three quarters of CVD deaths take place in low- and middle-income countries

Cardiac catheterisation is an invasive procedure indicated in  a wide  variety of  circumstances.  It is used for diagnostic and therapeutic purposes in the management of patients with cardiac diseases The procedure involves a catheter being inserted into a vein or artery and then led into the heart; usually the site of access will be from the groin, neck or throat.

Diagnostic cardiac catheters are inserted so that blood flow and pressure in the chambers of the heart can be evaluated; interventional cardiac catheters are preferred as an alternative to open heart surgery. The procedures that can be carried out when a cardiac catheter is used include (1);

• Closing septal defects; both ventricular and atrial
• Opening new passageways
• Narrow passageway expansion
• Stent placement

Cardiac catheterisation is usually carried out under a general anaesthetic and can have complications despite recent advances in operative techniques. However, statistics show that post cardiac catheterisation complications can still result in poor health and mortality in patients. To reduce the risk of complications, it is advised that specific management and vigilant monitoring is in place for early identification of problems. Healthcare professionals, specifically nurses, are in the best position to be able to identify complications and offer prompt care to patients.

Nurses are the healthcare providers considered to be the most competent in reducing the mortality and morbidity rates for post-operative cardiac catheterisation recovering patients.

Patient assessment

The healthcare provider needs to take in many factors when caring for patients who have had cardiac catheterisation. Firstly, patient history should be assessed. A healthcare provider should be aware of:

• Whether the patient had a diagnostic or interventional cardiac catheter inserted. This is because those who have had interventional cardiac catheter procedures will be at a higher risk of complications. The healthcare provider should also be fully aware of the findings of the procedure and whether there were any complications during theatre.
   
• Whether the patient was taking anticoagulants regularly before the procedure. Although all patients will receive heparin during the procedure, those who are take blood thinning agents beforehand have a higher risk of bleeding. The healthcare provider should also determine which medications have now been prescribed for the patient.
   
• What ‘normal’ cardiac rhythm for the patient was before the procedure took place. This can be found by referring to the pre-procedure ECG charts.
   
• The access site of the catheter, including the position and whether the catheter was arterial or venous.
   
• Age of the patient. Elderly patients and children under the age of one have a higher risk of complications.

Secondly, the healthcare provider should carry out a physical assessment of the patient in order to be aware of any potential complications. The puncture site itself should be routinely assessed to look for bleeding, haematomas, infection, and ecchymosis. Potential complications and management of complications which can occur after a cardiac catheterisation

The risk of major complications of diagnostic cardiac catheterization procedure is usually less than 1%, and the risk and the risk of mortality of 0.05% for diagnostic procedures. For any patient, the complication rate is dependent on multiple factors and is dependent on the demographics of the patient, vascular anatomy, co-morbid conditions, clinical presentation, the procedure being performed, and the experience of the operator.

Possible complications include, but are not limited to:

Bleeding

Bleeding should be monitored from the puncture site to assess patient recovery. If the patient suffers from a violent coughing fit or vomits, immediately check for bleeding. Aim to immediately apply pressure over the puncture site with gauze to achieve haemostasis; this will typically occur within five to ten minutes. Then the patient’s pressure bandage should be reinforced and the doctor should be notified.

Haematoma

The puncture site should be assessed for any swelling, redness, or pain. A haematoma can suggest internal bleeding; therefore again manual compression should be applied to prevent further bleeding. If the patient is being given any heparin infusions, they should be immediately stopped. The patient’s signs of intravascular volume depletion should be assessed. If any signs point towards insufficient cardiac output urgent medical help should be sought. Identification of the bleeding source is essential for patients with continued hemodynamic deterioration. These life-threatening bleeds are more frequent when the artery is punctured above the inguinal ligament. Most patients are managed with a reversal of anticoagulation, application of manual compression and volume resuscitation, and observation.

Arrhythmia

If the arrhythmia presents as something new for the patient, then a doctor should be notified. The healthcare provider should also make sure to assess the patient’s cardiac output, however even if the arrhythmia is already known yet cardiac output is insufficient, immediate medical help should be sought. The patient should also be placed on continuous cardiac monitoring once stable.

Pseudoaneurysm

Pseudoaneurysm Is a potential cause of important femoral bleeding and must be recognized. A pseudoaneurysm develops if a connection persists between a haematoma and the arterial lumen. It presents as a pulsatile mass and the diagnosis is confirmed by ultrasound. Small pseudoaneurysms of less than 2 to 3 cm in size may heal spontaneously and can be followed by serial Doppler examinations. Large symptomatic pseudoaneurysms can be treated by either ultrasound-guided compression of the neck of pseudoaneurysm or percutaneous injection of the thrombin using ultrasound guidance or may need surgical intervention.

Allergic reactions

Allergic reactions can be related to the use of local anesthetic, contrast agents, heparin, or other medications used during the procedure. Reactions to the contrast agents can occur in up to 1% of the patients, and people with prior reactions are pretreated with corticosteroids and antihistamines. The use of iso-osmolar agents decreases the risk compared to high osmolar agents. When severe reactions occur, they are treated similarly to anaphylaxis with intravenous (IV) epinephrine.

General patient care after the procedure

After the procedure, patients may be taken to the recovery room for observation or returned to their hospital room. They will remain flat in bed for several hours after the procedure. A nurse will monitor vital signs, the insertion site, and circulation/sensation in the affected leg or arm. The plastic sheath which was inserted in the patient’s groin, neck, or arm will be removed soon after unless the patient requires specialised blood thinning medication. After the recovery room, the patient should be transferred to a regular hospital or outpatient room. The length of the patient’s stay will be dependent on their condition. Some patients who have had a straightforward procedure may even be discharged on the same day, whereas others who have had an additional procedure such as an angioplasty or insertion of a stent will be required to stay overnight. Patients should be kept lying flat for several hours after the procedure so that any serious bleeding can be avoided and that the artery can heal. It is advised that diagnostic catheterisation patients are kept on bed rest for four hours, and interventional catheterisation patients stay on bed rest for six hours.

The patient is free to move side to side for their comfort. The head of the bed should be at a maximum thirty degree tilt. The patient should be allowed to eat and drink right after the procedure if they wish to.

After the specified period of bed rest has been completed, patients may get out of bed. The nurse will assist patients the first time they get up, and will check blood pressure while lying in bed, sitting, and standing. Patients should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

Patients may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

Patients will be encouraged to drink water and other fluids to help flush the contrast dye from the body. They may resume their usual diet after the procedure, unless the doctor decides otherwise.