Francis Anthony B.

Losloso, RN
Cardiac Catheterization
(Patent Ductus Arteriosus and Angiogram)

Minimally invasive procedures such as cardiac catheterization may be indicate to

some patients. It is less invasive than open heart surgery wherein a small incision will be
done and catheters and guidewires may be inserted in and out of the vessels to the heart.
The catheterization lab comprises of multi-disciplinary team which involves the
interventionists, electrophysiologists, radiologic technician, nurses and other members of
the health care team. During procedures, the patient may be under intravenous sedation.

The first room we entered is equipped with a biplane machine that can view 2
presentation at the same time given its name (biplane). With the help of that machine, it
serves as the eyes of the interventionist inside the patient’s blood vessels on its way to
the heart. There are a lot of monitors needed to do the procedure. It was entirely different
from the operating room which requires different skillset.

Babies who were born with congenital heart defects such as patent ductus
arteriosus may undergo cardiac catheterization. Under normal circumstances, this vessel
closes naturally or becomes tiny within the first few days of life. However, in some babies
particularly those born prematurely, this hole remains open. Some oxygen-rich blood
returns back in the lungs instead of going to the rest of the body. I find it very fortunate
for me to witness a PDA (patent ductus arteriosus) case in which the interventional
cardiologist showed me the device/ mesh that will be placed and act as a plug. The
mechanism of it is that through the femoral vein, a catheter will be inserted guided by x-
ray imaging. It will be followed by an occlusion device (coil) through the catheter and into
the baby’s PDA. The most commonly used device for very small babies is the Amplatzer
Piccolo Occluder device. It is made of nitinol wires that allow it to return to its shape after
passing through the delivery catheter Once in place, this device will block the vessel and
stop blood from flowing into the lungs. Finally, doctors will carefully remove the catheter
and cover the access point at the groin with a small bandage. Transcatheter PDA closure
usually takes an approximate time of 45 minutes. After the procedure, the baby will be
carefully monitored in an intensive care unit. Continuous monitoring of vital signs,
presence of dysrhythmias and other cardiovascular parameters will be done to facilitate
and interventions will be done until the baby’s recovery.

Diagnostic procedures such as an angiogram may also be done inside the cardiac
catheterization lab. A coronary angiogram is a dye test used to detect heart problems.
A long, thin flexible tube catheter is inserted into the patients wrist or groin and guided
towards the heart. Once in position, a dye is injected and x-ray pictures are taken. The
special dye allows the x-rays to capture pictures of the coronary arteries and highlights
where any blockages or narrowed spots may be. It can also look at the condition of heart
valves and muscles.

Pre-procedure must ensure that patients was able to sign consent forms, patients
will be asked to maintain NPO to prevent GI complications and aspirations. It is also
important to assess for allergies because dyes may contain allergens. Ensuring that
patient is has laboratory or other diagnostic results ready for reference, if abnormal
findings are present, corrections may be done such as electrolyte management and
anemia management if present as well as bleeding parameters. During the procedure,
ensuring the proper site has been marked, patient has been confirmed to be the right
patient and skin care will be done. Securing images such as x-ray may be posted at the
wall or negatoscope for reference during surgery and ensuring that instruments and other
supplies and needs are readily available. After surgery, vital signs will be monitored and
monitoring for signs and symptoms of bleeding is a must. A 6 pound sand bag will be
placed in the incision site (groin) to facilitate pressure and prevent bleeding tendencies.
Patient will remain flat on bed for a certain period of time and results will be discussed
afterwards.

Nurses in critical and special areas should be equipped not just with basic but with
advanced nursing skills especially advanced cardiovascular life support. Whatever the
nature of work is, from diagnostics, surgery and critical care, one should be an expert.
Even experienced nurses require to obtain such skill because even stable patients
undergoing cardiac procedures may become unstable and may lead to cardiac arrest or
other complications. To be a nurse in charge of a unit, one must be equipped with good
decision-making skills and knows everything, the ins-and-outs of the area because it does
not only involve 2 profession but instead, it involves multi-disciplinary professionals. In
the absence of one role, the nurse may take over roles to fill-in gaps so that the
intervention or procedure may push through. Good communication skills must also be
possessed by the nurse in charge to properly coordinate channels among inter-
professionals.

As advanced nurse practitioner, nursing interventions must be performed properly

and appropriately, but the focus of being an cardiovascular specialist is on how to assess,
diagnose, plan, intervene and evaluate the effectiveness of care is. Determining the
etiologies and risk factors, thorough history taking and physical assessment to correlating
diagnostic findings with clinical presentation will help make the management more tailor-
fit to each patient. Moreover, it does not actually focus more on the disease process but
how to prevent or at least slow down the disease process patients are experiencing.
Creating health education programs and evaluating are the weapons of each
cardiovascular nurse specialist.