MEDICAL SURGICAL NURSING

CLINICAL PRESENTATION ON,

ANGIOPLASTY.

SUBMITTED BY SUBMITTED TO

MS.ALMA SUSAN PROF.MAYA P JOSEPH

MSC.N MTCON
GENERAL OBJECTIVE

On completion of the class, the students will acquire knowledge about angioplasty and develop positive attitude towards rendering care to patients undergoing
angioplasty and apply this knowledge and skill in caring patients after angioplasty.

SPECIFIC OBJECTIVE.

 Explain the meaning.

 define angio plasty.
 Enlist the indications
 Describe the contra indications of angioplasty
 Listdown the equipment’s needed
 Describe types of angioplasty.
 Explain the procedure
 Explain the complications
 Describe the nursing management.
 Conclude the topic.
tim Specific content Teacher Learner Av evaluati
e objective activity s aids on
activity
To introduce
the topic INTRODUCTION. Lecture Listens
Angioplasty is a medical technology used unblock blood vessels, most commonly the cum
coronary artery. Angioplasty is an minimally invasive medical procedure that involves discussio
inserting a small wire with a balloon at the end into an blocked blood vessel. Inflation of the n
balloon opens up the blockage. Two types of angioplasty include balloon and balloon with a
stent.
Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty
(PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed
arteries or veins, typically to treat arterial atherosclerosis

A deflated balloon attached to a catheter (a balloon catheter) is passed over a guide-wire

 into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the
blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent
may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is
then deflated and withdrawn. Angioplasty has come to include all manner of vascular
interventions that are typically performed percutaneously.

Explain the MEANING

meaning. In the term angioplasty, “angio” means blood vessel, and “plasty” is opening up. In PCI, the
“P” stands for percutaneous or “through the skin” while coronary refers to the location of
blood vessels around the heart. Angioplasty is a conventional treatment for coronary heart
disease (CHD) and heart attacks (acute coronary syndrome).
Define
define angio DEFINITION. angiopla
plasty. Angioplasty is the mechanical widening of a narrowed or totally obstructed blood vessel. Lecture sty
These obstructions are often caused by atherosclerosis. cum
discussio
Angioplasty is a minimally invasive procedure performed to improve blood flow in the n
body's arteries and veins and is usually performed in an interventional radiology suite

INDICATIONS
Enlist the 1. Narrowing of large arteries (aorta and its branches) due to atherosclerosis , or hardening
indications other arteries, a gradual process in which cholesterol and other fatty deposits, called plaques, What all
build up on the artery walls. are the
2. Peripheral artery disease (PAD), a narrowing of the arteries in the legs or arms. In patients indicati
with PAD, angioplasty alone or angioplasty with stenting may be used to open up a blocked ons of
 artery in the pelvis, leg or arm. angiopla
3. Renal vascular hypertension, high blood pressure caused by a narrowing of the kidney sty
arteries. Angioplasty with stenting is a commonly used method to open one or both of the
arteries that supply blood to the kidneys. Treating renal arterial narrowing is also performed in
some patients to protect or improve the kidney function.
4. Carotid artery stenosis , a narrowing of the neck arteries supplying blood to the brain.
5. Coronary artery disease, a narrowing of the coronary arteries that carry blood and oxygen to
the heart muscle.
6.Venous narrowing involving the central veins (in the chest, abdomen or pelvis). In some
cases, stenting of the narrowed vein is also needed.
7. Narrowing in dialysis fistula or grafts. When there is decreased flow in the graft or fistula
making it inadequate for dialysis, angioplasty is generally the first line of treatment. Stenting Lecture
or stent grafting may also be needed in some case cum
8. Before a bypass surgery. discussio
n
CONTRAINDICATIONS
• Allergy to contrast (dye) medium Whicjh
Describe the • Uncontrolled Blood Pressure (Hypertension) all are
contra • Problems with blood coagulation (Coagulopathy) the
indications of • Kidney failure or dysfunction contra
angioplasty • Severe anemia indicati
• Electrolyte imbalance ons of
• Fever angiopla
• Active systemic infection sty
• Uncontrolled rhythm disturbances (arrhythmias)
 • Uncompensated heart failure
• Transient Ischemic attack

EQUIPMENTS NEEDED Enlist

Listdown the Room equipment: C-arm, monitoring device, couch, the
equipment’s ECG Procedure equipment: equipma
needed ◦ Sheath nts
◦ wire needed
◦ catheter for the
◦ stent procedu
◦ Balloon re?
Extension: inflator, contrast media, saline flush, nitro-glycerine, needle, syringe, gauze,
alcohol swap

 Sheath: is a plastic tube with a tap on one end. It usually measures 2–3 mm (1/8 inch)
in diameter. Once the sheath is in place, the balloons and stents are all passed through
this sheath.

 Wire: used to provides extra strength and stability during catheter placement . Used
two type stiff for chronic condition and floppy for acute condition

 Catheter : medical devices that can be inserted in the body to treat diseases or perform
a surgical procedure ◦ There is a two types of catheter: (diagnostic and therapeutic)

 Stent: A stent is a small mesh tube that's used to treat narrow or weak arteries. A stent
 is placed in an artery as part of a procedure called percutaneous coronary intervention
(PCI), also known as coronary angioplasty. PCI restores blood flow through narrow or
blocked arteries. A stent helps support the inner wall of the artery in the months or
years after PCI.

There are two type of stent: drug eluting and bare metal. The amount of restenosis at
drug eluting is less than bare metal because it has a drugs inside it avoid restenosis and
active as healing material .

 Balloon: Interventional cardiologists perform angioplasty, which opens narrowed

arteries. They use a long, thin tube called a catheter that has a small balloon on its tip.
They inflate the balloon at the blockage site in the artery to flatten or compress the
plaque against the artery wall. Angioplasty is also called percutaneous transluminal
coronary angioplasty (PTCA)

DIFFERENT KINDS OF ANGIOPLASTY

Describe Coronary Angioplasty /Percutaneous Coronary Intervention (PCI) What all
types of • Is a therapeutic procedure to treat the stenotic coronary arteries of the heart found in are the
angioplasty. coronary heart disease. These stenotic segments are due to the build-up of cholesterol-laden types of
plaques that form due to atherosclerosis angiopla
Peripheral Angioplasty/Percutaneous Transluminal Angioplasty (PTA) sty?
• Most commonly done to treat narrowings in the leg arteries, especially the common iliac,
external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat
narrowings in veins
Renal Artery Angioplasty/Percutaneous Transluminal Renal Angioplasty(PTRA)
 • Atherosclerotic obstruction of the renal artery can be treated with angioplasty.
• Renal artery stenosis can lead to hypertension and loss of renal function.
Carotid angioplasty
Carotid angioplasty and stenting are procedures that open clogged arteries to restore blood
flow to the brain. They're often performed to treat or prevent stroke. 
Venous angioplasty.
Venous angioplasty is a procedure done to treat vein blockages. Large veins that are narrowed
or blocked can cause severe swelling and pain. Sometimes a metal mesh tube called a stent
Explain the may also be placed into the vein to hold it open. What is
procedure the
PROCEDURE procedu
PRE PROCEDURE : PATIENT PREPARATION re?
◦ Patients may be required to be admitted to the hospital the night before the procedure. For
some patients, overnight stay is not required. (Nil per oral [NPO] or nothing to eat or drink by
mouth 6-8 hours before the test.)
◦ The cardiologist will explain the procedure and risks associated with it.
• Consent form should be signed before the procedure.
• Any questions or doubts should be asked and clarified with the doctor before surgery.
◦ The doctor should be informed of allergies to medications, iodine or food. It should also be
documented legibly in the patient’s chart.
• Previous allergic reactions to contrast dyes must be mentioned.
◦ Catheterization procedure requires X- ray fluoroscopy. Women patients in childbearing age
can undergo pregnancy test to rule out pregnancy.
◦ Medications that are taken on the day of cardiac catheterization should be discussed with the
doctor. Some medicines taken for blood thinning (e.g., Aspirin), erectile dysfunction
(Sildenafil or Tadalafil) or diabetic medication (metformin) needs to be stopped on the day or
few days before the procedure.
• Kidney disease should be assessed before, as contrast materials or dyes may not be used in
patients with abnormal kidney function. ◦ Some blood tests and electrocardiogram (ECG) will
be performed before the procedure.
• A mild sedative will be given orally or intravenously to comfort the patient and relieve
anxiety.
• All personal belongings and jewelry will be removed and patient will be dressed in a hospital
gown before being transported to the catheterization laboratory.
Protection
◦ lead apron of .5 mm lead equivalent is worn during the procedure .
◦ lead glass radiation shielding is used

PROCEDURE
◦ A nurse or technologist will insert an intravenous (IV) line into a small vein in your hand or
arm.
◦ A small amount of blood will be drawn before starting the procedure to make sure that your
kidneys are working and that your blood will clot normally. A small dose of sedative may be
given through the IV line to lessen your anxiety during the procedure.
◦ The area of the groin or arm where the catheter will be inserted is shaved, cleaned, and
numbed with local anesthetic
◦ The radiologist will make a small incision (usually a few millimeters) in the skin where the
catheter can be inserted into an artery
◦ Your surgeon will be able to see your artery with live x-ray pictures. Dye will be injected
into your body to show blood flow through your arteries. The dye will make it easier to see the
 blocked area.
◦ Your surgeon will guide a thin tube called a catheter through your artery to the blocked area.
◦ Next, your surgeon will pass a guide wire through the catheter to the blockage.
◦ The surgeon will push another catheter with a very small balloon on the end over the guide
wire and into the blocked area.
◦ The balloon is then filled with contrast fluid to inflate the balloon. This opens the blocked
vessel and restores blood flow to your heart.
◦ A stent may also be placed in the blocked area. The stent is inserted at the same time as the
balloon catheter. It expands when the balloon is blown up. The stent is left in place to help
keep the artery open. The balloon and all the wires are then removed.

Access to coronary artery: Radial artery-Brachial-Axillary-Subclavian-Ascending aorta-

Coronary artery
The other access is femoral artery: its rare entrance and for patient with renal disease

POST PROCEDURAL CARE:

Pressure dressing is applied to the procedural site.
Explain the Drink plenty of fluids to help flush your body of the contrast dye. Which
complication Avoid strenuous exercise and lifting heavy objects for at least a day afterward. all are
s the
STENTS. complic
Stents are used in the process of angioplasty so as to make the cross-section of the blood ations?
vessel wider and thereby curing the blockages in the vessel. The blockages in the blood vessel
may be very harmful. Stents hold the walls of the vessel and thus not let it sag or it’s area to
shrink.
 REQUISITES FOR STENTS.
The materials used in coronary stents must be flexible, supportive, capable of expansion, and
biocompatible.
The ideal coronary stent surface does not cause a reaction in the human body.
It should be quite resistant to corrosion.
Must be strong enough to bear the pressure.
Easy to manufacture.
PROS AND CONS OF STENT.

Explain
the
nursing
manage
ment?

Describe the
nursing
management.

RISKS.
◦ Allergic reaction to the drug used in a stent that releases medicine into your body
◦ Allergic reaction to the x-ray dye
◦ Bleeding or clotting in the area where the catheter was inserted
◦ Blood clotting in the legs or the lungs
◦ Damage to a blood vessel
◦ Damage to a nerve, which could cause pain or numbness in the leg
◦ Damage to the artery in the groin, which may need urgent surgery
◦ Heart attack
◦ Infection in the surgical cut
◦ Kidney failure (higher risk in people who already have kidney problems)
◦ Misplacement of the stent
◦ Stroke (this is rare), arrhythmias and maybe death.
COMPLICATIONS.
◦ Blood Clots
◦ Restenosis
◦ Infection
◦ Heart or Vessel Damage
◦ Bleeding

NURSING MANAGEMENT.
 Observations of blood pressure (BP), heart rate, respirations and temperature should be
recorded at a frequency recommended by local policy and according to the patient’s
condition. Initially this usually involves the measurement of BP, pulse and respirations
every 30 minutes, and temperature every four hours.
 When the patient returns to the ward or department following the procedure, cardiac
monitoring should be commenced to detect any arrhythmias, and the patient should be
observed for signs of chest pain. A 12-lead electrocardiogram should be recorded to
Conclude the identify any changes which could indicate the presence of ischaemia or stent occlusion.
topic.  The limb that has been used for the procedure needs to be closely monitored for signs
of poor arterial circulation. Colour and warmth of the limb should be checked. Pulses,
distal to the puncture site, should be monitored at regular intervals to ensure adequate
blood flow. For example, foot pulses should be checked if a femoral approach is used.
The nurse will also need to observe the puncture site itself for signs of haematoma or
bleeding.
 Patients may experience pain from the puncture site and discomfort from their
prolonged period of immobility, so analgesia may be required.
 All potential bleeding sites will need to be closely monitored, and the infusion itself
will need to be managed correctly.
 Once the activated clotting time is within an acceptable range, the arterial sheath may
be removed by a doctor or nurse who has received specific training in this procedure.
When the arterial sheath is removed from the artery, direct pressure is applied until
haemostasis is achieved. Pressure can be applied manually or by the application of a
compression device designed for this purpose, for example, a Femstop. After removal
of the sheath, the nurse must carry out regular observations of blood pressure, pulse,
temperature and circulation to the affected limb.
 The patient should lie flat for two hours following sheath removal (though this time
limit may vary according to local policy and consultant preference) as movement could
dislodge any newly formed clots and cause bleeding
 The removal of the sheath and subsequent pressure on the patient’s groin can activate
the parasympathetic nervous system, resulting in a drop in the patient’s heart rate and
blood pressure. Therefore, 500mcg of atropine sulphate is needed if these symptoms
occur.
NURSING DIAGNOSIS.
1. Acute Pain related to tissue trauma and prescribed post procedure
immobilization 
INTERVENTIONS.
a. Assess the patient’s pain every 2-4 hours
b. Assist the patient with re-positioning techniques as needed to help alleviate pain.
c. Educate the patient and his wife on 4 benefits of quitting smoking for the heart by
discharge.

d. Verbalized and demonstrate to the patient and his wife how the patient needs to take
his new medications by discharge.

2. Ineffective Peripheral Tissue Perfusion related to Clot formation at the puncture

site
INTERVENTIONS
a. Assess affected extremity, noting its color, temperature, and capillary refill; Palpate
distal pulses; Use doppler every 15 minutes for 4 times, every 30 minutes for 3 hours,
then every 4 hours.
b. Encourage bed rest and keep affected extremity straight or slight bend in the knee (10
degrees) for 6 hours.
c. Provide warmth to the opposite extremity.
d. Inform parents and child of a need for frequent vital signs monitoring and importance
of bed rest with an extension of the extremity.
3. Hyperthermia related to Reaction to the radiopaque contrast substance utilized
during catheterization
INTERVENTIONS.
a. Assess body temperature every hour for 6 hours and then routine.
b. Monitor and record intake and output hourly.
c. Maintain IV fluids while the PATIENT is drowsy, and when fully awake, encourage
fluid intake.
d. Instruct parents to encourage PO fluids.
e. Instruct parents to monitor temperature at home and notify any elevations after
discharge.
4. Risk for injury
5. Anxiety
CONCLUSION.
Percutaneous coronary interventions are a reasonably safe and effective treatment for patients
experiencing the symptoms of coronary heart disease. It is more affordable, requires fewer
resources and is less traumatic than coronary artery surgery.
Angioplasty is a standard, minimally invasive procedure that doctors use to unblock clogged
arteries and improve blood flow in the heart. It is generally a safe procedure, although arteries
can become blocked again, and there is a small risk of significant complications in some cases

BIBLIOGRAPHY.
1. https://www.nursingtimes.net/clinical-archive/critical-care/percutaneous-coronary-
intervention-08-07-2003/
2. https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-
20384761
3. Google.com/search?
q=angioplasty+procedure+steps&tbm=isch&ved=2ahUKEwjAjNaVsbzoAhXShuYKH
 aqzDSYQ2-cCegQIABAA&oq=ANGIOPLASTY+PROCEDURE+STE&gs_lcp
4. https://en.wikipedia.org/wiki/Angioplasty
5. https://www.slideshare.net/doctorjain1973/percutaneous-coronary-interventions-
simplified