PRE PROCEDURAL ASSESMENT

BY :
Ns. AL MASKANAH, S.Kep
CARDIAC CENTER HARAPAN
KITA
JAKARTA
2019
Learning Objectives
• Understand the preparation and assessment pre cardiac
catheterization.
• Review the preparation for cardiac catheterization
✓ Hydration
✓ Concomitant medications
✓ Known allergies
✓ Chronic kidney disease
✓ Diabetes
Aim
• To provide nurses with knowledge and skill set to competently assess a
patient pre catheterization.
• nurses that are competent in the assessment of patient before
catheterization are able to reduce the prevalence of complications post
cardiac catheterization
In Laboratory Assesment
The nurses of cardiac catheterization is responsible for patient preparation before the starts of
procedure.

Preparation of psychological, admisnistration & physical assesment

• Patient identification
• The patient understanding of the procedure
• Confirm that the consent form is signed
• Documentate of the pre catheterization condition note any physical
deficits
• A history of asthma
• Check Blood pressure and all pulses (arm & legs)
Allen test or Barbeau test
is perform to confirm adequate collateral circulation to the palm

Allen test is performed by compressing

both the radial and ulnar arteries
until the palm blanches and then
the ulnar artery is released.
If the color in the palm return
before 10 seconds, blood supply
to the hand via the ulnar artery
and palmar arch is considered
satisfactory.
Barbeau test
Barbeau test is performed by placing
a pulse oximeter on the ipsilateral thumb.
Compress both of the artery until pulse
oximetry trace is blunted. The test is
normal if he pulse oximetry tracing return
to normal within 10 seconds when
releasing the ulnar artery
Dorsalis pedis pulse
• The dorsalis pedis pulse artery palpable at the prominent arch of the
top of the foot between the first and second metatarsal bone
• Check laboratory result (Hb, platelet count, electrolytes, BUN,
creatinine), INR, PTT
• Check ECG baseline
• The patient has ingested nothing solid by mouth before the
procedure
• Check that the IV line is secure & patent
• Check whether premedication were given as ordered
• Shaving the puncture area carefully
Optimal preparation for cardiac catheterization
Several factors need to be considered when preparing a patient for
cardiac catheterization includes :
• Hydration
• Concomitant medications
• Known allergies (contrast)
• History of thyroid disorder
• Chronic kidney disease
• Diabetes
Hydration
Adequate hydration is needed in patients with high risk for contrast-induced
nephrotoxicity, particularly in patients with existing renal insufficiency.

• Intravenous fluid administration if:

– Clinical or biological signs of dehydration
– Renal failure (GFR<60ml/min per 1.73m2)
• Cockcroft-Gault equation:
– GFR = [(140 - age) x BWeight x A] / serum creatinine
(where A=1.23 if male, 1.04 if female)
Mehran et al proposed a risk score for prediction of contrast-induced
nephropathy based on 8 readily-available variables.
Concomitant medication
should be evaluated and adjusted as appropriate .
• Metformin:
– May cause lactic acidosis precipitated by contrast-induced renal
failure.
– Consider interruption if GFR < 60ml/min.
– Some recommend systematic interruption in all cases 24 hours
before PCI
• Warfarin:
– Consider interruption (with or without bridge with LMWH) or prefer
radial access.
Contrast Allergy If a patient is severely allergic to contrast, they may
require an alternative method or treatment
.

• Known allergies (contrast) – type of reaction to a previous

administration of contrast:
Contrast Allergy
In the case of milder known contrast allergy, specific preventative
measures should be taken to avoid or minimize a reaction

• Known allergies (contrast) – prevention:

– Pretreatment with corticosteroïds and anti histaminic agents
– Prefer a low osmolality non-ionic contrast agent
– Rapid recognition of problem and initiation of corrective therapy
Thyroid disorder
Thyrotoxicosis is another potential contrast-induced complication and could potentially be minimized
with prophylactic thyrostatic therapy.

• Iodinated contrast media may induce thyrotoxicosis, particularly in

patients with previous thyroid disorder.
• Define preventive strategy with endocrinologist for each individual
case with known thyroïd disorder
• Short-term prophylactic thyrostatic therapy (900 mg/day of sodium
perchlorate begun the day before cath) seems to have a protective
effect against iodine excess, although mild hyperthyroidism could not
be prevented in some cases.
Chronic kidney disease
is a risk factor for CIN (contrast-induced nephropathy) and requires specific prophylactic measures

• Prevention of contrast-induced nephropathy:

– Hydration
– Withhold potentially nephrotoxic medications
– Acetylcystein (oral dose of 1200 mg the day before and the day of
the procedure)
– Commonly used low-osmolar and isosmolar media are acceptable
– Minimize volume of contrast
Specific guidelines have also been developed to prevent CIN in patients with chronic
kidney disease
Diabetes
Patients with diabetes present unique complexities, requiring on individualized approach and
treatment

• Improving outcomes in diabetic patients undergoing coronary

angiography with glicemic control
• Specific recommendations for diabetic patients include:
- In patient on metformin, renal function should be carefully
monitored after coronary angiography
- In patient with known renal failure undergoimg coronary
angiography , metformin maybe stopped 48 j before the procedure
 Summary
• Several factors need to be considered when preparing a patient for
cardiac catheterization. Optimal preparation for intervention includes:
– Hydration
– Concomitant medications
– Known allergies (contrast)
– History of thyroid disorder
– Chronic kidney disease
– Diabetes