GUIDE OF INFORMATIONS REGARDING A

PATIENT SUBMIT TO CORONARY ANGIOGRAM,

ANGIOPLASTY AND STENT
Date: 30 / 09 / 2021
 1. INTENTION / PURPOSE
The aim of this booklet is to provide guidelines to the staff referred to the information/
answers, to give to patients / relatives regarding the cardiac catheterization.

2. GLOSSARY/ TERMS/ DEFINITIONS

PLEASE complete with Definition you think are important

3. GUIDELINES

3.1 Angiogram

What is an angiogram?

 An angiogram, also known as a cardiac catheterization or angio, uses X-ray pictures to look at the
function of your heart, the coronary arteries and heart valves.

3.2 Before the procedure

 During the appointment the procedure will be discussed with the patient and any questions will
be answered and consent taken.
 Maybe the patient will do during appointment or after, same complementary exams as blood or
an ECG if necessary.
 If patient female she must not undergo this test if she are pregnant or thinking there is a
possibility of being pregnant so by safety a pregnancy test will be done.
 Patient will be informed regarding the date of the procedure.
 The day before the cardiac catherization nurse will contact the patient to remember the
instructions and clarify any kind of doubt.

3.3 Patient Information

3.3.1 What medication must the patient not take before my test?

3.3.1.1 Warfarin, Dabigatran, Rivaroxaban, Apixaban:

Patient must stop taking the drugs listed above four days before your test (unless instructed
otherwise).

3.3.1.2 Metformin, Glucophage:

Patient must stop taking these one day before your test, and then can re-start the diabetic tablets two
days after the procedure .

3.3.1.3 Diuretics (water tablets):

Not take them on the morning of your test.

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 3.3.1.4 Insulin:

Patient should take your insulin as normal with the breakfast.

All other tablets that patient usually take in the morning must be taken with breakfast except the
medication suspended by the physician because of the procedure ( eg. Warfarin)

3.3.2 When do I stop eating and drinking before the test?

The patient may eat and drink as normal until 4/6 hours before the time of procedure

3.3.3 What do I need to do before coming into hospital?

3.3.3.1Transport

Patient will need to have someone to bring you to hospital and also to take you home again.

Usually, patients having an angiogram go home on the next day.

3.3.3.2 Items to bring in

Advise the patient to bring an overnight bag, with toiletries and nightwear, just in case you need to stay
overnight.

It is also essential that the patient bring all your medication , as the nursing staff and doctors will need
to see them

If patient wear nail varnish or false nails, please advise to remove them before coming into hospital.

Instruct patient do not use any bath oil or moisturizing body lotions or creams on the day of admission,
because this causes difficulty in sticking the ECG pads onto your skin to monitor your heart during the
procedure.

Instruct the patient to:

 remove all items of jewelry with the exception of your wedding ring.
 to not bring in any valuables or large amounts of money.

3.3.4 What happens when the patient arrive at the hospital?

Patient must report to main reception on the ground floor. The receptionist will direct him to the Ward
and they will provide you with the necessary paperwork.

Patient will be met by a nurse or support worker who will be looking after him.

A doctor and the cardiac cardiac laboratory nurse nurse will come to explain the angiogram and the
possibility of an angioplasty and stent to the patient. He/she will ask you to sign a consent form agreeing
to have the procedure done, if you have not already signed one when you attended the pre-admission
clinic.

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To the patient will be asked to put on a hospital gown and disposable underwear or a disposable patient
suit. A cannula (needle) will be inserted into the back of the left hand or arm.

3.3.5 How is the angiogram done?

 Patient will be taken by a nurse or support worker to the cardiac catheterization laboratory
allocated at Operating Room, where the test is done.
 This room is kept at a cool temperature because of the hi-tech equipment, television screens and
monitoring equipment.
 Will be asked to the patient to transfer on to the X-ray table, which is quite narrow, and he will be
connect to the heart monitor, saturation and blood pressure.
 After, the wrist or groin will be cleaned with an antiseptic lotion and then patient will be covered
by sterile drapes. A local anaesthetic will be injected to numb the area where the tube will be
inserted. Once the injection has taken effect patient should not feel any discomfort or pain at the
wrist or groin. If the procedure is done from the wrist patient may feel a sensation of the catheter
(narrow tube) passing up the arm, but usually this is not painful.
 Different catheters are used to look at the heart, dye is then injected down the catheter and
pictures are taken using X-rays. Patient will notice that the X-ray machine will move close to his
chest and will also move towards his head and from side to side, this enables a complete picture
of the heart, arteries and valves to be taken.
 Instruct that patient may notice a hot flush feeling when the dye is injected. This feeling will last
for about thirty seconds. Extra heart beats (palpitations), but this is perfectly normal.
 At time of inject contrast patient may have the sensation of having passed water but is only a
sensation.
 The procedure will take around thirty minutes. At the end of the test, the tube will be removed,
and the small hole sealed.
 If the wrist was used for the angiogram, a wrist band will be applied for between two – four hours
and then replaced with a small dressing.
 If the groin is used, then the catheter will be removed under manual pressure for at least 15
minutes and after a small dressing will also be applied. Patient will instruct to rest at bed at least
for six or eight hours.

3.3.6 What happens after the test?

The physician will examine the pictures that have been taken of your coronary arteries.

They will discuss the results with patient.

If angioplasty and stenting is required, then it may be offered at the same time as the angiogram.

3.3.7 What is an angioplasty?

An angioplasty is a treatment to improve blood supply to the heart, by stretching the

artery and reducing the narrowing with a balloon.

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3.3.8 What is a stent?

A stent is a small metal tube, which is inserted into the once narrowed artery. It acts as a support or
scaffolding to the blood vessel.

The Physician performing the procedure will decide which type of stent is required, depending on your
condition and pattern of narrowing in the arteries. Drug eluting stents tend to reduce the chance of
further narrowing developing within the stent.

3.3.9 How is the angioplasty and stent implantation done?

The procedure will take approximately thirty minutes to two hours, depending on the number of
narrowing’s in the artery or if more than one artery requires treatment.

A fine wire is passed through the guiding catheter and through the narrowing in the artery. A balloon is
then passed over the fine wire and into the narrowing. Once in position, the balloon is inflated for a few
seconds. This causes the fatty material to be compressed against the wall of the artery. In most cases, a
stent will also be inserted.

The scaffold is inserted on a balloon which is then expanded to hold the artery open.

Further balloons may be inflated to ensure that the stent is adequately fixed in place.

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When the required result has been achieved, the balloon, wire and guiding catheter will be removed.

If the wrist was used for the angiogram, a wrist band will be applied for between two – four hours and
then replaced with a small dressing.

If the groin is used, then the catheter will be removed under manual pressure for at least 15 minutes and
after a small dressing will also be applied. Patient will instruct to rest at bed at least for four or six hours.

3.3.10 Patient Information

During the procedure patient may experience angina-type pain when the balloon is being inflated,
similar to what you have been experiencing at home. This is due to the balloon temporarily blocking the
flow of blood through the artery. In most cases the pain is mild, but if you feel uncomfortable instructed
the patient to let the doctor or nurse know so that they can give you pain relief.

Following insertion of the stent, a thin film of cells grows over and lines the stent surface. Until this
happens there is a small risk of blood sticking to the stent which could then result in the artery blocking.
To prevent this you will be started on a drug called Clopidogrel, which will significantly reduce the risk of
a clot forming on the metal struts of the stent.

It is essential to instruct the patient to not stop taking your Clopidogrel following your procedure.

If any doctor asks you to stop taking Clopidogrel, please ask them to contact your cardiologist to discuss
their reasons.

3.3.11 What happens after the procedure?

After procedure the patient will return to the ward, where:

 May need to remain in bed for between half an hour and four hours but in some cases may be
able to get up and about immediately
 Blood pressure and pulse will be taken. The nurse will check the pulse in your wrist or feet
depending on where the test was performed, and the wound site will be checked.
 If the test was done at the groin, it is important that patient keep the leg straight to reduce the
chance of bleeding or bruising
 If the test was done from the wrist, patient should be able to mobilize more quickly but will need
to take care not to disturb the wrist band
 The Physician will discuss the results of your test with you before you go Home.
 The nurse will discuss the discharge instructions with patient and family and also will give
education regarding the pos care procedure, lifestyle changes, medications or others

3.3.12 What advice to be given before going home?

Will be given advice by the nurse and an information sheet about the care after procedure.

A relative or friend must take patient home

Patient will need to rest for 48 hours after the test before returning to normal activity.

The return to work will depend of patient, procedure and nature of the job.

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3.3.13 Patient Information

Remove the dressing after 24 hours; you do not require a further dressing on the insertion site. this is
not unusual notice some bruising or discoloration at the site

Keep the insertion site clean and dry.

Take pain killers if you feel that you require them

Avoid driving for the first 48 hours, as you may put pressure on the groin or wrist

3.3.14 Instructed the patient to contact hospital if any concerns or need further advice.

Reinforce to the patient that if bleeding occur from the catheter insertion site, he must apply direct
pressure to the groins or wrist and call 9999 , immediately .

Reinforce to the patient that chest pain occur and not go away in 15 minutes after medication call 9999 ,
immediately .

Policy /SOP Title:

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 Policy / SOP Number:

Name: Isabel Paulo

Prepared By: Signature:

Date: 30/09/2021

Name: Jose Batista

Reviewed By: Signature:

Date: 12/12/2021

Name:

Reviewed By: Signature:

Date:

Name:

Approved By: Signature

Date

Revision control
VERSIO
Status Revision Date Summary of Changes Author
N
1

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