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    Nursing Care in Hemodynamics

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    Nursing care for hemodynamic procedures or cardiac catheterizations is described.

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    © All Rights Reserved
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    Nursing Care in Hemodynamics

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    3 views27 pages
    Nursing care for hemodynamic procedures or cardiac catheterizations is described.

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    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    Nursing care for hemodynamic procedures or cardiac catheterizations is described.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3 views27 pages

    Nursing Care in Hemodynamics

    Uploaded by

    ScribdTranslations
    Nursing care for hemodynamic procedures or cardiac catheterizations is described.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 27

    Nursing care in

    Patients undergoing
    Procedures in
    Hemodynamics… A

    EU Carolina Pérez Sepúlveda.


    Intermediate Cardiovascular
    Medical-Surgical.
    National Thorax Institute.
    Essential Activity.
    MEDICAL INTERMEDIATE-
    CARDIOVASCULAR SURGICAL
    (POC )

    ■ Medical team: Cardiologists and Cardiac surgeons.

    ■ Medical residence: 24-hour shift system.

    ■ Nursing team: 8 nurses on 4th shift.

    ■ Technician team: 16 nursing assistants on the fourth shift.

    ■ 13 beds with monitoring.


    ■ Enter this unit:
    TRANSFERS
    ICU:
    EXTERNAL INCOME
    OPERATED WITH AND INTERNAL

    MORE THAN 24 HRS. FROM


    POLYCLINIC
    PACEMAKER
    yes
    Post EEF and
    HEMODYNAMICS
    HEMODYNAMICS UNIT
    LABORATORY BENEFITS
    OF HEMODYNAMICS
    ■ Elective coronary angiography.

    ■ Emergency coronary angiography.

    ■ Elective angioplasty.

    ■ Emergency angioplasty.

    ■ Valvuloplasty.

    ■ Aortic endoprosthesis.

    ■ Percutaneous ASD closure and


    Foramen Ovale.
    PROCEDURE
    CARDIAC
    HEMODYNAMIC
    CATHETERIZATION
    LEFT
    ■
    Diagnostic
    procedure, in
    Coronary angiography. which a liquid-

    ■ Ventriculography.
    opaque contrast
    medium visible to

    ■
    X- rays is
    arterial puncture
    introduced,
    Aortogr
    through
    radial
    puncture
    aphy. femoral

    ■
    with a catheter,
    with which it is
    Bypass study. possible to obtain

    ■ Peripheral
    arteriography.
    humeral a real-time image
    of the anatomy
    and activity of the
    Access - (

    ■ Aortic endoprosthesis.
    heart.
    cI A g é },
    Hume ral, —4—

    Radial Access
    F ainoraJ
    CARDIAC CATHETERIZATION
    RIGHT
    Right probe.
    Oximetry. Venous
    Measurement of cardiac puncture
    output.
    Pulmonary arteriography.
    Pulmonary valvuloplasty.
    Mitral valvuloplasty. Artery
    monar
    Endomyocardial biopsy. Come Left lung

    Closure of CIA. Subclav

    Adenosine test. Right


    ventri
    SMPT installation. cle

    Com
    e
    ?
    to,
    Half
    Basil
    Hypogastric
    vein——-—
    NURSING CARE
    PREVIO

    Adm.
    medications Bath with
    6 hour fast emphasis on Hair cutting if
    7:00 AM.
    the inguinal necessary.
    area.

    Suspension of
    HGO in DM TACO
    plus IC No makeup
    suspension
    scheme. and no Previous (medical
    prosthetics. urine indication)
    NURSING CARE
    PREVIOUS

    Preparation Heparin venous route


    kidney BIC peripheral Add inhaler if
    according to according asthmatic.
    left arm
    indication and to medical
    with indication.
    protocol.

    History of
    allergies.
    Moved to
    Premedication
    Creatinine Hemodynami
    according to and Current cs
    protocol. Coagulation. in
    stretcher.
    PREVENTION PROTOCOL
    NEPHROTOXICITY BY
    CONTRAST MEDIUM (CM)

    High risk groups: IR associated or not with DM.


    DM alone

    does not increase the risk.

    ADA.M.
    KIDNEY PREPARATION:
    HYDRATION
    L
    Normal kidney function: Ingestion of 500 cc. of liquid in the
    hours. prior to the exam and another 2500 cc. in 24 hours.
    following.

    L
    With creatinine above normal values: 0.9% physiological saline
    at 1 ml/Kg/hr (in ICC: 0.5 ml/Kg/hr), started 12 hrs. before and up
    to 12 hrs. after the study.
    Precautionary
    measures:
    •• CM with low osmolority or
    even isosmolar in renal patients.
    (RELIEV-VISIPAQUE OMNIPAQUE)
    . •Use less amount of MC.

    •If multiple interventions are


    0.5mg/dL required, they should be deferred
    for at least 2 weeks, with creatinine
    or 25% with respect monitoring between procedures.
    to
    to the basal, during • Disco
    48 to 72 hours ntinue
    use of
    post-procedure. NSAIDs before and after the
    procedure.

    Stenosis in the Artery Radiological Image of


    Right Coronary Catheterization
    PREVENTION PROTOCOL
    NEPHROTOXICITY BY
    CONTRAST MEDIUM (CM)
    HIGH RISK PATIENT
    ■ In addition to preventive measures consider;

    ■ N-acetylcysteine protocol: 600mg every 12 hours. to be


    ingested the day before and on the day of the study (total of 4
    doses).

    ■ With creatinine greater than or equal to 3.0 mg/dL: consider


    hemofiltration protocol in the ICU, started 4 hrs. before the study
    and until completing 18-24 hrs. post-exam.
    ■ Always strictly monitor serum creatinine level and ELP for up
    to 10 days.

    ANTICOAGULATION

    ■ Oral anticoagulation will be suspended 48 hours before the


    procedure and in the case of patients with cardiac prostheses it will
    be replaced by heparin in ICP.

    ■ Heparin in BIC will be suspended before catheterization


    according to medical indication, and in the case of low molecular
    weight Heparins the last dose will be administered 24 hours the night
    before.
    ALLERGIC REACTION TO MC
    Premedication scheme
    suggested
    Methylprednisolone: 32 mg v/o 12 hours. and 2 hrs. before the
    administration of MC and antihistamine 1 hour before.

    Prednisone: 50 mg v/o 12 hours. and 1 hr. before the administration


    of MC and antihistamine 1 hr. before.
    NURSING CARE
    DURING THE
    PROCEDURE

    Reception
    and deliver
    Hemodynamic from patients to
    monitoring. others
    hospitals and
    POC.
    NURSING CARE
    DURING THE
    PROCEDURE
    To coordinate
    Education to income
    Know rules Observe from others
    of protection adverse patient and centers
    radiological. reactions to assistance and
    family
    MC transfers within
    about use of of the units
    of the INT.
    clopidrogel.
    CLOPIDROGEL
    Aggregation inhibitor
    platelet
    □ Agreement with patients belonging to the Eastern Metropolitan
    Service, to whom the INT gives clopidrogel for one month.

    □ Every patient who undergoes PTCA with a Stent must receive


    Clopidrogel for at least one month.

    □ Therapy starts with 8 tablets immediately after the procedure. Then


    continue with one daily.
    NURSING CARE
    POST-PROCEDURE
    Reception Maintain
    of the patient compression
    with token, Repose according to °
    report hour guideline
    procedure and½then
    every hour for 2
    and CDs. - times (puncture
    radial)

    Observe site
    puncture,
    (edema, Keep
    Observe
    ecchymosis, tip
    dressing
    hematoma, aloft.
    (bleeding)
    bleeding)
    NURSING CARE
    POST PROCEDURE
    Puncture
    femoral, Notice
    remain C e o r nt P no u s n v c it i a o allergic rush,
    e ro n l le
    n s femoral; Regime broncho spasm,
    rest until keep according to laryngeal edema
    next day, with weight. doctor. hypotension
    do not flex vague reaction Maintain
    Nexttremity. hydration
    parenteral in
    patients
    kidneys.

    Feedback
    Abundant Diabetics.
    liquids. Control with
    HGT.
    Start diabetic
    therapy.

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