Med-Surg - Cardiovascular System, part 5: Diagnostic Procedures, Coronary Angiogram
by Cathy Parkes September 29, 2021 Updated: March 10, 2022 6 min read
This article and video covers cardiovascular diagnostic procedures including a coronary angiogram. The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
An EKG is a procedure that provides a graphic representation of cardiac electrical activity. We go into depth about EKG Interpretation in our EKG Flashcards for Nursing Students and our EKG Interpretation series.
An echocardiogram is a cardiovascular diagnostic exam that uses ultrasound waves to visualize cardiac structures (especially the valves) and measure ejection fraction.
Left ventricular ejection fraction (LVEF) is a measure of the percentage of blood leaving the left ventricle each time it contracts. A normal level for LVEF is 55 - 70%.
Reduced LVEF is indicative of heart failure.
Transesophageal Echocardiogram (TEE)
A transesophageal echocardiogram is a diagnostic exam wherein a transducer is placed down the esophagus for a more detailed view of the cardiac structures. This procedure is done under conscious sedation.
Hemodynamic monitoring provides direct measurement of pressures in the heart and great vessels through an arterial line. This is an invasive procedure. The pressures that can be obtained through hemodynamic monitoring include CVP, PAWP, and CO.
Central Venous Pressure (CVP)
Central venous pressure (CVP) is the pressure in the vena cava near the right atrium of the heart, it's the same as right arterial pressure. A normal level for CVP is 2 - 6 mmHg.
Pulmonary Artery Wedge Pressure (PAWP)
Pulmonary artery wedge pressure (PAWP) is an indirect estimate of left arterial pressure, it's also the same as Pulmonary capillary wedge pressure. The normal range for PAWP is 4 - 12 mmHg.
Cardiac Output (CO)
Cardiac output is a measure of the amount of blood the heart pumps in one minute; it's the heart rate times the stroke volume. A normal level for cardiac output is 4 - 8 L/min.
Coronary Angiogram (Cardiac cath/catheterization)
A coronary angiogram is an invasive procedure used to determine if a patient has a coronary artery blockage or narrowing. In a coronary angiogram, a catheter is inserted into the femoral artery and threaded up to the heart.
There are several nursing care steps to remember for a coronary angiogram, including pre-procedure preparation and post-procedure care.
A patient will need to be NPO (not eat anything) 8 hrs prior to their coronary angiogram procedure. Before the exam, assess the patient for any allergies to iodine or shellfish.
Also, remember to assess kidney function (BUN and creatinine) because if a patient has impaired kidney function, they may not be able to process and excrete the contrast dye as easily which can be toxic.
Assess and mark your patient's distal pulses (dorsal pedis and posterior tibial) for easy comparison post-procedure.
After your patient undergoes a coronary angiogram, check the insertion site for bleeding. Check the patient's extremity, distal to the puncture site, for pulse, capillary refill, temperature, and color. Take your patient's vital signs every 15 minutes four times, then every hour, four times. Your patient will need to lie flat for 4 - 6 hrs after the procedure.
I am Cathy with Level Up RN. In this video, I'm going to wrap up our coverage of diagnostic tests associated with the cardiovascular system. And at the end of the video, I'm going to provide you guys with a little quiz to test your knowledge of some of the information I'll be covering in this video. If you have our medical-surgical nursing, second edition flashcards, definitely pull those out so you can follow along.
Specifically, in this video, we will be talking about procedures that we can use to diagnose disorders of the cardiovascular system.
An EKG or electrocardiogram provides a graphic representation of the heart's electrical activity. And if you are needing help with EKG interpretation, we have a great flashcard deck and a complete video playlist to help you with that. So definitely check that out if needed.
An echocardiogram uses ultrasound waves to help visualize cardiac structures, especially the heart valves. It also measures ejection fraction, so normal left ventricular ejection fraction is between 55 and 70 percent. So if your patient has a reduced ejection fraction, then that would be indicative of heart failure.
We also have a transesophageal echocardiogram, so a TEE. This is where a transducer is placed down the esophagus to provide a more detailed view of those cardiac structures. And this procedure is done under conscious sedation.
Hemodynamic monitoring provides direct measurement of pressures in the heart and the great vessels through an arterial line.
So some of the pressures that we can obtain through hemodynamic monitoring include central venous pressure, which should be between 2 and 6 mmHg.
We can get the pulmonary artery wedge pressure, which should be between 4 and 12 mmHg, and we can also measure cardiac output through hemodynamic monitoring.
Next, let's talk about a coronary angiogram or what is referred to as a cardiac cath.
This is an invasive procedure that is used to determine if your patient has a blockage or narrowing of a coronary artery. And during this procedure, a catheter is inserted at the femoral artery and then threaded up to the heart. So in terms of nursing care, we have pre-procedure and post-procedure, nursing care.
Pre-procedure, we're going to want to make sure our patient is NPO for eight hours or more. We're going to want to assess for allergies to iodine and shellfish. Although I have to be honest with you, there's a lot of data and research to indicate that an allergy to iodine or shellfish does not increase an individual's risk for having a reaction to the contrast dye associated with a cardiac cath. However, most providers still assess the patient for these allergies, and as a nurse and a nursing student, this is definitely important to know as well. So you're going to assess for those allergies to iodine and shellfish. You're also going to assess your patient's kidney function. So you're going to check their creatinine and BUN levels because if the patient has impaired kidney function, then they may not be able to excrete the contrast dye easily, and that can be toxic to the kidneys. In addition, we want to assess and mark their distal pulses so that we can easily find those after the procedure and check their pulses. So you're going to mark that dorsal pitas pulse and that posterior tibial pulse as well.
After the procedure, we're going to want to check the insertion site at the femoral artery for bleeding, and we're going to want to check the extremity distal to that insertion site for pulse, capillary refill, color, and temperature. So we want to make sure we're getting good blood flow down to that extremity. And then we're going to closely monitor the patient's vital signs per facility policy. So this often includes taking vital signs every 15 minutes, four times. So that first hour, you're going to take it every 15 minutes and then after that, you're going to take it every hour for four hours. Again, your facility policy may vary, but we will definitely be closely monitoring their vital signs. And then we also want to encourage our patient to increase their intake of fluids to try to flush out that contrast dye. And we're going to have our patient lay flat for four to six hours after the procedure.
Okay, time for a quiz. I have three questions for you. First question, what procedure uses ultrasound waves to visualize cardiac structures and measure ejection fraction? If you said an echocardiogram, you're correct. Question number two, what lab values are used to assess a patient's kidney function prior to a cardiac cath? The answer is creatinine, as well as BUN. Creatinine being the more important of those two. Question number three, how should a patient be positioned after a cardiac cath? The answer is they need to lay flat, and they need to lay flat for four to six hours after the procedure.
Okay, that's it for this video. I hope it's been helpful. If so, be sure to like this video. Leave me a comment if there are other topics or suggestions you have for me. I definitely want to hear those. In my next video, we will start talking about dysrhythmias, so definitely check that out.
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