Interventional Cardiology, Electrophysiology and Cardiac Surgery: Peri-Procedural Nursing Care
Before the procedure
Verify consent, allergies, renal function, anticoagulation, and fasting status. Mark distal pulses and document baseline neurovascular status. For PCI, dual antiplatelet therapy is usually required. For EP studies and ablation, anticipate arrhythmia induction and possible sedation.
After the procedure
Monitor access site, distal pulses, color, warmth, sensation, and movement. Femoral access requires bed rest and close observation for bleeding, hematoma, retroperitoneal hemorrhage, and pseudoaneurysm. Radial access reduces bleeding but requires hand perfusion checks. Complications include stroke, MI, arrhythmia, contrast nephropathy, and infection.
Cardiac surgery
Postoperative care focuses on hemodynamics, bleeding, arrhythmias, ventilation, pain, sternal precautions, and early mobility. Low cardiac output, tamponade, and bleeding are emergencies. Pacemaker/ICD care includes site checks, device interrogation, and avoiding strong magnets.
Traps
Severe back pain or flank pain after femoral catheterization may signal retroperitoneal bleeding. Not all post-PCI chest pain is ischemia. Do not delay reporting an expanding hematoma.
Worked example
After femoral access, check the site and distal pulse every 15 minutes for four checks, then every 30 minutes for two, then hourly, following policy.