Cardiovascular Invasive Procedures and Patient Care
Core concepts
The invasive-procedure domain tests whether you can move a patient safely through the cath lab: pre-procedure assessment, informed consent, site preparation, intra-procedure monitoring, and post-procedure hemostasis and complication recognition. Know the indications and basic steps of right and left heart catheterization, coronary angiography, PCI with balloon and stent, and structural interventions such as TAVR and ASD/PFO closure.
Pre-procedure priorities include verifying allergies (especially iodinated contrast and shellfish), renal function, anticoagulation status, and fasting. Review baseline labs-creatinine, hemoglobin, platelets, and coagulation studies-because contrast load and bleeding risk drive planning. Obtain and document informed consent, including risks of bleeding, infection, arrhythmia, contrast reaction, and, for arterial access, limb ischemia.
Intra-procedure, the nurse or technologist monitors hemodynamics, rhythm, sedation, and anticoagulation (ACT for heparin dosing during PCI). Post-procedure care centers on access-site surveillance: assess pulses, color, warmth, sensation, and bleeding; maintain bed rest per protocol; and watch for hematoma, pseudoaneurysm, retroperitoneal bleed, or arteriovenous fistula. Recognize contrast-induced nephropathy risk and hydrate per orders.
Traps
Questions often test which complication matches which sign. Back or flank pain with hypotension after femoral access suggests retroperitoneal hemorrhage, not a simple groin hematoma. A pulsatile groin mass with a bruit suggests pseudoaneurysm. Loss of distal pulse with pain and pallor suggests arterial occlusion. Also distinguish vasovagal reactions (bradycardia, hypotension, diaphoresis) from contrast allergy (urticaria, bronchospasm).
Rule of thumb
Match the sign to the site: groin swelling = local bleed; flank/back pain + hypotension = retroperitoneal; cool pulseless limb = occlusion; hives/wheeze = allergic reaction.