PTCA

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PTCA

• Sanaa. Makahleh
• 18.2.2011

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Objectives

• What is Angiography ( PTCA).?
• How should I prepare?
• How is the procedure performed?
• What will I experience during and after the
  procedure?
• What are the benefits vs. risks?

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What Is Coronary Angioplasty?

• Over time, a fatty substance called plaque can
  build up in your arteries, causing them to harden
  and narrow this condition is called
  atherosclerosis.
• Coronary angioplasty is a procedure used to open
  blocked or narrowed coronary (heart) arteries.
• The procedure improves blood flow to the heart
  muscle.

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Angioplasty is a common medical procedure. It may
be used to

• Improve symptoms of CHD, such as angina and
  shortness of breath. (Angina is chest pain or
  discomfort.)
• Reduce damage to the heart muscle caused by heart
  attack. A heart attack occurs if blood flow
  through a coronary artery is completely blocked.
• Reduce the risk of death in some patients.

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Other Names for Coronary Angioplasty

• Percutaneous coronary intervention (PCI)
• Percutaneous intervention
• Percutaneous transluminal angioplasty
• Percutaneous transluminal coronary angioplasty
• Balloon angioplasty
• Coronary artery angioplasty

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How Is Coronary Angioplasty Done?
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Blood vessel with arthrosclerosis treated with
balloon angioplasty Coronary stent
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Preparation before the procedure

• Cardiologists do coronary angioplasties at
  hospitals.
• Doctor will take a medical history (including
  the medicines you take), a physical exam, and
  explain the procedure.
• some routine tests, such as blood tests, an EKG
  (electrocardiogram), and a CHEST X Ray.
• Consent form

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• If the patient smoke he should quit, as smoking
  increases the risk of getting a wound infection
  and slows recovery.
• You should inform your physician of any
  medications you are taking and if you have any
  allergy, especially to contrast material/ dye
• Also inform your doctor about recent illnesses
  or other medical conditions.

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• You may be asked to remove some or all of your
  clothes and to wear a gown during the exam.
• You may also be asked to remove jewelry,
  dentures, eye glasses and any metal objects or
  clothing that might interfere with the x-ray
  images.

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• Women should always inform their physician and
  x-ray technologist if there is any possibility
  that they are pregnant.
• If an x-ray is necessary, precautions will be
  taken to minimize radiation exposure to the baby.
  

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• If you are breast feeding at the time of the
  exam, you should ask your radiologist how to
  proceed.
• It may help to pump breast milk ahead of time
  and keep it on hand for use after contrast
  material has cleared from your body, about 24
  hours after the test.

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Once the angioplasty is scheduled, your doctor
will advise you

• When to begin fasting (not eating or drinking)
  before the procedure. Often you have to stop
  eating and drinking by midnight the night before
  the procedure.
• What medicines you should and shouldn't take on
  the day of the angioplasty.
• When to arrive at the hospital and where to go.

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• Even though angioplasty takes only 1 to 2 hours,
  you'll likely need to stay in the hospital
  overnight or longer.
• Your doctor may advise you not to drive for a
  certain amount of time after the procedure, so
  you may have to arrange for a ride home.

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What To Expect During Coronary Angioplasty

• Coronary angioplasty is done in a special part of
  the hospital called the cardiac catheterization
  laboratory. The "cath lab" has special video
  screens and x-ray machines.
• In the cath lab, pt lie on a table. An
  intravenous (IV) line will be placed in your arm
  to give you fluids and medicines. The medicines
  will relax you and prevent blood clots .

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• To prepare for the procedure, the area where your
  doctor will insert the catheter will be shaved
  and then numbed ( local anesthesia).
• During angioplasty, you'll be awake but sleepy
• ( conscious sedation).

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• You will not feel the catheter in your artery,
  but when the contrast material is injected, you
  may have a feeling of warmth or a slight burning
  sensation.
• The most difficult part of the procedure may be
  lying flat for several hours. During this time,
  you should inform the nurse if you notice any
  bleeding, swelling or pain at the site where the
  catheter entered the skin.

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• You may resume your normal diet immediately after
  the exam.
• You will be able to resume all other normal
  activities 8 to 12 hours after the exam.

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• Provide patient with proper information they need
  about wearing of elastic stoking to prevent blood
  clots forming due to immobility after the
  procedure.
• Patient can take over-the-counter painkillers
  such as paracetamol.
• Advice about how the pt can improve his diet and
  lifestyle.

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The Procedure

• The doctor will use a needle to make a small
  hole in an artery in your arm or groin.
• A thin, flexible guide wire will be inserted
  into the artery through the small hole.
• The needle is then removed, and a tube called a
  sheath is placed over the guide wire and into the
  artery.

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• Video with animation
• Angioplasty
• stinting

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What To Expect After Coronary Angioplasty

• After coronary angioplasty, pt will be moved to
  a special care unit.
• He stay there for a few hours or overnight.
• He must lie still for a few hours to allow the
  blood vessel in your arm or groin (upper thigh)
  to seal completely.

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• Nurses will check pt heart rate and blood
  pressure.
• They also will check your arm or groin for
  bleeding.
• After a few hours, pt will be able to walk with
  help.
• The place where the catheter (Sheath) were
  inserted may feel sore or tender for about a
  week.

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Going Home

• How much activity or exercise pt can do.
• When he should follow up with his doctor.
• What medicines you should take.
• What you should look for such as a signs of
  infection around the area where the sheath was
  inserted.
• When he should call his doctor. For example, you
  may need to call if you have shortness of breath
  a fever or signs of infection, pain, or bleeding
  .

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• Your doctor will prescribe medicine to prevent
  blood clots .
• Taking your medicine as prescribed is very
  important.
• If you got a stent during angioplasty, the
  medicine reduces the risk that blood clots will
  form in the stent.
• Blood clots in the stent can block blood flow and
  cause a heart attack.

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• Lifestyle changes may include
• Changing your diet.
• Quit smoking
• doing physical activity regularly.
• losing weight or maintaining a healthy weight.
• Reducing stress.

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What Are the Risks of Coronary Angioplasty?

• Bleeding from the blood vessel where the
  catheters were inserted.
• Blood vessel damage from the catheters.
• An allergic reaction to the dye given during the
  angioplasty.
• An arrhythmia (irregular heartbeat).
• The need for emergency coronary bypass grafting .

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• Damage to the kidneys caused by the dye used.
• (Acetylcysteine medication ) improve renal
  function before the angioplasty
• Heart attack .
• Stroke .
• Sometimes chest pain can occur during angioplasty
  because the balloon briefly blocks blood supply
  to the heart.

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• The risk of complications is higher in
• People aged 75 and older.
• People who have kidney disease or diabetes .
• People who have poor pumping function in their
  hearts.
• People who have extensive heart disease and
  blockages in their coronary (heart) arteries .

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Sheath Removal Care Post Percutaneous
Transluminal Angioplasty (PTCA)

• Arterial sheaths will be removed by designated
• personnel, or a cardiologist.
• When
• No hematoma will develop at sheath site.
• Patient will maintain adequate perfusion to
  affected extremity.
• Discontinue heparin drip, as per doctor order.

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• Verify that dressing supplies are available -
  4x4 elastoplasts.
• Have 0.9 NS IV infusion set up.
• Have Atropine available as per doctor order.
• Why ?

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• Monitor HR, B/P and O2 saturation q 10 minutes x
  30 minutes immediately after sheath removal.
• Follow your hospital policy.
• Then monitor vital signs q 15 minutes x 1 hour,
  then q 30 minutes x 1 hour, then q 1 hour x 2
  hours.
• Assess circulation, motion and sensation to both
  feet.
• Apply PRESSURE to site not less than 30 minute
  and as per doctor order. ( FemoStop).

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• FemoStop / Gold Compression Assist Device
• The FemoStop Gold Compression Assist Device
  includes an integrated digital manometer and
  transparent, inflatable dome that offer precise,
  hands-free femoral artery or vein compression.
• Compared to manual compression, FemoStop Gold
  has been shown to help achieve homeostasis
  quicker and more comfortably, while helping to
  improve staff efficiency.

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• Maintain bed rest while pressure is in place.
• No bending of groin is permitted. May turn side
  to side for back care.
• May resume diet, per doctor order.
• Obtain 12-lead EKG.
• Notify your doctor for
• a. Absent or diminished pulse in affected limb.
• b. Presence of a hematoma.
• c. Symptomatic bradycardia or other arrhythmia.
• d. Bleeding at insertion site.
• e. Recurrence of chest pain.

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Sheath Removal Care Post Percutaneous
Transluminal Angioplasty (PTCA)

• PATIENT TEACHING
• Reinforce need for no bending of affected limb,
  frequent vital signs and pulse checks, bed rest
  per doctor order post sheath removal.
• Instruct patient to report any numbness,
  tingling or acute pain of affected limb, or
  right/left lower quadrant abdominal pain.

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• Reinforce the following to patient
• a. Signs and symptoms of bleeding or hematoma.
• b. Dont strain while you are on bed.
• c. Use a pillow as a splint for coughing.
• d. Dont strain to start urine stream.
• e. RN will monitor puncture site for redness,
  swelling, hardness or abnormal drainage.

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Side-effects of angioplasty

• These are the unwanted, but mostly temporary
  effects of a successful treatment.
• Chest pain while the balloon is being inflated in
  the artery and some pain or bruising where the
  catheter was inserted.
•  
•  

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Complications of angioplasty

• The possible complications of any operation
  include an unexpected reaction to the anesthetic,
  excessive bleeding or developing a blood clot,
  usually in the leg deep vein thrombosis.
• Specific complications of angioplasty are rare
  but can include the following

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• The treated arteries gradually re-narrowing.
• If this happens the angioplasty may need to be
  repeated. Stents may help to slow down the
  narrowing.
• Some people can have an allergic reaction to the
  dye used in the angiogram.
• Bleeding at the insertion site, retroperitoneal
  bleeding or hematoma.
• Arterial thrombosis and distal embolization.

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• The angioplasty may need to be repeated straight
  away or emergency coronary artery bypass graft
  surgery may be needed to bypass the affected
  veins.
• The tip of the catheter can dislodge a clot of
  blood or fatty plaque from the wall of a blood
  vessel. It's possible for these to block an
  artery leading to the heart or brain, causing a
  heart attack or stroke.

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In summary the complications are

• Serious complications needs emergency
  interventions
• Coronary spasm, restonosis, and thrombosis.
• Bleeding Hematoma at site of vascular
  cannulation.
• compromised blood flow to involved extremity.
• Contrast induced renal failure.
• Dysrhythmias
• Vasovagal response

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• Reference
• Burns, S. Chulay, M. (2006). Essential of
  Critical Care Nursing. American Association of
  Critical Care Nurses. McGraw Hill