PCI Care Questions and Answers

PCI Care Questions and Answers What is PCI (Percutaneous Coronary Intervention) Is open up the arteries to restore blood flow. This includes all interventions such as PTCA (angioplasty) and stents What types of PCI are there? Emergent Urgent Scheduled Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:05 / 0:15 Full screen Brainpower Read More What is the timeframe for emergent PCI? Which types of heart condition(s) is this for? How long do you stay in the hospital? Straight to cath lab. GOAL is to open blocked artery within 90 minutes of arrival to facility. (Door to balloon time) First line of treatment with confirmed MI; STEMI 1-3 days What is the timeframe for urgent PCI? Can you wait? Which types of heart condition(s) is this for? Requires prompt intervention; within 12-72 hrs May prolong to optimize pt condition. NSTEMI and unstable angina Nurse will establish IV access, draw labs, 12 lead EKG (should have already been done to confirm STEMI), possibly prep groin sites Do you give thrombolytics to PCI patients? What is the timeframe of administering thrombolytics? Thrombolytic of choice? ^Only if the facility the pt went to does not have PCI capabilities. ^Administer within 30 minutes of arrival. ^ TPA (true clot buster) URGENT PCI Nursing Care Start heparin gtt while waiting to go to cath lab Push IV fluids pre/post op. Flush contrast out of kidneys Watch kidney function, especially if pt is CKD or CHF Hold metformin and resume 48 hrs later (possibility of causing lactic acidosis and acute nephropathy) Contrast preperation: corticosteroids, benadryl, sodium bicarbonate to help with allergic reactions NPO after midnight (6-12 hrs) *Get baseline kidney function established for comparison after interventions Nursing responsibility for Cardiac Cath Before: check for sensitivity to contrast media. Withhold food and fluids for 6-12 hrs before procedure Explain the procedure including local anesthesia at insertion site, placement of catheter Flushed sensation when dye is injected Heart flutters as catheter passes Pt may be asked to cough or take a deep breath when dye is injected. Continuous cardiac monitoring Give sedative and other drugs as ordered After cath: Frequently assess circulation to extremity used for cath insertion Check periphreal pulses, color, sensation of extremity, Observe insertion site for hematoma and bleeding Place compression device over arterial site to achieve hemostasis Monitor VS and EKG Assess for hypotention/hypertension Assess for dysrhythmias Assess for respiratory distress: PE! What is the timeframe for a scheduled PCI? SCHEDULED! lol Can be outpatient or inpatient, just need a positive stress test and/or unexplained chest pain patient may even go home same day (only for very low risk patients and typically only transradial approach) What does the nuse need to do preoperatively for PCI? Access to 2 IV lines (unstable patient, better to have multi-access) Mark peripheal pulses (to find later) Insert foley catheter (bed rest/not done much now) Cont. telemetry monitoring (if NSTEMI could turn in to (STEMI) Administer medications; MONA, heparin gtt, iv fluids, corticosteroids + Benadryl ( if contrast sensitivity) Educate patient and family on procedure and post-op What does the nurse need to do postoperatively for PCI? Keep affected limb straight for prescibed amt/time (could be +- 4 hrs- risk for tearing artery and sitting up can put pressure on the groin) Maintain bed rest and reduce physical activity until prescribed HOB 30 degrees (femoral approach) Neurovascular checks: periphreal pulses, catheter insertion site, color, sensation of affected extremity: Q15x4, Q30x2, Q1hx4 Frequently observe puncture site for hematoma, bleeding Monitor VS and EKG **CLOSELY monitor for chest pain 2 RN's for sheath removal (hold pressure for 15-20 minutes d/t bleeding) Delegate to LVN - PCI care Give drugs before and after procedure Assess neurovascular status of involved extremity every 15 min for the first hour, then titrate as policy Check for bleeding at catheter site every 15 minutes for the first hour, then titrate as policy Report changes to RN: neurovascular and/or bleeding Delegate to UAP- PCI care Take VS and report increase/decrease in HR, BP to RN Report decrease in O2 sat Report patient complaints of chest pain, SOB, other discomfort/distress Assist with oral hygiene, hydration, meals, toileting Record oral I/O Perform related skills as ordered (blood sugars) What are some PCI complications? Dissection of the newly dilated coronary artery; s/s hypotension and tachycardia (ie: tamponade, ischemia, MI, decreased CO, death) Abrupt closure of vessel can occur in first 24 hrs Coronary artery spasm from mechanical irritation of catheter or balloon **Restenosis- risk is greatest first 30 days s/s chest pain and EKG changes (usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed) Hematoma/bleeding at insertion site What are some post-op considerations for PCI? Assess for possible retroperitoneal bleeding (s/s flank pain and hypotension) caused by leakage of blood from femoral artery. Blood collects in the peritoneal cavity and exerts pressures on tissues within the space. Symptoms are usually vague and easily misinterpreted as normal discomfort after the procedure. Early signs include flank or lower abdominal pain, lower back pain, and possibly leg or flank bruising. Late symptoms are more obvious and include hypotension, tachycardia, and obvious drop in hemoglobin. Assess for cardiac tamponade (s/s DROWNED; Hypotension, JVD, Distant/muffled heart sounds) Lifelong antiplatelet drugs, Aspirin, clopidogrel, ticagrelor, prasugrel (meds will be used to help keep the stents patent) Coronary Artery spasm drugs: Nitrates, Calcium channel blockers Arrthymias (short spurts of V Tach) Possible MI post-op Some patient teaching for PCI? Teach patients to report sensations of warmth, pain, wet feeling, obvious frank bleeding from insertion site. Splint area if they have to cough/laugh/sneeze Most serious complications will involve restenosis or tamponade but more common complications will arise from insertion site bleeding Need to teach about movement restrictions and follow-up appointments where HCP will either lift or modify physical restrictions S/S to report (Hematomas can occur days after procedure) Teaching for long-term management is largely aimed at medication compliance and modifiable risk factors (Think back to teaching about CAD) May need cardiac rehab