Angiogram
An angiogram is an X-ray imaging technique to visualize the blood vessels used to diagnose and treat a cardiac patient. An angiogram is considered the gold standard for estimating the arteries and veins for the regular flow of blood inside the heart and other parts of the body. During the injection of an angiogram use to determines obstacle in the arterial blood flow system through X-ray technique. Once the blockage identified, it provides information that helps the surgeon to determine for best treatment option such as angioplasty. An Angiogram is typically carried out while the patient is in drowsiness and process duration last almost one hour. It may be longer if the treatment is decided in the same settings in critical condition. In addition, the local anesthetic is used for patient sedation but there is does not need to go sleep. Mostly angiogram is used to identify flow at the coronary angiogram (arteries near the heart), Pulmonary angiogram (lungs), cerebral angiogram (brain), carotid angiogram (head and neck), Peripheral (legs or arms), and aortogram (the aorta) (Saw, J., 2014).
Procedure
A special dye and camera are used in an angiogram procedure to take the picture of blood flowing in an arterial system. During the procedure, a Catheter (a thin tube) is placed into a blood vessel in the groin or just over the elbow. This thin tube guided to the area to be examined. Then a special dye (Iodine dye as contrast material) is injected into the vessels to observe clear area on the X-Ray image. This is angiogram process. An angiogram finds an aneurysm into blood vessels and can see narrowing or any blockage in arterial system that affect the flow of blood. An angiogram can clearly show the coronary artery disease existent and the severances of the disease (Tonino, et al 2010).
Why People go angiogram
Generally, an angiogram is a most common part of heart catheterization procedure. An angiogram is carried out to identify the blood flow problem in vessels. In the following patient’s condition angiogram carried out such as heart failure, aortic stenosis, an irregular heart stress examination, recent heart attack, angina for the first time, atypical chest pain. while patients undergo with other tests are normal, to have heart surgery and at high risk for coronary artery diseases and unstable angina, which is not going away as quickly or more frequently at rest in severity (Mehra, et al 2010).
Role of nurse for the angiogram
As in all surgical protocols, there is the requirement of full attention and concentrations for the surgery. Therefore, appropriately trained and experienced registered nurse plays a vital role for the interventional surgery team. Furthermore, the registered nurse has the account with the additional responsibility of caring for the anxious patient. The procedures are performed in emergent, planned or rescue situations (Mikosch, et al 2010). Over past decades, technological progress, adjuvant treatments and novel indications for stenting have increased the need of registered nurse with expertise. Preparation before the procedure of angiogram nurse enthusiastic and endorsing efficient, safe and operational nursing care through nurturing a mesosphere encouraging to exposed communication, problem explaining and group work establishment with the patient as well as the other staff member of the catheterization labs. Nurse performance in angiogram to reduce anxiety and attain his/her trust and cooperation for the overall process of cardiac catheterization (Warnock, C., Tod, A., Foster, J. and Soreny, C., 2010).
The pre-procedure step involves identifying the person and helping for hand hygiene and following the surgeon order regarding food, labs, fluid, lab and preparation of the site prior to the procedure of angiogram. It is the doctor role to describe the process for coronary angiogram method to patients. However, registered nurse role to assess and make the significant change to others or the patient. Already, develop the complete understanding about the angiogram and the procedure performance. Although, if the patient and others still have significant hesitations, question, concerns, and doubts then refer them to their attending surgeon for further clarifications. So as a registered nurse, check guidelines before the procedure start (Auyeung, V., et al 2011).
Patient Education
Before the cardiac patient undergoes angiogram a pre cardiac catheterization patient teaching plan must be developed and originated. This cardiac angiogram teaching plan must be personalized according to the cardiac patient requirements. As part of the education plan, the cardiac patient should be visited the cardiac catheter laboratory along with cardiac ward nurse. The registered nurse should introduce herself, and advise the patient at what time the technique may occur to the patient and his family. Registered nurse in the cardio ward should evaluate the patient and family awareness as well as the understanding of the process. In addition, deliver additional information as the requirement to satisfy the person and family (Farahani, M.A, et al 2011).
In order to prepare patient mentally for the technique, briefly, describe the procedure of angiogram and what will be situation and feeling of the patient in the catheter lab during a process. The procedure takes 1 to 2 hours to complete and meanwhile patient will be conscious due to local anesthesia. When a dye is injected, patient realized metallic taste and sensation of a hot flash (warmth). Furthermore, some heartbeat skipped or rapid pulse is expected during the procedure generally. A good understanding of the angiogram procedure and anticipated perception lessens nervousness and increase cooperation and trust of the cardiac patient during the procedure (Rawson, K.A., O’neil, R. and Dunlosky, J., 2011).
Register nurse in cardiac ward delivers routine pre procedure care as ordered in the following manner which is part of the teaching plan. The Registered nurse needs to check the patient chart for per angiogram orders. Signed informed consent from the patient and explain what is written in it such as this is the legal requirement for a procedure. In this document all test, treatment or protocols documented as need according to the patient health issue. As a Registered cardiac nurse, develop the patient understanding what will be done and decision makes on your desire. Further explanations include that it is permission from your side to the surgeon to start and continue the procedure of medical care. (Qaseem, A., et al 2012). If the patient is not able to sign then cardiac registered nurse sign the informed consent from the other blood family member of the patient. Before taking sign on informed consent, a nurse must teach and inform the patient and his family about the risk and benefits of the technique. The patient makes sure to obtain all answer of the question from the cardiac nurse in a very good environment. Other pre-angiogram procedure includes blood tests, chest x-ray, circulation monitoring and a Foley catheter and heart monitor (McEvoy, J.W, et al 2011).
Pre-procedure fasting carried out to monitor the patient diet with the help of his family. Suggested cardiac medications administered with a small sip of water except contraindicated. During the procedure, to prevent dysrhythmias or cardiac compromise regular prescribed medicines are continuing. Nurse assess for hypersensitivity to radiologic contrast media such as iodine or any food allergy as seafood. Because an angiogram, typically radiologic contrast dye which is iodine based used for the procedure.( Morton, P.G., et al 2017). The risk of anaphylaxis increase due to iodine or seafood allergy and need an alternative dye with a special precautionary measure. The nurse must record base line assessment data of the patient such as the vital sign, height, and weight. The further nurse must mark the locations of peripheral pulses point, and their amplitude and equality documented. The data deliver a standard for evaluating variation after a procedure (Ryu, M.J., Park, J.S. and Park, H., 2012). The nurse must advise avoiding before going to the cardiac catheterization laboratory for the angiogram to promote comfort to the patient. All documentation of the cardiac patient such as patient education and pre-procedure evaluation should be the dead end of a patient clinical record. A pre-catheterization policy or checklist established as they do for the cardiac patient undergo expected surgery in each institution.
Post –procedure care
After every 15 minutes for the first hour, a cardiac registered nurse should evaluate the vital sign, peripheral pulses, and neurovascular status and catheterization placement point for bleeding. Then these step, a nurse should monitor after every 30 minutes for the next hour and subsequent follow up hourly for four hours or until patient discharge. All patient monitored data recorded through a registered cardiac nurse. The data give crucial evidence about the patient condition and impending complication such as hematoma, hemorrhage, or thrombus development (Hamon, M., Pristipino, et al 2013).
According to suggested instruction by a surgeon, if femoral artery used, a nurse must provide care for a patient as maintain bed rest normally for 6 hours. Moreover, 2 or 3 hours bed rest maintain in case of brachial location used. The head of the bed may be elevated to the extent of 30 degrees because patient bed rest minimized the movement of and resultant pressure in the affected artery (Ryu, M.J., Park, J.S. and Park, H., 2012). These also support to reduce the risk of hematoma and bleeding. The nurse should retain a compression dressing, ice pack, and sandbag, in place above the arterial contact location. In addition to nurse must monitor frequently for hemorrhage in case of the entrance point is in the groin area and also monitor below the buttock bleeding. As the high-pressure system is present in arteries so ultimately the significant bleeding risk is expected after an invasive practice (Rao, S.V., et al 2010).
For 12 to 24 hours, a nurse must follow the instruction to avoid hyperextending and flexing the affected extremity. Therefore, reduce movement of the affected joint permit the artery to effectively seal and improve blood flow, minimizing the risk of hemorrhage, thrombus development, and hematoma. The nurse should promote the liberal fluid intake unless not contraindicated by a surgeon or as per instruction. Because of excessive fluid intake increases the excretion of the injected contrast medium dye. In order to reduce the risk of toxicity particular to the kidney health promotes urination (James, M.T., et al 2011).
As nurse monitor the condition of the patient, if she observes diminished peripheral pulses, enlargement of an existing and formation of the new hematoma, critical discomfort at the entry point or in the pretentious extremity, dyspnea, or chest pain. The nurse promptly reports to the consulting doctor further instruction for reducing the chance of complications. If there is low risk for complication in such situation as insertion place or myocardial infarction complication occurs. These requirements promote intervention placement. Furthermore, registered cardiac nurse must give proper guidance and instruction regarding dressing changes, potential complication prior to discharge and follow up appointments (Olin, J.W., et al 2010).
Post procedure education
The cardiac registered nurse must educate the patient for post care of angiogram with the stent. Normally angiogram is the safe technique with minimal complication. The nurse teaches the patient that if the patient experiences any unusual finding after having the angioplasty. The patient should immediately inform the nurse about a situation because some side effect must to treat in time to avoid complication. In the following condition, the patient should take prompt action such as if there is extra bleeding form point of catheter entrance. After an angiogram, a little bit blood is normal but if the bleeding is persistent or can’t be stopped with minor strapping. Furthermore, if patient notice that there is redness, pain with swelling at the place of catheter insertion. Minor pain usually happens after an angiogram procedure but this pain becomes problematic when the site of a catheter is very painful associated redness and swelling (Hiratzka, L.F., et al 2010).
After discharge from the hospital, a nurse must teach about the subsequent care for recovery from the angiogram with the stent. Furthermore, nurse educates that the patient essential to continue relaxing for almost a week or more. If the patient also had other serious health issues or cardiac problem then need to take rest for prolong time as the patient can do to recover from the procedure. Patient avoids walking up stairs for the week after the angiogram in case of catheter insertion into the patient groin area. In addition, patient escapes any heavy weight lifting or other vigorous actions for the at least first couple of days. After the angiogram with stent procedure, Patient should not drive almost to week or more he can and do not take bath after 24 hours of the procedure. The Registered cardiac nurse should advise patient to take plenty of water to drink for promoting the excretion of toxic radiology material from the body system (Weeks, B.P. and Nilsson, U., 2011).
Registered nurse should advise patient about the prescribed medication and their proper order of dosage administration. Nurse assure that her patient understanding fully developed about his drugs dosage and related precautions for an avoidance of complication and interaction. Furthermore, the nurse instructs for strict adherence to his medication for the speedy recovery. Nurse educates the patient to keep an ice pack on the catheter insertion location to relieve swelling and pain. In addition, the instruction that ice pack should not be kept more than 20 minutes at the time along with over the counter pain reliever. Therefore nurse should educate the patient about the expected life style and eat changes. The patient needs specific changes depending upon the angiogram with stent procedure. Generally, if a patient is a smoker then the patient quit smoking and he will get regular exercise and reduce weight in case of obesity and remain stress-free as he can (Hamon, M., et al 2013).
References
Saw, J., 2014. Coronary angiogram classification of spontaneous coronary artery dissection. Catheterization and Cardiovascular Interventions, 84(7), pp.1115-1122.
Tonino, P.A., Fearon, W.F., De Bruyne, B., Oldroyd, K.G., Leesar, M.A., Ver Lee, P.N., MacCarthy, P.A., Van’t Veer, M. and Pijls, N.H., 2010. Angiographic versus functional severity of coronary artery stenoses in the FAME study. Journal of the American College of Cardiology, 55(25), pp.2816-2821.
Mehra, M.R., Crespo-Leiro, M.G., Dipchand, A., Ensminger, S.M., Hiemann, N.E., Kobashigawa, J.A., Madsen, J., Parameshwar, J., Starling, R.C. and Uber, P.A., 2010. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy—2010.
Warnock, C., Tod, A., Foster, J. and Soreny, C., 2010. Breaking bad news in inpatient clinical settings: role of the nurse. Journal of advanced nursing, 66(7), pp.1543-1555.
Rawson, K.A., O’neil, R. and Dunlosky, J., 2011. Accurate monitoring leads to effective control and greater learning of patient education materials. Journal of Experimental Psychology: Applied, 17(3), p.288.
Farahani, M.A., Sahragard, R., Carroll, J.K. and Mohammadi, E., 2011. Communication barriers to patient education in cardiac inpatient care: A qualitative study of multiple perspectives. International journal of nursing practice, 17(3), pp.322-328.
McEvoy, J.W., Blaha, M.J., Nasir, K., Yoon, Y.E., Choi, E.K., Cho, I.S., Chun, E.J., Choi, S.I., Rivera, J.J., Blumenthal, R.S. and Chang, H.J., 2011. Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population. Archives of internal medicine, 171(14), pp.1260-1268.
James, M.T., Ghali, W.A., Knudtson, M.L., Ravani, P., Tonelli, M., Faris, P., Pannu, N., Manns, B.J., Klarenbach, S.W., Hemmelgarn, B.R. and Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators, 2011. Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography. Circulation, pp.CIRCULATIONAHA-110.
Olin, J.W., Allie, D.E., Belkin, M., Bonow, R.O., Casey, D.E., Creager, M.A., Gerber, T.C., Hirsch, A.T., Jaff, M.R., Kaufman, J.A. and Lewis, C.A., 2010. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 Performance Measures for Adults With Peripheral Artery Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Society for Vascular Nursing, and the Society for Vascular Surgery (Writing Committee to Develop Clinical …. Journal of the American College of Cardiology, 56(25), pp.2147-2181.
Hiratzka, L.F., Bakris, G.L., Beckman, J.A., Bersin, R.M., Carr, V.F., Casey, D.E., Eagle, K.A., Hermann, L.K., Isselbacher, E.M., Kazerooni, E.A. and Kouchoukos, N.T., 2010. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Journal of the American College of Cardiology, 55(14), pp.e27-e129.
Hamon, M., Pristipino, C., Di Mario, C., Nolan, J., Ludwig, J., Tubaro, M., Sabate, M., Mauri-Ferré, J., Huber, K., Niemela, K. and Haude, M., 2013. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology. EuroIntervention, 8(11), pp.1242-1251.
Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2017. Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.
Qaseem, A., Fihn, S.D., Williams, S., Owens, D.K. and Shekelle, P., 2012. Diagnosis of stable ischemic heart disease: summary of a clinical practice guideline from the American college of physicians/american college of cardiology foundation/american heart association/american association for thoracic surgery/preventive cardiovascular nurses association/society of thoracic surgeons. Annals of internal medicine, 157(10), pp.729-734.
Ryu, M.J., Park, J.S. and Park, H., 2012. Effect of sleep‐inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit. Journal of clinical nursing, 21(5‐6), pp.728-735.
Mikosch, P., Hadrawa, T., Laubreiter, K., Brandl, J., Pilz, J., Stettner, H. and Grimm, G., 2010. Effectiveness of respiratory‐sinus‐arrhythmia biofeedback on state‐anxiety in patients undergoing coronary angiography. Journal of Advanced Nursing, 66(5), pp.1101-1110.
Ryu, M.J., Park, J.S. and Park, H., 2012. Effect of sleep‐inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit. Journal of clinical nursing, 21(5‐6), pp.728-735.
