The Technique of Performing Cardiac Catheterization
Cardiac catheterization should be performed or supervised only by experienced operators in properly equipped laboratories. Before carrying out any interventional procedure the patient should be informed on the method of execution, the risks and benefits of the procedure. The written consent of the patient must be obtained and documented according to protocols. All protocols consent should include the possibility of performing an intervention in emergency need. It is necessary to know the patient’s indications to the respective procedure. It should also be known any change in symptoms or medical event produced after the establishment indication and until surgery. Medical concomitant diseases that must be considered and evaluated pre-procedural are listed as follows: clotting disorders, history of stroke, chronic renal failure, diabetes mellitus, peripheral vascular disease, hypertension, anemia, thrombocytopenia, cancer, liver disease, known allergy to contrast substance, heparin-induced thrombocytopenia, cardiac catheterization or surgical history.
Pre-procedure evaluation of the patient involves resuming to the history of the patient and to examination objective. It should be noted signs of heart failure: pulmonary rales, jugular turgor, noise 3 or significant edema. Determination of peripheral pulse pressure and possible murmurs is extremely important because it influences the choice path name and serves as a standard of comparison for assessing possible vascular complications post-procedural.
The necessary laboratory tests should include complete blood count (the number of platelets), serum electrolytes and creatinine. They must be recent (from the last 2-4 weeks) and repeated pre-procedural in cases when there was a change in symptoms, medication or the patient has been exposed to the contrast substance in the meantime. In patients with liver disease, chronic oral anticoagulation or hematologic disorders, it is necessary and determining the prothrombin time or INR. Women at the reproductive age should perform determination of serum or urinary human chorionic gonadotropin B, 2 weeks before the procedure.
The electrocardiogram pre-procedure is useful as reference to subsequent post-procedural routes. Should also be noted electrical signs of ischemia, myocardial infarction, arrhythmias and cardiac cavities abnormalities. Echocardiographic data on systolic and diastolic function, valvular significant abnormalities of the aorta should also be recorded. If you previously performed a stress test should be noted the territories ischemia and necrosis.
Patient preparation consists of: cleaning local venous access line, emptying the stomach 2-6 hours before the procedure, pre and post-procedure hydration.