4 Cardiac Catheterization Nursing Care Plans and Management

This nursing care plan guide offers comprehensive care and management strategies for patients undergoing cardiac catheterization. Enhance your understanding of the nursing assessment, interventions, goals, and nursing diagnosis specific to cardiac catheterization to deliver effective care and support to patients throughout the procedure and recovery process.

What is cardiac catheterization?
Nursing Care Plans & Management
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What is cardiac catheterization?

Cardiac catheterization is an invasive procedure that involves the insertion of a flexible catheter into the heart through a vein or artery, typically the femoral vein. It serves diagnostic and therapeutic purposes, often combined with angiography to visualize blood flow using contrast media. This procedure allows for the measurement of blood gases, pressures, and cardiac output, as well as the identification of anatomical defects like septal defects or obstructions. In therapeutic cardiac catheterizations, balloon angioplasty is used to correct issues such as stenotic valves or vessels, aortic obstruction, and closure of patent ductus arteriosus.

Nursing Care Plans & Management

Nursing care planning goals for a child who will undergo cardiac catheterization include promoting adequate perfusion, alleviating fear and anxiety, providing teaching and information, and preventing injury. Close monitoring of a child post cardiac catheterization is also crucial for the early identification of complications that will minimize mortality and morbidity rates.

Nursing Problem Priorities

The following are the nursing priorities for patients undergoing cardiac catheterization:

Promoting adequate tissue perfusion. Patients undergoing cardiac catheterization are at risk for bleeding, vascular injury, and impaired tissue perfusion, necessitating close monitoring to prevent complications.
Preventing injury and infection control. There is a risk of infection at the catheter insertion site or in the bloodstream following cardiac catheterization. Strict aseptic technique, monitoring for signs of infection, and proper wound care are essential to prevent the development of infections.
Reducing fear and anxiety. Many patients experience anxiety and fear related to the invasive nature of the procedure, potential complications, and uncertainty about the outcomes. Providing emotional support, education, and relaxation techniques can help alleviate anxiety and promote a more positive patient experience.

Nursing Assessment

Assess for the following subjective and objective data:

Decreased or absent pulses distal to the catheterization site
Cool, mottled appearance of the affected extremity
Tingling sensation on the affected extremity
Pain
Increased body temperature within a few hours postoperatively
Expressed concern over the impending procedure.
Apprehension
Increased motor activity in children
Inattention
Clinging to parent
Crying
Verbal protests
Withdrawal
Decreased level of consciousness
Increased apical heart rate and decreased blood pressure
Bleeding from the catheterization site
Bruising

Assess for factors related to the cause of cardiac catheterization:

Clot formation at the puncture site
Reaction to the radiopaque contrast substance utilized during catheterization
Fear of needles and fear of exposure.
Invasive, painful procedure
Separation from parents
Risk of harm
Altered hemostasis and trauma from a percutaneous puncture

Nursing Diagnosis

A nursing diagnosis helps in identifying and addressing specific patient needs and responses related to cardiac catheterization. By conducting a comprehensive assessment, nurses can formulate an accurate nursing diagnosis that guides the development of a customized care plan.

Nursing Goals

Goals and expected outcomes may include:

The client’s involved extremities for cardiac catheterization will be pink and warm.
The client’s pulses will be present distal to the catheterization site and equal bilaterally.
The child’s axillary temperature will be less than 100° F.
The child will not cry, cling to parents, or protest.
The child’s parents will verbalize decreased anxiety/concern.
The child will not experience bleeding from the puncture site.
The child’s heart rate and blood pressure will remain within normal limits.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients undergoing cardiac catheterization may include:

1. Promoting Adequate Tissue Perfusion

Promoting adequate tissue perfusion is essential for patients undergoing cardiac catheterization to ensure adequate oxygen supply to the heart and prevent tissue damage. Monitoring vital signs, maintaining proper hydration, and ensuring adequate blood flow to the catheter insertion site can help prevent complications such as bleeding or thrombosis. Proper tissue perfusion is crucial for the success of the procedure and the patient’s overall health and well-being.

1. Assess the affected extremity, noting its color, temperature, and capillary refill; Palpate distal pulses; Use Doppler every 15 minutes 4 times, every 30 minutes for 3 hours, then every 4 hours.
Formation of a clot at the puncture site and the child is at risk of the clots severely obstructing distal blood and resulting in tissue damage. Frequently assessment of the extremity for adequate perfusion enables prompt intervention as needed.

2. Encourage bed rest and keep the affected extremity straight or slight bend in the knee (10 degrees) for 6 hours.
Bed rest and slight, or no flexion, provide improved circulation and minimizes the risk of further trauma which could promote the formation of a clot.

3. Provide warmth to the opposite extremity.
Enhances blood flow without causing the risk of increased bleeding at the site.

4. Inform parents and child of the need for frequent vital signs monitoring and the importance of bed rest with an extension of the extremity.
Promotes understanding and cooperation.

2. Regulating Body Temperature

The contrast medium can cause a reaction in some patients, leading to increased body temperature and increased demand on the heart. Regulating the body temperature is necessary for patients undergoing cardiac catheterization to prevent complications such as hypothermia or hyperthermia, which can negatively impact the patient’s hemodynamic stability and recovery. Close monitoring of body temperature and implementing appropriate interventions such as warming blankets or cooling measures can help maintain the patient’s normal body temperature, optimize hemodynamic stability, and prevent adverse events. Proper regulation of body temperature is crucial for the success of the procedure and the patient’s overall well-being.

1. Assess body temperature every hour for 6 hours and then routine.
Provides information on which action to take.

2. Monitor and record intake and output hourly.
Evaluates the routine adequacy of fluid intake and elimination.

3. Maintain IV fluids while the child is drowsy, and when fully awake, encourage fluid intake per orem.
Increased fluid intake helps to flush out the dye.

4. Instruct parents to encourage PO fluids.
Including parents in the care boosts the probability of achieving the goal.

5. Instruct parents to monitor the child’s temperature at home and notify any elevations after discharge.
Teaching empowers parents to care for their children and helps monitor for hyperthermia.

3. Reducing Fear and Anxiety

Reducing anxiety and fear is important for patients undergoing cardiac catheterization as these emotions can negatively affect the patient’s hemodynamic stability and recovery. Anxiety and fear can also increase the patient’s perception of pain and discomfort during the procedure. Implementing appropriate interventions such as relaxation techniques, counseling, and pre-procedure education can help alleviate anxiety and fear, improve the patient’s overall experience, and optimize their recovery.

1. Assess parents’ and child’s understanding of catheterization and any special fears.
Provides information on parents and child’s knowledge, misunderstanding, and particular concerns; sources of anxiety for the parents include fear and uncertainty over the procedure, guilt and anxiety over the child’s pain, fear of complications, and uncertainty over the outcome; for the child, fears may include separation from parents, fear of the unknown (if the first catheterization), fear of mutilation and death, or remembered fear and pain (if repeat catheterization).

2. Encourage the expression of fears, and clarify any misconceptions or lack of knowledge.
Enables parents and children to express feelings and provides them with accurate, complete information.

3. Prepare the child using age-appropriate guidelines; use concrete explanations just prior to an event for younger children. Include information on what the child will experience through all senses.
Age-appropriate information given to the child allows for greater understanding and reassurance; young children process information through all their senses and need to know what to expect to better cope.

4. Allow parents to accompany the child and be with the child when awake postoperatively.
Children in stressful events adjust well to the presence of their parents.

5. Suggest to parents and child to bring a familiar, comforting item such as a blanket, pillow, or stuffed toy.
A familiar object provides comfort and security to the child experiencing unfamiliar events and surroundings.

6. Provide a rationale for pre and post-catheterization procedures.
Having knowledge and awareness of the reason for each procedure promotes better understanding and acceptance.

7. Inform parents that the child may momentarily act differently at home: may need to stay close to parents, have unpleasant dreams, and be less self-sufficient; encourage parents to comfort and reassure the child, to allow the child to “re-live” the experience through stories or play, and to accept temporary setbacks in development.
Stressful events may cause the child to need extra reassurance and may cause a temporary regression in development as the child reverts to comfortable, familiar “safe” activities; children, like adults, have a need to replay stressful events in order to understand and cope, and this is often accomplished through play activities.

4. Preventing Injury and Infection Due to Contrast Medium

Contrast medium can cause adverse reactions such as allergic reactions or renal failure, and can also increase the risk of infection at the catheter insertion site. Proper administration of the contrast medium, close monitoring of the patient’s vital signs, and appropriate infection prevention measures such as proper hand hygiene and sterile technique can help prevent injury and infection, optimize the success of the procedure, and improve the patient’s overall health outcomes.

1. Monitor vital signs every 15 minutes for 4 times, every 30 minutes for 3 hours, then every 4 hours.
Vital sign changes may reveal blood loss and internal bleeding may be the first indicator of health problems.

2. Gather baseline laboratory results from the pre-catheterization assessment.
Provides comparative data for post-catheterization assessment.

3. Assess the affected extremity, noting its color, temperature, and capillary refill; Palpate distal pulses; Use Doppler every 15 minutes 4 times, every 30 minutes for 3 hours, then every 4 hours.
Formation of a clot at the puncture site and the child is at risk of the clots severely obstructing distal blood and resulting in tissue damage. Frequently assessment of the extremity for adequate perfusion enables prompt intervention as needed.

4. Keep pressure dressing on the catheterization site and assess every 30 minutes for bleeding. If bleeding does occur, apply continuous direct pressure 1 inch above the puncture site and immediately report to the physician.
Direct constant pressure on site is needed to avoid bleeding; no bleeding, even oozing, should happen.

5. Maintain bed rest for 6 hours post-catheterization as ordered.
Bed rest avoids strain to the catheterization site which otherwise might hasten to bleed; an elevation of the head (45-degree) and a slight bend at the knees are acceptable; young children may be held by parents, and this is beneficial in lessening agitation.

6. Keep the affected extremity straight or slight bend in the knee (10 degrees) for 6 hours.
Bed rest and slight, or no flexion, provide improved circulation and minimizes the risk of further trauma which could promote the formation of a clot.

7. Provide warmth to the opposite extremity.
Enhances blood flow without causing the risk of increased bleeding at the site.

8. Inform parents and child of the need for frequent vital signs monitoring and the importance of bed rest with an extension of the extremity.
Promotes understanding and cooperation.

9. Encourage parents and children to engage in quiet activities such as storytelling, and music.
Allows for expression and interaction without physical stress; provides a distraction for comfort.

10. Inform parents and children of the need for periodic monitoring and for bed rest.
Promotes understanding and cooperation.

11. Encourage parents of infants and young children to hold their children as an acceptable option for resting in bed.
Allows parents to be in contact with and comfort their child in a more normal manner; this minimizes episodes of agitation, thereby encouraging more rest.

12. Instruct parents to observe and notify any sign of bleeding immediately. Educate parents that pressure dressing will be removed after 24 hours and that they should continue to assess the site and report to the physician if any bleeding is noted.
Increases close monitoring of the site.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
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Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
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Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
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All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
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