cardiac catheterization:

This information is provided exclusively for Queen's Heart patients. Please review this infomation carefully before arriving for your test.

Preparing for the Procedure

• All medications or drugs you take including: prescriptions, over the counter herbals, street drugs and alcohol.
• Let them know if you are allergic to iodine. The x-ray dye used during the procedure contains iodine. If needed, you will be given medication to help prevent and allergic reaction.
• If you have any kidney problems or are on hemodialysis.
• Do you smoke tobacco, if yes, how much per day.
• Any problems you have such as any angina you feel, shortness of breath, indigestion, or being tired all the time.

Your cardiologist will take time to explain the risks and benefits of the procedure.

• Bleeding from or infection of the catheter insertion site.
• Infection at the catheter insertion site.
• Allergic reaction to the x-ray dye.
• Abnormal heartbeat (arrhythmia).
• Tearing of the artery.
• Kidney damage or failure.
• Heart attack, stroke, or death (very rare).
• The need for emergency cardiac surgery (very rare).

• Clearing a narrowed or blocked artery without having open heart surgery.
• Decreased risk for having a major heart attack.
• Improved blood flow reducing damage over time to heart muscle.
• Reduced chest pain/angina with activity.

Before the Procedure

• Do not eat or drink after midnight before your procedure.

• Take your medicine as prescribed by your doctor with a sip of water. Your doctor may prescribe new medicine, or may ask you to stop certain medicines prior to the procedure.

• Please arrange for a ride home after the procedure as you will be sleepy from the medicine you received and you will also not be able to use your leg or arm for activity.

• Please pack a small overnight bag in case you need to stay in the hospital.

• Please let your doctor know if you are or think you may be pregnant.

The Day of Your Procedure

The staff will help you get ready for your procedure. Please feel free to ask them any questions you may have. Before you are taken into the cardiac catheterization laboratory:

• You will be asked to change into a hospital gown. Please remove all jewelry. (If possible, please leave your jewelry items at home.)

• Please remove your contact lenses, you may wear your glasses though.

• You may receive medications or a mild sedative.

• You be asked to lay down on a gurney and an IV line will be started in a vein on your arm.

Both of your groins, and in some cases your wrist, will be shaved in preparation for the procedure.These areas will also be scrubbed with a special antiseptic solution.

In the cardiac catheterization room, you will be moved to a special x-ray table. Once you are positioned your body will be covered with sterile towels and sheets. Your face, as well as the area where the catheter is inserted will remain uncovered. If you are cold, please ask the staff for a blanket.

The room you will be in for your procedure has many special sophisticated pieces of equipment. You may be able to see part of your procedure on the screens. The area where the catheter is to be inserted will be numbed with a local anesthetic. This may cause minor stinging and burning. An introducing sheath is then inserted into an artery in the groin, arm, or wrist. The sheath remains in placed during the entire procedure. If you are having a right heart catheterization, a sheath will also be placed in the vein next to the artery in the same area.

Next, a flexible hollow plastic tube called a catheter will be threaded over a wire through and guided into the vessel until it reaches your heart.

Contrast dye is then injected into the catheter, making it easier to see your heart and its blood vessels. The dye will help evaluate the pumping action of your hearts main chamber, the left ventricle. It will also be used to see any blockages or narrow spots in the arteries of your heart. This may be done several times during the procedure to see all the coronary arteries and heart chambers. Pictures are taken during the dye injection to record this information.

When the dye is injected, you may feel a warm sensation or hot flashes. This is normal and will go away in 20-30 seconds. Some patients may notice nausea or extra heartbeats, but these feelings should pass quickly and not return. Please let your doctor know if they do. Although you may talk freely during your procedure, your doctor or nurse may ask you to take a deep breath, cough, or turn to one side, or not speak for a few moments while heart pressures are recorded.

The total catherterization procedure usually takes between 30-60 minutes.

After Your Procedure

Once the procedure is completed, the catheters are removed. A sealing device maybe used to close the puncture site, this will allow you to get out of bed sooner. This device is called an angioseal. It will feel like a small hard pea sized knot. It will dissolve over time.

You may have bruising at the site of puncture. This will improve gradually over time. To help stop bleeding, pressure is held at the puncture site. A compression device such as a clamp or sandbag may be applied to maintain pressure.

Your doctor may leave the introducer sheath in for a couple hours after the procedure. You will need to keep your leg straight and not bend the groin area while the sheath is in place and for 4-6 hours after it is removed.

• Do not attempt to sit upright in bed. Your nurse can raise the head of the bed up to 30 degrees so you can watch TV, eat, or read.

• It is important to follow these instructions to help prevent bleeding at the catheter insertion site.

• If you have any back pain or discomfort, please let your nurse know and they can give you medicine to help.

• Notify your nurse immediately if you feel sudden pain at the catheter site, or a warm sticky feeling or fluid on or around the cathetersite. Your nurse can assist you with activity and help make you comfortable.

After your procedure your IV may be left in to help provide extra fluids that will flush the contrast dye from your system. You will be asked to drink extra fluid to help your kidneys flush contrast dye as well. You may also be asked to cough to help get the dye out of the blood vessels of your heart.

Your physician will discuss the results with you and your family after the procedure and will make recommendations for therapy. Depending on the findings, you may have to stay overnight.

Patients often go home a few hours after a diagnostic cardiac catheterization. Depending on your procedure you may go home the same day or you may need to stay overnight. When you go home:

• Keep drinking plenty of fluids (six to eight 8oz glasses) over the next 24 hours, for this will help continue flushing out the contrast dye.

• Resume or start a heart healthy low fat, low cholesterol, low salt diet. Ask your doctor if you have any questions or need help making changes.

• Avoid lifting anything over 10 pounds for 1 week. (1 gallon of liquid is 8 pounds)

• Avoid strenuous activities for 1 week. Your doctor will advise you when you can resume exercise, sexual activity, and driving.

• Most people are able to return to work almost immediately depending on the type of work you do. If you have had a heart attack more time off may be advisable. Discuss when you may return to work with your doctor.

• Keep the site clean and dry.

• You may take a light shower, but do not take a tub bath or swim for 2 to 3 days after you get home.

• You may remove the bandage the next day. You may apply a new bandage over the site to reduce irritation from clothing.

• You may have some discomfort and a pea sized knot at the wound site. This is normal and will go away over time.

• A bruise or mild swelling is expected and may take several weeks to resolve.

• You have fever and chills.

• Your arm of leg becomes difficult to bend or move.

• You develop tingling, numbness, coldness/blueish color, or severe discomfort at the cath site or in your arm or leg.

• Chest pain or shortness of breath.

• The insertion site is bleeding.

Call your doctor's office to make a follow-up appointment for 7-10 days after discharge. When you go to your follow-up appointment, please bring your discharge medication sheet and discharge instruction sheet with you.

On the day of the test you may go directly to Queen's Heart, on the 3rd floor of the Pauahi Building, located directly above the Emergency Room.

Call Queen's Heart at 808.547.4535