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Once in the haemodynamics room, the nurse will apply stickers connecting you to the electrocardiogram to monitor you at all times, and will check the IV line is working correctly to administer medication if required during the procedure. Next, the access site chosen by the haemodynamics specialist (either the groin or wrist) will be disinfected and covered with a sterile dressing. It is very important not to touch anything to maintain sterility and avoid infection, and you should keep completely still while the procedure is carried out.
A member of the unit’s nursing staff will be beside you throughout the procedure, and you may ask them any questions or let them know if you are uncomfortable in any way.
Possible access sites are the radial artery, femoral artery and humeral artery.
How is the artery accessed?
Arterial access has to be obtained via a small puncture of the skin so that a catheter that travels to the heart can subsequently be introduced. This is always done under local anaesthetic. Next, the artery is punctured and a small tube inserted which will provide access for the exploratory catheters. You may notice some discomfort or pressure in the puncture area, but it should not be painful.
Once the tube is in position in the chosen artery (usually the radial artery in the wrist), a catheter will be introduced (the narrow blue tube in the above photo) which will travel along the blood vessels until it reaches the heart, where the arteries that irrigate it originate. A radiopaque contrast substance will be injected into the same catheter, which will allow radiological images of the anatomy of your coronary arteries to be viewed on a monitor.
If no angiographic lesions are found: A report will be sent to your cardiologist, who will decide the treatment to be followed.
If angiographic lesions are found: If angiographic lesions are found during catheterization, a decision will be made as to whether they should be treated there and then, or whether discussion with your cardiologist is needed first in order to decide the most beneficial treatment. You will be told of the findings and decisions taken at all times.
When treatment is required for the angiographic lesions found, the specific material used in each case will depend on the type of coronary lesion to treat, the aim being to open it up and restore blood flow through the artery. You may notice some discomfort, and should inform the nurse of this so they can administer the necessary analgaesics to keep you comfortable.
If you have a stent implant, you will have to take specific medication, if this has not already been prescribed. You will be told the type of medication and how to take it in the haemodynamics unit and once you have been transferred for recovery, it will also be recorded in your discharge report so that both you and your cardiologist or GP are aware of it
Post-catheterization compression devices
Once the procedure has finished, a haemostatic compression device is applied to the puncture site. This performs conventional haemostasis by compression, which helps clotting and subsequent healing of the arterial wall. It is a non-invasive technique.
There are several types:
Elastic radial compression: A solid dressing is placed on the puncture site, held in place with elastic bandages which exert consistent pressure on the area. This bandaging should be worn for at least 4 hours and be removed by the Day Hospital or ward nurse, as appropriate. In any case, it should be worn for longer if the puncture site continues to bleed when the compress is removed.
Radial compression with a pneumatic device: This involves a plastic device held in place on the wrist with Velcro. An air chamber inflates, exerting consistent pressure on the insertion point. It should be worn for at least 4 hours and be removed by the Day Hospital or ward nurse, as appropriate. In any case, it should be worn for longer if the puncture site continues to bleed when the compress is removed.
It is normal for the thumb to go numb when using either of these devices. You can move your fingers and raise and lower your arm, but you should not bend your wrist under any circumstances. The wrist must be rested in the days after the catheterization and no sudden movements or lifting of heavy items should be attempted in order to help the radial artery heal completely.
Elastic femoral compression
The leg should not be moved until the bandages are removed 4-8 hours after catheterization depending on whether it was simply for diagnosis or if any coronary lesions have been treated. Movement should begin again gradually.
Percutaneous femoral closure device: This device puts a stitch in the femoral artery. You should rest and then begin to move again 4-6 hours after the procedure.
The arterial access tube is removed and firm pressure applied to the artery until bleeding stops, at which point bandage compression should be applied immediately. You should rest for 4-8 hours after the procedure and then start to move again gradually.
Once in the Day Hospital or ward, you may start to drink liquids, unless you are told otherwise by the professionals who looked after you in the haemodynamics unit. You may start to eat solid food two hours after the catheterization.
Transfer and discharge
Once the catheterization has finished, you will be transferred back to the Day Hospital, where you will stay as long as necessary until the compression bandaging is removed and there is no evidence of bleeding or other complications. If everything is in order, the doctor will discharge you and you can go home.
If you have been admitted to hospital, the nurse will remove the compression bandaging after the requisite time, and will check the puncture site. They will also give you instructions on eating and drinking. Your cardiologist will talk to you about the process during your stay in hospital and the best treatment plan for you so that you can be discharged and go home as soon as possible.