newer advancements in interventional cardiology by deepak arjun, rn,rm

www.globalhospitalsindia.com Frost & Sullivan Healthcare Service Provider Company of the Year | India’s Most Admired Promising Hospital Chain

NEWER ADVANCES IN

INTERVENTIONAL

CARDIOLOGY

ROLE OF A NURSE

Mr. DEEPAK ARJUN, RN

CARDIOTHORACIC & TRANSPLANT UNIT

GLOBAL HEALTH CITY


Define Interventional cardiology

Interventional cardiology

Branch of Cardiology that deals with catheter based diagnosis

and treatment of structural heart diseases.

Its minimally invasive & Painless.

It include Paediatric and Adult Intervention.


Perfusion of the Heart


PAEDIATRIC

INTERVENTIONAL

CARDIOLOGY


ASD CLOSURE - Atrial Septal Defect :


Types of Closure Devises

(1) Amplatzer - Septal Occluder System - Nickel-titanium Metal Alloy.

(2) HELEX - Septal Occluder -


PROCEDURE-ASD Closure


ASD - CLOSURE


Ventricular Septal Defect

.


Types of VSD


Device Closure Of VSD

Car

dioSEAL Device

Perimembranous VSD Occluder Size – 15 – 35 mm

Amplatzer Muscular VSD Occluder Size - 18,25,30,35 mm

Cardio SEAL Device- INLET VSD Closure Size - 23, 28, 33,40 mm


Sollysaffe

TwoFolldabllePollyestterpattches

Occlluttech Contain Polyethylene (PET) patch,


VSD - CLOSURE INSERTION


PATENT DUCTUS ARTERIOSUS

Patent ductus arteriosus (PDA), in which there is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus


PDA CLOSURE


Preoperative :

Stop oral anticoagulants 3-5 days before the procedure

Soluble aspirin, 325 mg , before the procedure

Diabetic Management – Not OHA but Insulin

Doctor’s written order for the test.

NPO – 6 hours

Secure IV – Line

Nurses Responsibility


Intraoperative:Haemo dynamic ManagementArrythymia Management

Postoperative: Bed rest for at least 4 to 8 hours & keep the affected leg straight at all times Maintain Vital parameters Check for Groin site(s) for bleeding or swellingMonitor for the COMPLICATIONS ASD “unsuitable” for device closure Air Embolism (via long sheath)- Device Embolization Arrhythmias Atrial wall erosion with pericardial tamponade SIRS –Systemic Inflamatory Response syndrome


Discharge Education

After the procedure, to take anticoagulants - for 6 months.

Diabetics Mgt - metformin 48 hours after the procedure

On the day of discharge, limit the activities

Check for redness & drainage around the Puncture site.

Warning Alerts for the patient on Discharge

Pain at the puncture site that makes walking difficult.

Numbness or tingling in the thigh or leg.

Calf tenderness or pain, Swelling of the ankle or foot.

Discoloration or coolness of the leg or foot


ADULT INTERVENTIONAL CARDIOLOGY


TYPES OF INTERVENTIONAL PROCEDURES

1. Fractional Flow Reserve ( FFR ) – Assessment

2. Thrombectomy

3. Stents – Drug eluting & Biogradable

4. Mitra clip

5. Percutaneous valve Repair

6. Balloon Valvuloplasty

7. Atherectomy – Directional / Rotational / Transluminal / Laser

8. Radiation therapy / Brachytherapy

9. Embolization Prevention Devices


Fractional Flow Reserve - Assessment

FFR = Maximum flow in the presence of a Stenosis

Normal Maximum flow

Normal FFR- 1.0

Myocardial Ischemia- 0.75-0.80

FFR = Pd/Pa

Pd = pressure distal to the lesion,

Pa = pressure proximal to the lesion


FFR - ASSESSMENT


Angiojet

Contraindications: Severe eccentricity / angulation of the targeted lesions (due to risk of perforation by deep cuts) Major sidebranch involvement (due to risk of occlusion) Heavily calcified lesions (as they prevent the device from crossing the lesion) Lesions with major dissections

due to risk of perforation caused by the poor integrity of the vessel wall

THROMBECTOMY

Transluminal Extraction Catheter (TEC)

Indications:Thrombus-containing blockages in blood vesselsBlockages in saphenous vein graftsBlockages in aged, degenerated bypass grafts


TYPES OF STENTS

Everolimus-eluting PLLA/PDLLA Polymer Stent

REVA Tyrosine–Polycarbonate Slide and Lock Polymer Stents

Absorbable Magnesium Metallic Stent


MITRA CLIP

• Contraindications

Active inflammation of the heart (endocarditis)

1) Rheumatic mitral valve disease

3) Blood clots present at the intended site of implant or blood clots in vessels through which access to the defect is gained

4) Patients who cannot tolerate blood thinners (anti-coagulation and anti-platelet medications).


PERCUTANEOUS VALVE REPAIR – Mitral Regurgitation


PERCUTANEOUS VALVE REPAIR - TAVI


BALLOON VALVULOPLASTY


BALLOON VALVULOPLASTY - Procedure


ATHERECTOMY - Types


DIRECTIONAL ATHERECTOMY


ROTATIONAL ATHERECTOMY


TRANSLUMINAL EXTRACTION


LASER ATHERECTOMY


RADIATION THERAPY / BRACHYTHERAPY

Brachytherapy - Direct application of radiation to an artery Treating restenosis Radiation source is applied to the blocked stent for a period of

several minutes and then removed.

Low-dose rate (LDR) implants High-dose rate (HDR) implants Permanent implants Low-dose rate (LDR) implants

“ Radioactive seeds “


EMBOLIZATION PREVENTION DEVICES


Embolization Prevention Devices


Risks For Percutaneous Coronary Intervention

Bleeding at the catheter insertion site

Blood clot - insertion site / Device

SIRS – Infection

Cardiac dysrhythmias or arrhythmias

Chest pain or discomfort

Rupture of the coronary artery - requiring open-heart surgery

Risk for allergic reaction to the dye - CKD


Complications:

Acute Re-occlusion Rhythm and conduction disorders Bleeding Accidental dissection of the valvular ring (PVI) Cardiac tamponade Acute heart failure - Valve Implantation Death

Major Complications


Complications

Side branch occlusion Ventricular/atrial arrhythmias Bradycardia Left-to-right shunt Hypotension Blood loss Arterial thrombus Coronary embolism Emergency recatheterization Ischemia - cannulated extremity Decrease in renal functions - Contrast medium Systemic embolism Hematoma in the groin, retroperitoneal hematoma, pseudoaneurysm, A-V

fistula

Minor Complications


Prevention and early diagnosis of potential complications,

Education of the patient and the family,

Rehabilitation

Continuous Nursing education.

The nurse to follow recent advances and published literature

and join nursing seminars for the improvement of her knowledge about

individualized and structured patient care and education of the patient

and the family

Goal Of RN


NURSES RESPONSIBILITY - PCI

Pre Operatively: Explain the procedure & sign a consent Allergic to any medications /contrast dye / latex and anesthetic agents Npo & prepration History of bleeding disorders Remove any jewelry Remove clothing and will be given a gown to wear. Empty the bladder prior to the procedure. Secure IV-Line

Intra Operatively: Placed in a supine position Haemodynamic Monitoring sedative medication


Check Peripheral Pulses Check for any breathing difficulties, sweating, numbness, itching,

nausea / vomiting, chills, or heart palpitations. Arrythmia Management -

Post Opeatively : Apply manual pressure / sutures / closure device that uses collagen Check for bleeding Tight bandage will be placed / sandbag Chest pain or tightness, any feelings of warmth, pain at the insertion site Bedrest for two to six hours Maintain Strict I/O Chart - contrast dye and increased fluids Check for Orthostatic hypotension Encourage oral liquids


Home Care Teaching:

Monitor the insertion site - bleeding,unusual pain,swelling & abnormal

discoloration or temperature change

Regular aerobic exercises such as walking, swimming, jogging &

bicycling

Advised not to participate in any strenuous activities

Diabetic Mgt - Changes in glucose and fat metabolism enhances

atherosclerosis

Follow up tread mill test performed to determine success of procedure


Chest Pain

Etiology:

Decresed coronory perfusion

Severe Ischemia

Goal :

Alleviation of pain

Supporting the circulation


Arrhythmia

Etiology :

Inability to deliver sufficient O2to the myocardium

Type of contrast medium

Electrolyte imbalance

Goal :

Preventing the development of arrhythmia,

Eliminating arrhythmia

Stabilization of cardiac rhythm


Decreased Cardiac Output

Etiology : Decrease in circulating volume, Blood loss, Cardiac tamponade, Arrhythmia, Myocardial ischemia / MI Necrosis Increase in pulmonary arterial pressure

Goal : Early diagnosis of symptoms and signs showing a decrease in CO Prevention of complications, Increasing cardiac output to the normal level


Decrease In Peripheral Tissue Perfusion

Etiology

Mechanical obstruction in the arterial or venous cannula

Arterial vasospasm,

Thrombus formation

Embolization / immobility / Bleeding or hematoma

Goal :

Providing adequate peripheral tissue perfusion

To reduce ischemic pain, Presence of senses, warm and pink skin

at the extremity


Risk of Thrombo embolism

Etiology :

Decrease in peripheral perfusion

Goal :

Prevention of thromboembolism

Prevent Numbness & edema

Normal sensory & motor function