Cardiac Catheterization

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    What are the labs that should be evaluated before a cardiac catheterization and the rationales why? I know BUN and Creatine are important to determine kidney function to excrete the contrast. Also, I recall my prof. mentioning Mucomyst being given to help reduce Creatine levels so the cath can be done, how does that work?
    Any help is appreciated. Thanks!
  2. 9 Comments so far...

  3. 0
    Is this for an assignment?

    What are your initial thoughts on what labs would be needed?
    What have you found in your reading?
    Last edit by dianah on Jun 30, '10
  4. 0
    Yes this is an assignment. I am supposed to write a short paper on the nurses role in cardiac catheterization. My textbook does a great job in describing nursing interventions before and after the procedure, but lab value evaluations aren't discussed, and my prof. is always interested in lab values.
    I know the BUN and Creatine are important to determine adequate kidney function so that the contrast dye can be secreted. I did more research on the mucomyst and found that the mucomyst helps to protect the kidneys and liver when clearing the contrast. PT and PTT values to determine clotting, I am unsure as to weather the range would be therapeutic because I am not sure when Heparin therapy is started in relation to the procedure. Hematocrit, Hemoglobin and Platelet levels I think just for baseline. Electrolytes are also important to check. I know Potassium is a concern because it may cause dysrthymias or have other effects on the heart, along with Calcium and Sodium. This is what I think from what I have learned, please correct me if I am wrong or if I am missing anything.
  5. 1
    great job!
    i just wanted a baseline, to know how much to spew forth, lol!

    bun and creatinine and egfr (estimated glomerular filtration rate, which factors in pt's age) all provide indications of how well the kidneys are functioning.
    http://www.google.com/search?hl=en&d...q&ved=0cbuqkae
    as the contrast used in the cath is primarily excreted from the kidneys, one of the risks of doing the exam is cin, or contrast-induced nephropathy. this exhibits as a rise in the creatinine post-cath (or, post-exposure to the iodinated contrast).
    our mds prefer gfr >60 and creatinine <1.5 ('normal' range may differ, depending on the lab at each hospital).
    they give serious pause to performing a cath on a pt with, say a creat. of 1.8 or higher.
    always weigh risk vs benefit.
    biggest protection for the kidneys in any case is hydration, hydration, hydration! some recommend 1 liter over 6 hr pre-cath, then another liter post-cath (taking care not to overhydrate a pt who has a reduced ejection fraction [ef], say an ef of 30%.)

    re: mucomyst:
    role of mucomyst in patients with elevated renal function:
    http://www.ctisus.com/multidetector/syllabus/renal_mucomyst.html
    article from journal of the american society of nephrology:
    http://jasn.asnjournals.org/cgi/content/full/15/3/761

    some swear by it, some swear at it. as presented in the two links above, the jury is still out on giving this pre-procedure. nevertheless, our mds do order it if the creat is elevated (cover all the bases!).

    pt/ptt/inr: our mds will proceed with cath if inr <1.7.
    if the inr is >1.7 risk of bleeding increases (we are going in an artery!).
    we use vascular closure devices unless contraindicated (these are deployed under the skin, right on top of the hole made in the artery. e.g.: angioseal, mynx).
    heparin, if infusing when the pt arrives to the lab, is turned off and not restarted till 4-6 hr after the case is finished, to allow the body sufficient time to heal over the hole made in the artery.

    cbc - mainly i check the wbcs (if high, why? if the case is an elective one, best to treat any infection first, then perform the cath when the infection is subdued) and the hgb and hct (if low, why? is pt chronically low or is this new? if pt has a slow gi bleed, for example, and hgb and hct have been dropping over the past week or two, then gets a stent put in and put on plavix = can cause massive bleeding! again, risk vs benefit, esp. if the case is elective [not an acute mi coming up for cath from the ed] ).
    platelets - usually mds will perform the cath if the plt count is >50k. as we puncture the artery, it is important to have adequate platelets for clotting afterwards!

    chemistry - yes, normal k+ level is very important (review movement of lytes across the cell membrane) for decreasing risk of dysrhythmias (or sustain of such that happen during the cath. and they do occur, especially if a catheter is put into the left ventricle to measure pressures or do a left ventriculogram [inject contrast in the left ventricle to see how well the walls move]).

    hope this has helped.
    good luck!
    vkotyay likes this.
  6. 0
    This really helped... Thank you so much!!
  7. 0
    Glad it helped.
  8. 1
    All you want to know about Cardiac Catheterization, visit http://www.cardiaccatheterization.org
    dianah likes this.
  9. 1
    Rule of thumb..

    All surgeries require CBC...H/H to see blood levels, plt for clotting, and wbc for poss infection

    bmp: to check for renal function... BUN/Creat: they may need more or less ivf to flush kidneys, glucose for DM for NPO insulin coverage, K/Mg for Cardiac function.

    Everyone you cut must have plt/pt/ptt/inr combo pack for bleeding/clotting factors.

    CXR for smokers, COPD, asthma, obese, and elderly to decide if they may have complications in pacu.

    lots more but you must do your homework.

    hope this helps..!!
    dianah likes this.
  10. 1
    the following blood tests are performed to identify abnormalities that may complicate recovery:
    blood urea nitrogen (BUN) and creatinine levels,
    International Normalized Ratio (INR) or prothrombin time (PT),
    activated thromboplastin time (aPTT),
    hematocrit and hemoglobin values,
    HIV, HBV, HCV and HTLV
    platelet count, and electrolyte levels.
    dianah likes this.
  11. 0
    Quote from sharifi9879
    the following blood tests are performed to identify abnormalities that may complicate recovery:
    blood urea nitrogen (BUN) and creatinine levels,
    International Normalized Ratio (INR) or prothrombin time (PT),
    activated thromboplastin time (aPTT),
    hematocrit and hemoglobin values,
    HIV, HBV, HCV and HTLV
    platelet count, and electrolyte levels.
    For a heart cath? No.
    No routine PTT. If they come down on a heparin gtt then we'll get an ACT after access.
    HIV, HBV, HCV, HTLV? Never. Never, ever will that be drawn for a heart cath.

    Most times, just an h/h, bun/cre are needed. And a PT only if necessary (coagulopathic, on Coumadin, blah, blah)


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