Cath-lab nurses, Arm or Groin???

tvccrn, ASN, RN · Feb 23, 2005

I work in the cath lab at a very busy hospital in Wisconsin. I have a couple of questions for you. Please keep in mind I am not a doctor and don't know the entire situation.

1. Why can't your DH be off the coumadin for the cath? We usually have patients off this if it's for A-fib with no problems.

2. Are they considering valve replacements surgery? Is he having chest pain? What I am getting at here is, why are they doing the cath. If he is having no chest pain, SOB, arm/neck pain then I can see no reason to just look for blockages.

As for the approach, the reason for the groin as you stated is that it is much easier to get into. There is no increased danger with an arm approach that I am aware of. As a patient your DH has the right to state that he prefers the arm approach, but be aware that the groin may be the only way they can get in.

mbrester · Feb 23, 2005

I work in the cath lab at a very busy hospital in Wisconsin. I have a couple of questions for you. Please keep in mind I am not a doctor and don't know the entire situation.
1. Why can't your DH be off the coumadin for the cath? We usually have patients off this if it's for A-fib with no problems.
2. Are they considering valve replacements surgery? Is he having chest pain? What I am getting at here is, why are they doing the cath. If he is having no chest pain, SOB, arm/neck pain then I can see no reason to just look for blockages.
As for the approach, the reason for the groin as you stated is that it is much easier to get into. There is no increased danger with an arm approach that I am aware of. As a patient your DH has the right to state that he prefers the arm approach, but be aware that the groin may be the only way they can get in.

Thanks for the reply.

I don't know why he can not go off the coumadin, it is for a-fib, and they don't want him off of it I think because he is very hard to get the dossage to work.

No chest pain what so ever, and no SOB either.

At the moment, the heart is not strong enough to stand a new valve.

Also, he has great veins etc. The lab gals love him.

Editorial Team / Admin · Feb 23, 2005

A lot of these questions should be aimed at your dh's cardiologist, and perhaps even get a second opinion.

The cath is probably requested to provide info about the reason for the enlarged heart: could it be due to ischemic heart disease? You'll want to check on this, but I'm not sure any surgeon would perform valve repl. surgery without coronary angiography. If he has coronary disease and he's to have valve replacement, the coronary disease needs to be treated (either with a stent or bypassed during the valve replacement surgery). BUT, the surgeon needs to know the risk your dh will be taking; he doesn't want any surprises during surgery. Perhaps a CT Angiogram would be an additional useful screening tool, but I doubt the surgeons would accept ONLY a CTA, without the angio ("gold standard").

He MUST be off the coumadin for the cath. If necessary, the Cardiologist can arrange for you to give him enoxaparin (Lovenox) injections daily for the 4 days or so pre-cath, then he may be admitted to be put on heparin the day before. The Coumadin can then be resumed the evening after the cath.

If the Cath Lab and Cardiologist use some sort of Vascular Closure device (PerClose, AngioSeal, even some of the newer pads: ChitoSeal, Clo-Sur P.A.D., QuikSure Pad), your dh can have his head elevated up to 30 degrees immediately after the cath, and potentially be up in two hours (IF the device is used in the Lab, and their protocol matches what ours is, AND if the device is ABLE to be used post cath -- there are instances where it may be unsafe to deploy one of the internal devices). Some Cardiologists prefer not to use any of the closure devices. Again, you'll have to check with your dh's Cardiologist.

Re: doing an arm case. Some labs do use 4Fr catheters from a radial approach with good success. The Cardiologist has to be trained in this technique, it's not something s/he just chooses to use one day, out of the blue. Same with a brachial artery approach, you want someone to perform the cath from this approach ONLY if that person has extensive experience with this approach. The catheter choices and techniques used for manipulation are different from the arm; the risks are different too, slightly higher risk of nerve damage (same w/radial approach).

Either way, he won't be able to lift anything heavy for at least 48-72 hours post-cath. Perhaps he could arrange to have the cath on a Thurs or Fri, that would give him the weekend to recuperate. Again, I urge you to speak honestly with his Cardiologist about your concerns.

Re: your attending the cath: unless he needed you in there as an interpreter, most labs would not permit you to be present in the room. Hopefully there's a room VERY close by, where you can be reached easily and a staff member or the Cardiologist can let you know when the test is over. Most ppl are, understandably, VERY frightened to have such a test. He should receive IV sedation and all the reassurance and information (questions answered, etc) he requires ( some ppl don't want to know ANYTHING about it!!). The test is usually about 20 min, add to that 15-20 min for set-up and 15-20 min for finishing duties. If he has a hx of back pain he should receive pain meds in the room or before, to help. I have a lot of pts tell me (without even prompting from me! :) ), after having the cath, that it was "a piece of cake, " and they'd "rather have this test than go to the dentist." Really.

I have posted all this mainly from the top of my head, my first gut impressions and thoughts, of which some of the details (e.g., surgeons preferences, etc) may not be entirely accurate. A Cardiac Surgeon would be able to advise you on what tests are truly needed pre-valve replacement; but then, the Cardiologists who refer the pts for surgery DO know what the surgeons require from them in order to have their pts accepted as candidates for surgery (or, they should).

I realize this is a scary time for both you and your dh. Do your homework, ask questions and ask questions, and if you don't understand something, ask more questions. I wish you both the best. -- D

mbrester · Feb 24, 2005

Thanks for the info, it sure helps. We will be talking to the Cardiologist before, but I

Wanted to know what I was talking about before we got there. He won't be having any surgery for at least a year. Heart is not strong enough to handle a new valve.

I do have one other question; I think I got my info wrong, I think they said he would not be off blood thinners for the cath. I assumed they meant Coumadin. If he is on say heparin during the cath, do they stop it during and after, so the blood will clot, then start it again, and would his heart throw a clot during that time, Thanks again. : :balloons:

Editorial Team / Admin · Feb 25, 2005

This is another question to put to the Cardiologist who will be performing the cath. Years ago we heparinized all pts undergoing cath, as soon as the catheter was in the artery, and then reversed it after the exam. Nowadays we only heparinize if the case is prolonged (searching for an anomalous vessel take-off) or we're imaging both native vessels AND grafts -- and then it's usually with 2-3000 units of heparin, which we don't reverse. We usually don't heparinize pt who is in A fib.

Again, I only can offer our lab's practice. Keep asking the questions though!! I'd be interested to hear what the Cardiologist says.

I have a question: if his heart is "too weak" now to undergo valve replacement, what is being done to 'strengthen' it for future surgery? Is he being started on some meds? Just curious. Thanks. -- D

mbrester · Feb 26, 2005

[Well he is diffinitely in A-fib. The meds he is on are as followes: Digoxin, Enalapril, Atenlol, and warfarin 20mg. The heart valve has improved in the last 6 weeks. Echo results in as of yesterday. Another Echo scheduled for first part of May. No cath scheduled as of yet thank God.

Thanks for the help, If a cath is ordered, my DH thinks arm will be the best for him.

Editorial Team / Admin · Feb 26, 2005

Thanks for the update; glad he's doing better! :) -- D

mbrester · Mar 3, 2005

Thanks for the update; glad he's doing better! :) -- D

We are heading for Mayo Clinic, Rochester, the end of the month. Wish us luck. Anyone work cardio or the cath lab up there?

thanks for the replys