Cardiac Catheterization & PCI

After the catheter comes out, the real nursing emergency isn't in the heart — it's at the femoral access site. Knowing what to watch for in the first 6 hours separates safe care from a life-threatening bleed.

Cardiac catheterization is a diagnostic procedure that threads a catheter through the femoral or radial artery to visualize coronary arteries via contrast dye. Percutaneous coronary intervention (PCI) is the therapeutic extension — a balloon is inflated at the stenosis and a stent is placed to restore blood flow. Nursing priorities center on pre-procedure and post-procedure care, not the procedure itself. Pre-procedure: verify informed consent, assess for allergy history (including prior contrast reactions), check baseline peripheral pulses and mark them, obtain BUN/creatinine (contrast is nephrotoxic), hold metformin before the procedure and for 48 hours after (risk of lactic acidosis with contrast; resume only after renal function is confirmed adequate), and ensure adequate hydration. Post-procedure for femoral access: the patient remains on bed rest with the affected leg straight for 4–6 hours. Monitor the access site every 15 minutes for the first hour, then per protocol — check for hematoma, bleeding, and bruit. Assess the 5 P's of distal circulation: pain, pallor, pulselessness, paresthesia, paralysis. Monitor BUN/creatinine post-procedure for contrast-induced nephropathy. Radial access (increasingly common) allows earlier ambulation but requires Allen test beforehand to confirm collateral ulnar circulation. Post-PCI patients receive dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor like clopidogrel), so bleeding risk is elevated.

Key Distinctions

Don't confuse diagnostic catheterization (visualization only, no intervention) with PCI (balloon/stent placement) — nursing assessments are similar, but PCI patients have higher bleeding risk due to anticoagulation during the procedure. Students mix up metformin hold timing: hold before the procedure and for 48 hours after, resuming only when renal function is verified. Femoral access requires leg immobilization; radial access does not — interventions differ by site.

Clinical Pearl

Femoral site post-cath: think 'flat and straight.' Leg extended, HOB no higher than 30 degrees, and sandbag or manual pressure if bleeding starts — never a tourniquet.