Which drug is held before contrast and for 48 hours after?

The correct answer is Metformin.

Which lab is checked because contrast dye is nephrotoxic?

The correct answer is BUN and creatinine.

Cardiovascular · Topic 10 of 34

Cardiac Catheterization & PCI

Q: After femoral cath, how should the affected leg be positioned?

The correct answer is Kept straight.

After the catheter comes out, the real nursing emergency isn't in the heart — it's at the femoral access site.

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Overview

Cardiac catheterization threads a catheter through the femoral or radial artery to visualize the coronary arteries with iodinated contrast dye. Percutaneous coronary intervention (PCI) is the therapeutic extension: a balloon is inflated at the stenosis and a stent is placed to restore flow. Nursing priority is peri-procedure care, not the procedure itself, and the most dangerous early complication is bleeding at or behind the access site.

Indications

coronary artery visualization

diagnostic angiography

coronary stenosis treatment

PCI balloon plus stent

acute coronary syndrome

Before the Procedure

verify informed consent

assess contrast dye allergy

prior iodinated-contrast reaction

mark distal pulses

baseline for post-procedure comparison

hold metforminHold

before and 48 h after contrast; lactic acidosis risk

NPO before procedure

~6 h, aspiration risk

ensure adequate hydration

nephropathy prophylaxis

Allen test for radial access

confirm ulnar collateral flow

Diagnostic

baseline BUN and creatinine

contrast is nephrotoxic

During — Monitoring

bed rest with leg straight

femoral access, 4–6 h

HOB no higher than 30 degrees

avoid hip flexion at puncture site

keep pressure dressing intact

4–6 h, no premature removal

TR Band for radial access

allows earlier ambulation

Monitor

inspect access site every 15 minutes

first hour, then per protocol

assess distal pulses

5 P's of distal circulation

auscultate for bruit

continuous cardiac rhythm monitoring

post-PCI reperfusion dysrhythmias

After — Complications

access-site hematoma

most common immediate complication

access-site bleeding

distal arterial occlusion

thrombus or embolus, limb-threatening

contrast-induced nephropathy

rising creatinine, falling urine output

stent thrombosis

acute, within hours of PCI

pseudoaneurysm

pulsatile mass with bruit

Patient Teaching

adhere to dual antiplatelet therapy

aspirin plus a P2Y12 inhibitor like clopidogrel

do not stop antiplatelets abruptly

stent thrombosis risk

report bleeding or expanding bruising

increase fluid intake

flush contrast, protect kidneys

resume metformin only after renal function verified

avoid heavy lifting

protects access site

Report Nowescalate immediately

rapidly expanding hematoma

flank or low back pain Hallmark

retroperitoneal hemorrhage

hypotension

concealed bleeding

tachycardia

concealed bleeding

hemoglobin drop without visible bleeding

retroperitoneal hemorrhage

increasing abdominal girth

retroperitoneal blood accumulation

diminished or absent distal pulse

arterial occlusion

recurrent chest pain

acute stent thrombosis

Clinical Pearl

Femoral post-cath: flat and straight — leg extended, HOB ≤ 30°, manual pressure if it bleeds, never a tourniquet. New back or flank pain with falling BP is retroperitoneal bleed until proven otherwise.

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.

Knowledge Check

3 quick questions on the must-knows for this topic.

Question 1 of 3

After femoral cath, how should the affected leg be positioned?

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Overview

Indications

Before the Procedure

During — Monitoring

After — Complications

Patient Teaching

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.

Key Distinctions

Clinical Pearl

Knowledge Check

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