Cardiac Catheterization: Complete Protocol and Best Practices

Pre-Procedure Protocol

Patient Assessment

• Verify NPO status (6-8 hours)
• Review medication history, especially anticoagulants
• Check renal function (Creatinine/eGFR)
• Assess for contrast allergies
• Document vital signs

Equipment Preparation

• Sterile catheterization tray
• Appropriate catheter selection (4F-8F)
• Contrast media
• Emergency medications
• Monitoring equipment

Procedure Steps

1. Patient Preparation

• Obtain informed consent
• Mark entry site (femoral/radial)
• Apply surgical prep
• Position patient supine

2. Access Site Management

• Administer local anesthetic
• Obtain vascular access using modified Seldinger technique
• Secure sheath
• Document pulses and perfusion

3. Catheterization Sequence

1. Advance guidewire under fluoroscopy
2. Position diagnostic catheter
3. Obtain pressure measurements
4. Perform contrast injection
5. Document findings

4. Hemodynamic Assessment

• Record baseline pressures
• Calculate cardiac output
• Measure oxygen saturation
• Document pressure gradients

Post-Procedure Care

Immediate Care

• Monitor vital signs q15min x 2hrs
• Assess access site
• Manage hemostasis
• Begin ambulation protocol

Discharge Criteria

• Stable vital signs
• No access site complications
• Adequate hemostasis
• Patient education completed

Documentation Requirements

• Procedure note
• Hemodynamic measurements
• Contrast volume used
• Fluoroscopy time
• Access site status
• Post-procedure orders

Complications Management

Major Complications

• Bleeding
• Vascular injury
• Contrast reaction
• Arrhythmias

Emergency Response

• Emergency equipment location
• Team roles
• Communication protocol
• Documentation requirements