Coronary Angiogram: Standard Protocol and Best Practices

Pre-Procedure Requirements

Patient Preparation

• Verify NPO status (6-8 hours)
• Review recent laboratory results
  • Coagulation profile
  • Renal function
  • Complete blood count
• Check and document allergies
• Obtain informed consent
• Mark peripheral pulses

Equipment Verification

• Sterile catheterization tray
• Appropriate catheters (typically JL4, JR4)
• Contrast media
• Emergency medications
• Resuscitation equipment

Procedure Steps

1. Access Site Preparation

• Choose appropriate access (radial vs. femoral)
• Perform modified Allen's test for radial approach
• Prep and drape using sterile technique
• Administer local anesthesia

2. Arterial Access

• Obtain access using Seldinger technique
• Insert appropriate sheath size (typically 5-6F)
• Administer heparin per protocol

3. Catheter Engagement

1. Left Coronary System

   • Advance JL4 catheter
   • Engage left main coronary artery
   • Obtain images in standard views:
     • LAO cranial
     • RAO caudal
     • AP cranial
     • Lateral

2. Right Coronary System

   • Exchange for JR4 catheter
   • Engage right coronary artery
   • Obtain images in standard views:
     • LAO
     • RAO
     • Lateral

4. Left Ventriculogram (if indicated)

• Position pigtail catheter
• Perform power injection
• Obtain RAO 30° projection

Post-Procedure Care

Immediate Post-Procedure

• Remove sheath per protocol
• Apply compression/closure device
• Monitor vital signs
• Check access site

Documentation Requirements

• Procedure note
• Medication administration
• Complications if any
• Post-procedure orders

Quality Metrics

Technical Parameters

• Radiation dose
• Contrast volume
• Procedure time
• Image quality

Safety Monitoring

• Vascular complications
• Contrast reactions
• Radiation exposure

Emergency Protocols

• Coronary dissection
• Vasovagal reaction
• Contrast reaction
• Cardiac arrest