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RAK HoSPITAL
Premium Healthcare. Premium Hospitality
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Cardiac Catheterisation Form
Procedure Date: Procedure Time; Consultant:
Pre- Procedure Check List Elective Emergency
Temp Pu lse BP Resp Weight Height Pre -Procedure Diagnosis
Shifting time Ward Nurse Cath nurse ls patient on Yes No Screening
lD Band Hepa rin cBc Creat
\r Aspirin Urea HCV
Consent signed Clopidogrel HIV HbSAg
PT PTT
NPO from: Metformin INR Electrolytes
Pre-op meds TIME OUT CHECK LIST Yes No N/A
Site prep/ marking Correct Patient
Lab reports Correct Position
ECG/X-Rays Correct Procedure
Allergies Correct Site/side
Bladder empty Equipment present
Prosthesis : specify Consent signed
lV Line in situ Team present
Procedure Start Time: Time out at Signed:
Procedure End Time: Circulating Nurse.
lntra procedure record
Medication Dose Route Time By
VitalSigns
Time HR RR BP SPO2 Pedal Pulse IV ECG
O
t
O
o
t
Findings / Diagram: 1. Angiography
e5-
AM
K K* \1
2. PCI (Percutaneous Coronary lntervention )
Consumables used (stents etc)
Item Size Quantitv
Post Procedure
Start time Finish Time TotalTime
Diagnosis:
Procedure :
Condition at transfer from Cath Lab Stable Fair Critical
Disposition Ward rcu Home
Post Procedu re I nstructions
(Please check (/)the box below for applicable orders and cross (x)for non-applicable orders).
Monitoring
Check 02 Sat. on arrival to floor q.8 h x 3 and for dyspnea, if 02 <92%;
Notify physician
Administer 02 per NC.
Titrate 2-4L/min to maintain A2> 92%
Discontinue 02 after 6 hrs. if no chest pain, dyspnea and 02 Sat on room air > 92Yo
Do the following 15 minutes x4 then every 30 minutes x2 then every I hour x4 hours,
V Blood pressure and pulse
Observe R/L femoral /radial site for arterial bleeding, notify cardiologist STAT if bleeding
noted
Observe R/L leg/hand for arterial occlusion, check for loss of peripheral pulses, notify
cardiologist
Take ECG post procedure and the following morning
lf patient complains of chest discomfort give oxygen ,take ECG and notify
cardiologist
Sheath
Remove in Cath Lab
Vessel closure devise used: Angioseal Suture
Arterial Access - With Sheaths
Absolute bed rest when sheaths are in place
Sheaths will be removed when ACT < 180 or PTT <50sec
For sheath removal have Midozolam 1-5mg, Atropine 1-mg NTG-SL 0.5mg and Xylocaine 1"%
h^.l"i.l^
Sheaths to be pulled ICU by: Cath Lab Staff / RN (under MD's Supervision)
Following sheath removal :Complete bed rest for
4 hours 6hours I
l8hours 1-0 hours
While on bed rest, may turn to side but not to bend or use affected leg
While on bed rest, may elevate head of bed to 30 degrees only
After bed rest, bathroom privileges followed by activity as tolerated
Bed rest
Following sheath removal complete bed rest during infusion and 6 hours following
discontinuation of Gllb / lll a inhibitor.
lf bleeding, hold up GP ll b/llla blocker, apply pressure bandage and inform cardiologist
Medication Note: Medications are to be written on the Drug Order Sheet (MRD/NUR/027)
Hold Metformin (glucophage) for 48 hours. Allergies
Medications to be administered:
Aspirin 75mg
Clopidogrel (Plavix) 75mg PO Resume the following medications
Resume the following medications: See patient's Drug Order Sheet (MRD lNURlOZTl
Discontinue the follording medications:-
PRN Medication
Paracetamol 500mg tab. PO two tablets every 4 hours PRN mild pain/headache.
Midazolam 1.-2mg lV every 1-2 hours PRN black/leg discomfort
Lorazepam 1,-2mg PO every 6 hours PRN anxiety
Xanax (Alprazolam) 0.5mg
lnj. Hydrocortisone LO0mg lV for allergic rash
lnj. Piriton (Chlorpheniramine) lV fbr allergic rash
lnj. Primperan (Metoclopramide)1 amp. lV for nausea 1
Sublingual nitroglycerin 0.5mg PRN for chest pain q 5mins.x3, obtain stat EKG and notify
ca rd iologist.
lV Fluids
lV fluid solution totalvolume
rate (cclh), duration
lV Nitroglycerin start at........................... ug/min titrate by 5-10 ug/min for chest pain and to
keep SBP > l-00 < 140mmHg.
For patients on GP llb/llla inhibitors
Conti nue Tirofiba n (Aggrastat) : Bol us at. ............... ml/h r
lnfusion at ..........,....m1/hr ...................sing1e/double dose (for 24/48 hours)
Continue Eptifibatide (lntegrilin) infusion at................ ml/hr..................sing1e/double dose
(for 24/48 hours)
Full dose supply sent with patient from cath lab
Receiving Nurse's signature Employee #
Laboratory
ACT at................ On................. repeat at q 2 hour until ACT < 180 seconds
Troponin l, CPK/MB, CPK at 4 hours and the following morning
Diet
Light mealto resume 2 hours post intervention
Consultation
Dietitian Endocrinologist
Doctors Name Date Time
Doctor's signature / stamp
Vital Signs: (see above for frequency)
Time HR RR BP sPo2 Temp Wound site Pedal pulse lV lnfusion
NB: Separate intake and output chart to be maintained.
Progress Notes
Date/time Note Signature
\
Progress Notes Cont.
Date/time Note Signature
(Continue on separate sheet if needed)
Discharged from ICU Transferred to Ward Transferred other HC Facility
Complete below on discharge from hospital
Date of discharge Time i Discharged from: To:
Vitalsigns I Temp: BP: Pulse: SPO2: Pedal Pulse:
Wound site clean / No bleeding Extremities colour:
MentalState:
Bill /insurance settled lnstructions to patient Yes No
Education / Avoid lifting Chest Pain Exercise
instructions given: heaw weiehts
Diet Wound site
Discha rge Medications:
Follow up :Lab work (date) ECG (date)
Emergency contact number given to patient : Yes No
Follow up appointment date /time I e iven to patient yes No
Sisnature /lD discharpe nurse: Date /timc