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TOPIC 04 · MEDICAL-SURGICAL NURSING

Cardiac Catheterisation

Procedure, nursing care & the warning signs that matter.

Understand radial and femoral access, prepare safely, recognise complications and revise nursing priorities before, during and after cardiac catheterisation.

Before · During · After2 visual guides10 explained MCQsFree · No login

1. What is cardiac catheterisation?

Cardiac catheterisation is an invasive procedure in which a thin catheter is guided through a blood vessel to investigate or treat a heart condition. Fluoroscopy helps guide catheter position. Coronary angiography uses iodinated contrast to show coronary anatomy; haemodynamic studies can measure pressures, oxygen saturations and cardiac output.

Remember the distinction: angiography shows the vessels; angioplasty and stenting are treatments that may be performed during the same session. A diagnostic cath does not automatically mean a stent will be inserted.
Left and right heart catheter routesArterial access reaches the aorta for coronary angiography or the left heart. Venous access reaches the right atrium, right ventricle and pulmonary artery. Diagram is schematic.Two routes. Different information.LEFT / CORONARY STUDYRadial or femoral artery→Aorta→Coronary ostiaor left heart, as indicatedRIGHT HEART STUDYLarge vein→Right atrium→Right ventricle→Pulmonaryartery
Original schematic, not an anatomical map. A coronary angiogram images coronary vessels; a right-heart study measures right-sided and pulmonary pressures. They are not interchangeable.

Arterial access

Radial access at the wrist or femoral access at the groin may be used for coronary or left-heart procedures. Radial access often allows earlier mobilisation and has a lower access-site bleeding risk in appropriate patients.

Venous access

A large vein, such as an internal jugular or femoral vein, may be used for right-heart catheterisation. Selection depends on the study, anatomy, clinical urgency and operator assessment.

2. Indications and risk assessment

  • Investigate suspected coronary artery disease or an acute coronary syndrome when clinically indicated.
  • Measure intracardiac or pulmonary pressures and cardiac output, or assess selected valve and congenital problems.
  • Guide treatment such as PCI, balloon valvuloplasty or selected structural interventions.

Before an elective procedure, promptly flag active bleeding, significant coagulopathy or anaemia, renal impairment, previous contrast reaction, unstable rhythm, major electrolyte disturbance, infection or uncontrolled blood pressure. The clinician weighs benefit against risk and plans optimisation.

These findings are not a universal list of absolute contraindications. An urgent life-saving procedure may still be necessary. Verify informed consent or the applicable emergency consent process.

3. Pre-procedure nursing care

Three stages of nursing care: prepare, monitor, reassessThe nursing care pathway01 · BEFOREConsent + assessmentKidney function + medicinesBaseline distal circulation02 · DURINGECG + BP + oxygenationComfort + sterile techniqueRecognise deterioration03 · AFTERAccess site + distal pulsesBleeding + renal monitoringTeach + document
Always use the prescribed monitoring schedule and local cath-lab protocol. An abnormal finding needs immediate reassessment rather than waiting for the next scheduled observation.
  1. Confirm identity, procedure and consent. Check understanding and escalate unanswered questions to the procedural team.
  2. Record a baseline. Assess BP, pulse, respiratory rate, SpO₂, rhythm, pain, consciousness and fluid status. Document distal pulses, limb colour, temperature, sensation and capillary refill for comparison afterwards.
  3. Review investigations. Check ordered CBC/platelets, creatinine/eGFR, electrolytes and coagulation studies when indicated. Flag abnormal results and possible pregnancy.
  4. Clarify allergy history. Document the actual substance, previous reaction and its severity, especially a prior iodinated contrast reaction. Check latex, antiseptic and medication reactions too.
  5. Verify fasting and medicines. Follow the specific fasting order; timing varies with food, clear fluids, sedation and urgency. Review anticoagulants, antiplatelets, diabetes medicines and recent PDE-5 inhibitor use with the team.
  6. Prepare safely. Establish prescribed IV access, perform skin antisepsis and use clippers if hair removal is required; avoid routine razor shaving. Ensure monitoring and emergency equipment are ready.
  7. Explain what to expect. Local anaesthetic is common; sedation may also be used. Brief warmth with contrast can occur. Ask the patient to report chest pain, breathing difficulty or new symptoms immediately.
Exam trap: shellfish is not a contrast allergy. Shellfish allergy alone does not establish a specific allergy to iodinated contrast. Prior contrast reactions require a separate risk assessment; premedication is prescribed when appropriate.

Metformin: do not apply an automatic stop/restart rule to every patient. Renal function, acute kidney injury, the arterial contrast procedure and local guidance determine the plan. Confirm the written order and any renal reassessment before restarting. SGLT2 inhibitors and other diabetes medicines also need an individual peri-procedure plan.

4. Intra-procedure nursing care

  • Support positioning and the sterile field. Observe ECG continuously; monitor BP, oxygenation, respiratory effort and sedation level at the required intervals.
  • Assess chest discomfort, dyspnoea, consciousness and haemodynamic changes promptly. Do not dismiss palpitations or chest pain as an expected finding.
  • Maintain ordered catheter flushes and equipment connections, excluding air and preventing thrombus according to cath-lab protocol.
  • Watch for vasovagal deterioration: bradycardia with hypotension, pallor, sweating or nausea. Escalate promptly and assist treatment as ordered.
  • Recognise a possible contrast reaction: urticaria, facial swelling, wheeze or hypotension. Alert the team, stop contrast administration and support emergency assessment and treatment under protocol.
  • Document access site, contrast type/volume, drugs, fluids, observations and patient response.

Medicines: know the purpose

GroupNursing focus
Local anaesthetic; sedative/analgesic if prescribedComfort, allergy checks, airway, breathing and haemodynamic monitoring.
Anticoagulant such as heparin, when indicatedVerify prescription, bleeding risk and ordered anticoagulation monitoring.
Antiplatelet therapy for PCI/stentingConfirm the prescribed regimen and reinforce adherence.
Emergency and reversal medicinesAssist according to the event, prescription and resuscitation protocol.

Diagnostic cath and PCI do not use identical drug regimens. Drug doses and sedation choices require a patient-specific prescription.

5. Post-procedure nursing care

AssessmentWhat the nurse checks
Access site / haemostasisBleeding, expanding swelling, pain, dressing and compression/closure device. Follow the device protocol; do not independently loosen compression.
Distal circulationCompare pulse, colour, temperature, capillary refill, sensation and movement with baseline. A new cold or numb limb needs urgent assessment.
Systemic statusBP, HR, rhythm, breathing, consciousness and chest symptoms. Assess deterioration even when the visible dressing is dry.
Kidney / fluid statusMonitor intake/output and renal tests when ordered. Give oral/IV fluid as prescribed, with caution in heart failure or fluid restriction.

Radial versus femoral recovery

Radial: protect the wrist and follow the compression-band and activity instructions. Earlier ambulation may be possible after clinical review. Continue hand perfusion assessment.

Femoral: keep the affected leg straight and follow prescribed bed rest and head elevation until mobilisation is authorised. Duration depends on sheath removal, anticoagulation, closure device and clinical stability; a fixed four-to-six-hour rule does not apply to everyone.

Use the unit’s observation schedule, with more frequent assessment after arrival, sheath removal or a change in condition. Document findings, interventions and escalation clearly.

6. Complications: recognise the warning pattern

Priority pattern: hypotension plus new back/flank pain after femoral access can indicate concealed retroperitoneal bleeding, even without obvious groin bleeding. Escalate urgently, assess ABCs and haemodynamics, and prepare prescribed investigations and treatment.
  • External bleeding / haematoma: call for assistance, assess haemodynamics and apply appropriate pressure according to access-site protocol.
  • Limb ischaemia / arterial occlusion: new pallor, coolness, reduced pulse, pain or numbness requires urgent review.
  • Pseudoaneurysm / AV fistula: persistent swelling, a pulsatile mass or bruit needs medical assessment; do not massage the site.
  • Contrast-associated acute kidney injury: monitor high-risk patients for changes in urine output and creatinine as ordered.
  • Other serious events: contrast reaction, arrhythmia, myocardial infarction, stroke or vascular injury. New focal neurological symptoms, severe chest pain or breathing difficulty are urgent.

7. Discharge teaching and quick revision

  • Provide written access-site, dressing and bathing advice. Explain the individual limits on wrist/leg strain, lifting, exercise, driving and return to work.
  • Arrange a responsible escort when required after sedation. Confirm follow-up, renal tests if ordered and who to contact.
  • Teach medicine names and the next doses. After stenting, do not stop prescribed antiplatelet therapy without the treating clinician’s advice.
  • Explain the local emergency contact plan for ongoing bleeding, rapidly growing swelling, chest pain, dyspnoea, fainting or a cold/numb limb. Fever, redness or drainage also needs assessment.
Fast recall: Before = baseline and risks. During = rhythm, breathing and reactions. After = site, circulation, bleeding and kidneys. Always compare new findings with the baseline.

For nursing education and exam revision. Clinical care follows the treating team’s orders and institutional protocol.

8. Practise: 10 nursing MCQs

Choose your answer first, then open the explanation.

1. Which access route is commonly associated with earlier mobilisation and less access-site bleeding in suitable coronary-procedure patients?

  1. Radial artery at the wrist
  2. Femoral artery in every patient
  3. Femoral vein for all coronary angiograms
  4. A peripheral IV cannula alone
Show answer & explanation

Correct answer: A. Radial arterial access often allows earlier mobilisation and reduces access-site bleeding in suitable patients; access selection remains individual.

2. After femoral catheterisation, which assessment most directly checks the puncture site and distal limb perfusion?

  1. Bowel sounds and appetite only
  2. Dressing/haematoma, distal pulse, colour, warmth and sensation
  3. Visual acuity and hearing only
  4. Daily weight without examining the limb
Show answer & explanation

Correct answer: B. Inspect for bleeding or swelling and compare distal neurovascular findings with baseline. A normal urine output does not exclude a local vascular problem.

3. A patient becomes hypotensive and reports new flank pain after femoral access. The visible dressing is dry. What is the priority interpretation?

  1. Routine discomfort needing review tomorrow
  2. Proof that there is no bleeding
  3. Possible concealed retroperitoneal haemorrhage requiring urgent assessment
  4. Expected effect of drinking water
Show answer & explanation

Correct answer: C. Concealed bleeding may cause hypotension and back/flank pain without visible external bleeding. Escalate and assess haemodynamics immediately.

4. During contrast injection, a patient reports brief warmth but has no rash, dyspnoea or haemodynamic change. What is the best response?

  1. Begin CPR immediately
  2. Ignore all subsequent symptoms
  3. Give emergency atropine without assessment
  4. Explain that warmth can occur while continuing observation
Show answer & explanation

Correct answer: D. Transient warmth can occur with contrast. Continue assessment; rash, airway symptoms, hypotension or chest pain require prompt evaluation.

5. Which history is most directly relevant to assessing a previous contrast hypersensitivity reaction?

  1. The exact contrast agent, reaction features and severity
  2. Shellfish allergy alone proves contrast anaphylaxis
  3. All foods containing iodine must be avoided
  4. A dislike of seafood is the main risk marker
Show answer & explanation

Correct answer: A. A prior reaction to contrast needs careful characterisation. Shellfish allergy alone does not establish a specific contrast allergy.

6. Before a patient taking metformin undergoes an arterial contrast procedure, what should the nurse do?

  1. Double the dose before fasting
  2. Check renal status and verify the prescribed withholding/restart plan
  3. Automatically restart immediately in every patient
  4. Substitute IV metformin independently
Show answer & explanation

Correct answer: B. Metformin management depends on renal function, AKI risk, procedure and local guidance. Follow the documented plan rather than a universal rule.

7. Which combination is most consistent with a vasovagal reaction during catheterisation?

  1. Hypertension and marked tachycardia only
  2. Fever and purulent drainage
  3. Bradycardia, hypotension and sweating or nausea
  4. An isolated increase in appetite
Show answer & explanation

Correct answer: C. Increased vagal activity may cause bradycardia with hypotension and autonomic symptoms. Prompt assessment and prescribed management are required.

8. A patient with heart failure is recovering after contrast exposure. Which fluid plan is safest?

  1. Force several litres orally regardless of symptoms
  2. Restrict all fluid in every patient
  3. Give diuretics routinely without an order
  4. Use prescribed hydration with fluid balance and renal monitoring
Show answer & explanation

Correct answer: D. Hydration should be individualised. Fluid overload risk makes automatic high-volume drinking unsafe; follow orders and assess volume status.

9. During recovery from radial access, the hand becomes cold and numb. What should the nurse prioritise?

  1. Urgent neurovascular assessment and escalation
  2. Reassurance without checking circulation
  3. Massaging the access site vigorously
  4. Waiting until the next day
Show answer & explanation

Correct answer: A. A new cold or numb hand may indicate impaired arterial perfusion. Compare neurovascular findings with baseline and obtain urgent review.

10. Which discharge statement shows appropriate understanding after coronary stenting?

  1. I can stop antiplatelets when the bruise settles
  2. I will take antiplatelets as prescribed and discuss changes with my treating team
  3. Every patient must avoid walking for ten days
  4. Any chest pain is normal for several weeks
Show answer & explanation

Correct answer: B. Adherence to the prescribed antiplatelet regimen is important after stenting. Do not stop it independently, and report concerning symptoms promptly.

Sources and further reading

Adapted and expanded from supplied teaching notes, with clinical clarifications checked against the sources below. Reviewed 18 October 2026.

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