 Hi, welcome to nursing school explain and this video on coronary angiogram That is sometimes also referred to as PCI or Percutaneous coronary intervention and if you think about it percutaneous means through the skin so we access the skin or through the skin to Get access to the coronary arteries and this is the first line treatment when the patient has a STEMI or an ST elevation MI Please watch my other video where I go about the detail into STEMI non-STEMI and myocardial infarction The goal of this procedure is to open up an occluded coronary artery or Multiple arteries and maybe place a stent to keep it open permanently Now typically when the patient is suffering from a STEMI an acute Myocardial infarction the we want to get the patient to this procedure within 90 minutes of the patient entering the hospital It's called door to balloon time When this is a treatment also for unstable angina or non-STEMI Which basically means that this is nothing as acute right now But we still have to evaluate the patient's coronary arteries Then typically we have about 12 to 24 hours to get this done So it's not quite as emergent as for the procedure It's usually performed by the cardiologist or an electrophysiologist if they have been trained to do so and They access either the femoral or radial artery depending on the patient's anatomy and the physician's preference and So a catheter is inserted in one of those arteries and then with a camera is threaded all the way down To the heart and it allows the physician or the provider to look at the coronary arteries from the inside and Determine the percentage or the degree of the occlusion if it's partially or completely occluded and they use contrast media to do that and So by injecting contrast media, there's also a separate monitor where they can On a big monitor see what is happening on these coronary arteries because of that camera that's been inserted They can determine the degree of the blockage and then the presence of any collateral Circulation and I'll have a separate video on what collateral circulation is and then a stent can be inserted as needed If there's a certain percentage of blockage The stent is a device that can be inserted that kind of helps to open up and keep that Coronary artery open and restore the blood flow distally from that occlusion Now as you can imagine We are inserting something a foreign object into the patient's heart into the arteries that supply the patient's heart So there are certainly complications involved and they involve injuries to the coronary artery When that inner lining of the coronary artery may be a little bit nicked It can lead to a dissection Which that means that inner layer of that coronary artery is bulging out and eventually it can rupture It can lead to an acute MI if we're just doing this for unstable angina or non-stemming if the patient is not quite having that acute MI yet It can lead to a stent embolus every time we mess with really for lack of better terms or we Manipulate a clot it can burst off so it can cause an embolus that then gets into the bloodstream which then can dislodge and get settled in The brain and cause a stroke It can also lead to coronary artery spasm where at artery just gets irritated and then the patient might experience symptoms during the procedure if this is a significant MI and Stemmy and the patient may have hyper perfusion with a low blood pressure because of a low cardiac output Because the pumping ability of the heart is impaired it might also lead to acute kidney injury from prereno Causes and that is hypovolemia in this case and I have a separate video that talks about acute kidney injury if you're interested Certainly there can be bleeding either from the coronary arteries themselves or from the insertion site whether it's the radio or the Femoral artery Anytime we cut the patient's skin open. There's a risk for infection We talked about stroke there might be a need for a cabbage Which is a coronary artery bypass graft and that many times is indicated if there are more than three arteries That are pretty blocked or pretty much occluded or if the Location of the blockage is in such a spot that a stent would be difficult or impossible to be inserted and certainly whenever we Manipulate the patient's heart Physically or or manually with that stand on the camera It can lead to dysrhythmia because that heart muscle can be irritated during the procedure Now for our nursing considerations, I've divided them into pre and post procedure So before we have the procedure We have to check the patient for allergies and that is mostly because they are going to be getting this contrast media So we need to assess them for contrast die allergies as well as any other allergies They might have we need to make sure that they are in PO. Of course, it's of an emerge if it's an emergency That's always an exception We need to check their EKG that they've most likely done Or hopefully done in this patient check the consent Of course, we're just the witnesses to assigning that consent and Certainly we want to have the emergency equipment ready if we are going to manipulate the patient's heart in any way All kinds of things can happen that we just discussed in the complications here So we want to have the crash card and defibrillator ready to go and also have intubation equipment ready in case this is needed We want to manage their medications and I have a whole separate video that explains the different medications that are needed for treatment of MI and Then we want to talk to our patients and explain to them the access side What does it involve? What is it going to feel like the contrast media side effects? And this is a typical Contrast media as if you were given the patient contrast for let's say a cat scan So the patient might feel flushed they might feel like they're going to urinate on themselves But these are just side effects from the contrast They might experience palpitations and it's good to tell them about this ahead of time Otherwise it might contribute to the anxiety They might already experience because of the procedure itself And then the need for the continuous monitor and also we might want to hook them up to the cardiac Monitor and the defibrillator to have it ready And so that we have the equipment ready to go in case we need to use it And certainly we'll need to explain that to the patient before we head into the procedure Now after the procedure the most important part is to check the distal five P's the distal circulation Whether that is the radio artery so we'll assess the hand or if it's been the femoral artery Then it would be the foot that we assess Because whenever we manipulate an artery here it can lead to neurovascular complications and so we need to be able to assess for those and Then the insertion side as you can imagine the access goes through an artery So there's a high risk for bleeding and if the bleeding is not stopped right away it can lead to a hematoma that can get fairly big and If there's continuous oozing or bleeding there might be significant blood loss involved So we want to keep an eye on that site and I wrote here ABCs Because this comes up on exams all the time too and if you think about bleeding it has to do with circulation So that would be a C problem. So that is a high priority list on your option choices when it comes to exams We want to monitor the patient's vital signs frequently and that's per protocol as with any post-op patient More frequently right after the procedure and if things are normal then we can space out the time frame That we check those vital signs Certainly we want to do repeat EKGs and keep the patient on the cardiac monitor Assess the cardiovascular and respiratory systems frequently Because things might happen and they might change after this procedure because we've just manipulated their blood supply to their heart We want to keep the patient flat on bed rest That is mostly the case if it's been the formora artery Because we don't want the patient to bend their leg and kind of put pressure on this insertion site Radio artery sites are a little bit easier to manage although we want to immobilize them and teach the patient on what to watch out for The plate the patient will need to be an anti platelets for at least 12 months If a stent has been inserted and the reason is that a stent is a foreign body and our body wants to Get rid of or kind of encapsulate anything. That's not normal and platelets kind of help us with that function So we want to prohibit these platelets from aggregating at the stent sites Because if they just keep clumping and clumping and clumping together eventually that stent will be occluded So anti platelets help here and most cardiologists like to keep the patients on for 12 months And then reevaluate to see how the patient is doing and reevaluate the need for the anti platelets and And then certainly also after the procedure we want to check the patient's urine output and renal function because we know In case they've gone hypovolemic or the contrast media has a bad effect on the patient It can lead to acute kidney injury and the best indicator of that is urinary output And then we also want to check the patient's neurostatus for any changes because we know that Complications also include a stroke. So if we don't check the patient's neurostatus We're not going to be able to assess them for signs and symptoms of a stroke Now the other procedure That I talked briefly about over here is cabbage. So it's the bypass graft I'll talk about this in a separate video because it's a completely different surgery that's much more invasive and Has a potential for more complications and of course is much more involved in terms of nursing care So watch out for that video. Thanks for watching Please give me a thumbs up if you've enjoyed this video and I'll see you soon right here on nursing school explain Thanks for watching