Percutaneous Transluminal Coronary Angioplasty

Definition

  • Percutaneous transluminal coronary angioplasty is used to treat coronary artery disease. It offers some patients a nonsurgical alternative to coronary artery bypass surgery.
  • PTCA is performed for occlusion that decreased the artery lumen by 70% or greater.
  • A tiny balloon catheter is used to dilate a coronary artery that has been narrowed by atherosclerotic plaque.
Positioning
  • Supine, with arms extended on armboards.
Packs/ Drapes
  • Cardiovascular pack
  • Drape sheet
Instrumentation
  • Cardiac procedure tray
  • Specialty tray
  • Hemoclips
Supplies/ Equipment
  • Fluoroscopy
  • Guide wire
  • Cardioverter with internal paddles
  • Cell-saver unit
  • Heart-lung machine
  • Hemodynamic monitoring lines
  • Basin set
  • Blades
  • Beaver blade
  • Assorted syringes and needles
  • Asepto syringes
  • Foley catheter
  • Medications
  • Solutions
  • Heparinized saline
  • Chest tube with Y-connector
  • Sealed chest drainage unit
Procedure
  1. After preparing and anesthesizing the catheter insertion site, the surgeon inserts a guide wire into the femoral artery by a percutaneous approach.
  2. The surgeon threads the catheter into the coronary artery with the help of fluoroscopy and confirms the lesion by angiography.
  3. The surgeon introduces a small double-lumen balloon-tiped catheter through the guide wire, positions it, and repeatedly inflates the balloon with normal saline solution and contrast medium.
  4. The duration of inflation and the amount of infusion may vary, depending on the severity of the patient’s symptoms and myocardial ischemia.
  5. Several inflations with different balloon sizes may be necessary to expand the arterial wall.
  6. The expanding balloon compresses the atherosclerotic plaque against the arterial wall, expanding the arterial lumen.
  7. Quantitative measurements of the procedure’s success are derived from pressure gradient measurement across the stenotic area of the artery.
  8. The surgeon then performs a repeat angiogram.
  9. After completing the procedure, the surgeon leaves the catheter in place to provide access in case coronary artery occlusion develops.
Perioperative Nursing Considerations
  1. Aseptic surgical technique must be established and maintained during the insertion procedure.
  2. Confirm with the surgeon the type and length of the catheter to be used.
  3. An instrument count in not required; however, sponges and sharps are to be counted according to protocol.
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