Which discharge instruction would the nurse include for a child who has undergone a cardiac catheterization?

Herrmann J. Cardiac catheterization. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 19.

Kern MJ, Kirtane AJ. Catheterization and angiography. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 51.

Mauri L, Bhatt DL. Percutaneous coronary intervention. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 62.

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    Doctors do cardiac catheterizations in an operating room called a catheterization lab. 

    In a cardiac catheterization:

    • Your child gets a sedative medicine through an IV line to sleep through the procedure and not feel pain.
    • Small sticky patches (electrodes) placed on your child’s chest are attached to an electrocardiograph (ECG) monitor. This checks the heartbeat throughout the procedure.
    • The area where the catheter will go in (usually the groin) is shaved (if necessary) and cleaned.
    • The cardiologist uses a type of X-ray called fluoroscopy throughout the procedure to see the heart and blood vessels. 
    • The cardiologist:
      • Puts a sheath (a tube about the size of a coffee straw) through the skin and into a blood vessel. The sheath lets the catheter enter the blood vessel smoothly.
      • Gently guides a catheter through the sheath, into the blood vessel, and to the heart. 
      • Checks the pressures and oxygen levels in the heart and blood vessels.
      • Puts a type of dye called contrast into the heart to see the heart's vessels, valves, and chambers more clearly.
      • Does the test or procedure.
      • Removes the catheter and sheath, then bandages the site.

    What Happens After Cardiac Catheterization?

    You can join your child in the recovery area after the procedure. Your child must lie down and keep the leg that the catheter went in straight until the doctor says it's OK to get up, usually in 4–6 hours.

    The doctor will talk to you about:

    • pain medicines
    • when your child can eat and drink
    • continuing medicines your child was on before the procedure or starting new ones
    • when to remove the bandage
    • if your child should get up and move if you have a long trip home
    • when your child can bathe
    • when your child can return regular activities, school, and sports

    How Can Parents Help?

    Take the bandage off as instructed by the cardiologist, usually the day after the catheterization. Wetting the sticky parts of the bandage will help it come off. Then, dry the area and put a small adhesive bandage over the place where the catheter went in.

    Gently wash the area with soap and water at least once a day. Then, cover it with a new adhesive bandage.

    For about 2–3 days, your child should take sponge baths or short showers so that the area does not get too wet. They should avoid baths, hot tubs, and swimming, and not use any creams, lotions, or ointments on the area.

    Are There Any Risks From Cardiac Catheterization?

    Cardiac catheterizations are generally safe procedures. It's normal for the area where the catheter went in to be bruised, sore, or slightly swollen for a couple of days afterward.

    More serious problems are uncommon, but can happen. These include:

    • bleeding
    • allergic reaction to the medicines or contrast dye
    • heart attack
    • stroke

    When Should I Call the Doctor?

    Call the cardiologist if your child has:

    • bleeding or swelling in the area where the catheter went in 
    • chest pain
    • trouble breathing
    • a fever

    What Else Should I Know?

    Cardiac catheterizations are an important way to diagnose and treat heart problems. Most kids have no problem with the procedure and go home the same day. Sometimes, a child is watched overnight in the hospital. Usually, kids are back to their regular activities within a week.