Angiogram, Stenting, and Percutaneous Transluminal Angioplasty HF#6072

Angiogram is a procedure in which a series of x-ray picture are taken using contrast (x-ray dye).

 

Percutaneous Transluminal Angioplasty (PTA) is a procedure in which a series of x-ray pictures are taken using contrast (x-ray dye).  Using a balloon, arteries or veins that have been narrowed or blocked are opened.  A special catheter with a balloon on the tip is inflated and deflated to open a blocked vessel in your body.  Before the PTA, an MRA (arteriogram) may be  done to help the doctors see the arteries in a certain part of the body.

 

Why Do I Need a PTA? An MRA, CTA or ultrasound has shown that a blood vessel is narrowed or blocked. The PTA has become a best method for the people who should not have surgery. Most of the time, it is the preferred method to open blocked vessels that can be reached easily. Stent is an artificial device placed in the artery to help keep the artery open.   During the PTA Procedure   This procedure is done in the cath lab.  Before starting, our doctor will talk with you about what to

expect and ask you for your consent to do it.  Be sure to tell the doctor if you have any allergies to contrast dyes, antibiotics, anesthetic agents, latex, or any medicines that you may have taken before.

 

It often takes several hours, sometimes longer.  An IV (intravenous) will be started to give you fluids.  Medicine to relax you may also be given.

 

During the PTA, the nurse will check your vital signs.  After the doctor or tech finds your femoral/radial artery and marks it, that area will be shaved and cleaned.  You will then be covered with sterile drapes to help prevent infection.  The doctors will wear sterile gowns and masks to provide a clean environment.

 

The skin at the entry site will be numbed with 1% Lidocaine so you will have little pain.  Most patients do not feel a lot of pain, but you may feel pressure during the catheter placement.  Using fluoroscopy, a small tube (catheter) is placed into the artery.  The doctor will advance the tube into the area that needs to be studied.

 

The tube will be hooked up to an injector at which time the "contrast" or dye is injected into the artery.  The contrast highlights the vessels.  During this process you may feel warmth or heat.  This is normal and is often felt in the abdomen and buttocks.  You will be asked to hold your breath so you do not move while the films are being taken.  Several injections or "runs" are done.

 

After finding the place and size of the blockage, the angioplasty will begin.  The tube is threaded up until it reaches the blocked area.  At the end of the tube is a balloon.  The balloon is inflated for 15-60 seconds and then deflated.  This process may be done several times.  You may feel pressure at the site where the inflation occurs.  Some patients have some pain as the balloon is being inflated.  If this happens, you can be given IV pain medicine.  Peripheral pulses often improve right away, the lower leg or arm color improves, and you may have less pain.

 

 

How the PTA will be done

 

 

 

 

 

After your Procedure

 

1. You will need to lie flat with your extremity straight for 6 or more hours after your sheath (a large IV in your groin or elbow) is removed.

 

2. Vital signs such as blood pressure, pulse and temperature will be taken often.  Circulation checks of your leg or arm will be also done.

 

3. The groin or elbow site will be checked for bleeding.

 

4. You may eat and drink after the sheath is removed.

 

5. You may start taking most of the medicines you took before the procedure.  Your blood thinners (coumadin, plavix, aspirin) may be changed.  A doctor, nurse, or pharmacist will talk with you about this.
 

6. You may have a Foley catheter in place while you are lying flat.  A Foley is a tube used to empty your bladder.

 

7. You will have an IV in to make sure you have enough fluids.

 

Before You Go Home

• You will learn how to apply direct pressure to the site in case it bleeds.

• Talk with your doctor about when you can return to work or normal routines.

• Talk with your doctor about when you can resume driving.

Home Care

 

If bleeding occurs at the site, apply direct pressure.  Call 911 and go to the nearest emergency room. If you feel extreme dizziness, faint or light-headed, this may be due to low blood pressure.  You may be bleeding internally.  If you feel this way, call 911 and go to the nearest emergency room.

1. Leave the Tegaderm® dressing on during your first shower after PTA.  After your shower, remove the dressing and leave the site open to the air.  If you notice drainage, place a band-aid over the site.  Do not take a tub bath for the first 24 hours.

 

2. Drink at least 10-20 (8 oz.) glasses of fluid (water, coffee, juice, tea, etc) for the first 24 hours.  Do not drink alcohol the first day.

 

3. Keep your leg or arm (with the puncture site) straight when sitting or lying down for the first 24 hours.

 

4. No heavy lifting (more than 10 pounds) for 1 week.

 

5. Puncture Site - once a day for five (5) days, look at puncture site on your leg or arm for signs of infection.  Call your doctor if you notice:

• Redness or warmth at the site
• Foul-smelling, yellowish or greenish drainage from puncture site
• Increased swelling at puncture site
• Temperature (by mouth) above 101.5°F or 38.5° C 

Pain Medicine

 

You should feel only a little pain after you are home.  For relief, take acetaminophen (such as Tylenol®).

 

When to Call Your Doctor

• Signs of infection
• Large firm area under and around the puncture site
• Severe pain or spasms in the leg or arm
• Numbness and/or tingling in foot, leg, arm or hand
• Loss of motion in foot, leg, arm or hand
• Itching or hives anywhere on your body
• Vomiting

Phone Numbers

 

If you have any questions or problems once you are at home, call the PVS Clinic (608) 263-8915 during the day (8:00 am to 4:30 pm).

 

Nights, weekends and holidays, call (608) 262-0486.  Ask the paging operator for the PVS resident on call.  Give the operator your name and phone number with the area code.  The doctor will call you back.

 

If you are calling from out of the area, call 1-800-323-8942.

 

References

 

Fahey,Victora  Vascular Nursing 4th Edition
Carlson, Karen; Lynn-McHale, Lynn  4th Edition AACN Procedure Manual for Critical Care

 

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 11/11/2011

Copyright © 11/11/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6072

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