Contents. Welcome to the Cath Lab P4/5

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2 Contents Welcome to the Cath Lab Preparation Instructions : information to ensure you are ready for your procedure in the Cath Lab, set out for you as questions (Q) and answers (A) How the day will go Information about the procedure Risk of complications Further Information P3 P4/5 P7 P9 P10 P11

3 Welcome to the Cath Lab You have been referred for a procedure at the Cardiac Catheterisation Laboratory, often shortened to Cath Lab. This is staffed by a specialist team consisting of Cardiologists (heart doctors), nurses (who assist the doctor and look after you), cardiac physiologists (who monitor your heart throughout) and radiographers (who control the x-ray machine). 3

4 Preparation Instructions Please read carefully as the preparation is slightly different for Coronary Angiogram ( angio ) and Angioplasty & Stenting ( stent ). See your appointment letter to check which procedure you are having. Q. Do I need to start any new medication before my procedure? A. Yes, if you are having a stent. In order to undergo this procedure you must take ASPIRIN 300 mg (4 x 75 mg tablets) and CLOPIDOGREL 300 mg (4 x 75 mg tablets) the day before the procedure. On the day of the procedure you must take ASPIRIN 75 mg (1 x 75 mg tablet) and CLOPIDOGREL 75 mg (1 x 75 mg tablet). Please see your GP to arrange prescriptions for these. If you are already taking ASPIRIN and CLOPIDOGREL daily, continue to do so, there is no need to increase the amounts. Q. Do I need to stop any medication before my procedure? A. None, unless you take the following : WARFARIN : If you take this for an irregular heartbeat (called Atrial Fibrillation or AF) please stop taking it 5 days before your procedure. Then have an INR blood test 1-2 days before the procedure date and if this is above 2 your procedure may be postponed. 4 If you take WARFARIN for another reason such as heart valve replacement or previous blood clots, or take any other blood thinning medications (such as RIVAROXABAN, APIXABAN or DABIGATRAN), please contact your Cardiologist (see your appointment letter) via their secretary for advice. METFORMIN : do not take on the day of your procedure. You will be advised by nursing staff when to restart taking it. WATER TABLETS : e.g. FUROSEMIDE; BUMETANIDE: do not take on the morning of your procedure, this is for your comfort during the procedure! Please take ALL other medications (including insulin) as usual

5 Q. What blood tests do I need to have before the procedure? A. Kidney Function and a Full Blood Count. Please contact your GP surgery to arrange these blood tests if you ve not had them done within the last: 6 months before an angio 2 months before a stent Q. What arrangements do I need to make for after the procedure? A. Someone to collect you from the ward and stay with you overnight. Angio : You must not drive for 24 hours following this procedure. You must have an adult with you at all times for the rest of the day and overnight, so you will need to arrange for a relative or friend to accompany you on public transport or drive you home. Stent : As for Angio except you must not drive for 1 week following this procedure. In addition you must also stay within 40 miles of Raigmore Hospital on the night of your procedure, so you will need to arrange accommodation locally beforehand, if you live further away than this. If you are unable to make these arrangements you will require admission to hospital overnight. Please let us know beforehand by contacting your consultant s secretary (on your appointment letter). 5 Q. What should I bring with me on the day of my procedure A. An overnight bag and your medication. This test is planned as a day case, although you may be admitted to hospital overnight for medical reasons. This is much more likely if you are having a stent. A. Reading material/personal music players/puzzles etc to entertain yourself, as you may be with us for the whole day. A. Comfortable clothing. (minimal buttons/zips/belts/laces etc). Please wear comfortable clothing to hospital for ease of dresssing after your procedure.

6 Q. Do I need to fast for this procedure? A. No, please have breakfast before you leave home. Q. How long will I be at the hospital? A. Most of the day. You may have a long wait of up to 5 hours before the procedure. This is due to having to fit emergencies (people having or had heart attacks) into the schedule of our one procedure room. Q. What time will I leave hospital after the procedure A. Recovery time following your procedure will be : Angio - at least 3 hours Stent - at least 6 hours Q. Will I get the result of the test / treatment on the day? A. Yes, your Cardiologist will discuss the result of the test or outcome of any treatment with you before you go home. 6

7 How the day will go... Before the procedure: On arrival you will be greeted by our receptionist, who will make sure your registration details are up-to-date and that we have any phone numbers we might need. A nurse will collect you from reception, show you to your bed or chair, allowing you to settle in before asking all the usual admission information. Your blood pressure, pulse, temperature, height and weight will be recorded, and a heart tracing (ECG) done by a technician. Your nurse will then place a tube (called a cannula or venflon) into a vein in your arm. This is needed to give any medications if required, and for a drip if you are having a stent. Your doctor will discuss the procedure with you and ask you to sign a consent form stating that you understand the procedure. You will then have a variable amount of time to wait for your procedure. The procedure: 7 Once in the Cath Lab you will lie on an x-ray table, be connected to the ECG monitor, then covered in a sterile sheet. You will be awake throughout the procedure but we can give you sedation if you need it. The doctor will inject local anaesthetic to numb the skin, before placing a tube (sheath) in the artery. This is most commonly in your wrist but if this is not possible then the artery at the top of your leg will be used. Catheters are then passed through the sheath towards your heart. The x-ray camera will move around and you will be asked to move your head from side to side, and maybe take a deep breath, but otherwise you should lie as still as possible.

8 Most patients have little or no discomfort during the test. Some patients feel a few extra heartbeats while the doctor moves the catheter into the right position, a hot flushing sensation when the contrast is injected or a slight tightness in your chest as the contrast displaces the blood and oxygen for a few seconds. All these symptoms are normal. At the end of the test the sheath is removed. If it was in your wrist a tight band is placed around your wrist to seal the puncture for 2 3 hours. If it was in your leg, the doctor will seal it with a small plug or by pressing with their fingers. You will have to lie flat or rest on your bed for 1-3 hours afterwards. After the procedure: Once back on the ward you will have your blood pressure, pulse and puncture site regularly monitored by your nurse. The recovery routine varies slightly depending whether the procedure was done through your wrist or groin, or whether you ve had a stent. You will be offered tea, coffee, toast or a sandwich during your recovery period. Once we are happy that your arm or leg has stopped bleeding we will mobilise you. The doctor will discuss with you and your family (if you want) your results of the test or treatment. Your venflon will be removed and you will be ready to be discharged. Your nurse will explain to you and whoever is collecting you (ideally the person who is staying with you overnight) how to care for the arterial puncture site when you go home. You will be given a report with the test results and changes to treatment to give to your GP. There may be some bruising at the site of the catheter insertion which may be a little sore for a day or two. Painkillers such as Paracetamol will help to ease this. 8

9 Information about the procedure Coronary Angiogram ( angio ): This is a procedure/ test done to study the blood vessels (heart arteries) that bring blood and oxygen to the heart muscle. It is done by injecting x-ray visible dye (contrast) through a long, flexible, hollow tube (a catheter) positioned at the opening of the coronary (heart) arteries, to produce x-ray pictures of the inside of the arteries like the one below. 9 Angioplasty and Stenting ( stent ): This is a treatment procedure that unblocks narrowed blood vessels using balloons and stents. If you are having this procedure a British Heart Foundation (BHF) booklet entitled Coronary angioplasty should be enclosed with your appointment letter, if not please contact your doctor s secretary or go to

10 Risk of complications Most of the side-effects are minor and may include: A bruise, which may form under the skin where the catheter was inserted. This is not serious, but it may be sore for a few days. The small wound where the catheter is inserted sometimes becomes infected. Tell your GP if the wound becomes red and tender. A short course of antibiotics will usually deal with this if it occurs. Some people get a brief angina-type pain during angiography. Rarely, some people have an allergic reaction to the x-ray contrast dye. Serious complications are very rare, but do sometimes occur. For example, 1 in a 1000 patients can have a stroke or a heart attack (myocardial infarction) during the procedure. The risk of serious complications is small and is mainly in people who already have serious heart disease. Your doctor will only recommend your procedure if they feel the benefits outweigh the small risk. You will have the opportunity to discuss these risks and any other concerns with your doctor before you sign the consent form on the day of your procedure. 10

11 Further information For general advice about the procedure, or preparation for it, you are welcome to telephone the Cardiac Day Case nurses on The British Heart Foundation has lots of information about all things heart related: Scotland s health information service is a good source for information about illnesses, tests, treatments and services at The Chaplaincy Department is a Highland wide service which seeks to deliver Spiritual, Religious and Pastoral Care. If you wish to see a member of the Chaplaincy team then please let a member of the nursing staff know or contact them directly on

12 Devised by Marianne O Hara / Prof. Steve Leslie Issue No. 2 Updated : Oct Review date : Oct Oct. 2016