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
- After preparing and anesthesizing the catheter insertion site, the surgeon inserts a guide wire into the femoral artery by a percutaneous approach.
- The surgeon threads the catheter into the coronary artery with the help of fluoroscopy and confirms the lesion by angiography.
- 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.
- The duration of inflation and the amount of infusion may vary, depending on the severity of the patient’s symptoms and myocardial ischemia.
- Several inflations with different balloon sizes may be necessary to expand the arterial wall.
- The expanding balloon compresses the atherosclerotic plaque against the arterial wall, expanding the arterial lumen.
- Quantitative measurements of the procedure’s success are derived from pressure gradient measurement across the stenotic area of the artery.
- The surgeon then performs a repeat angiogram.
- After completing the procedure, the surgeon leaves the catheter in place to provide access in case coronary artery occlusion develops.
Perioperative Nursing Considerations
- Aseptic surgical technique must be established and maintained during the insertion procedure.
- Confirm with the surgeon the type and length of the catheter to be used.
- An instrument count in not required; however, sponges and sharps are to be counted according to protocol.
