Deviation in the Standard of Invasive Cardiac Care During a Cardiac Catheterization (Heart Cath, Angiography)

Evaluate breaches in the standard of care to determine if there was a Deviation in the Standard of Invasive Cardiac Care During a Cardiac Catheterization (Heart Cath, Angiography)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following indications for cardiac catheterization did the patient present?(Choose all that apply)
    Valvular heart diseases
    Congenital heart diseases
    Chronic heart failure/Cardiogenic shock
    ST elevation myocardial infarction /Acute coronary syndrome
    Percutaneous coronary intervention
    Coronary artery bypass surgery
    None of the above
    Answer unknown
    Why is this important?
    A diagnostic cardiac catheterization is recommended whenever it is clinically important to define the presence or severity of a suspected cardiac lesion that cannot be evaluated adequately by noninvasive techniques.
    (2001) 37 JAMECC 8 2170-2214

  • With which of the following contraindications did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    
There is no absolute contraindication to cardiac catheterization other than refusal of the competent patient. The procedure can be successfully performed even in the most critically ill patient with a relatively low risk.

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  • Were all the risks discussed with the patient and documented? Why is this important?
    Answer this question
    
The cardiologist who is responsible for the procedure must explain the procedure fully, including all the risks associated with the procedure, as well as the consequences of refusing the procedure.

    (2001) 37 JAMECC 8 2170-2214 



  • Was an informed consent obtained prior to the cardiac catheterization? Why is this important?
    Answer this question
    
The laws of most states require that (physicians) obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Was a pre-catheterization evaluation performed? Why is this important?
    Answer this question
    
The pre-catheterization evaluation includes obtaining the patient's medical history, a physical examination, an electrocardiogram, routine laboratory investigations, and a chest X-ray.

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  • Which of the following diagnostic laboratory investigations were performed?(Choose all that apply) Why is this important?
    Answer this question
    
Routine laboratory studies include complete blood count with platelets, serum electrolytes, BUN with creatinine, glucose concentrations, prothrombin time with international normalized ratio (INR), and partial thromboplastin time (in patients receiving heparin).

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  • Was Metformin stopped before the procedure? Why is this important?
    Answer this question
    
Patients with diabetes receiving metformin should have the medication discontinued the morning of the procedure.

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  • With which of the following conditions did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    
Documentation of any previous exposure to x-ray contrast and whether any reaction occurred is essential for the safety of the patient.

    (2001) 37 JAMECC 8 2170-2214 



  • Which of the following precautionary measures were initiated?(Choose all that apply) Why is this important?
    Answer this question
    
Patients with a prior history of contrast medium allergy need prophylaxis before the procedure.

    (2001) 37 JAMECC 8 2170-2214 



  • How many hours elapsed between the patient’s last meal and the planned procedure? Why is this important?
    Answer this question
    
Patients should be fasting at least 6 hours before cardiac catheterization.

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  • Was the staff currently certified in advanced cardiac life support? Why is this important?
    Answer this question
    
It is necessary that all members of the cardiac catheterization laboratory staff be certified in advanced cardiac life support and that the certifications are current.

    (2001) 37 JAMECC 8 2170-2214 



  • Was a strict sterile environment maintained? Why is this important?
    Answer this question
    
Infection control guidelines for the cardiac catheterization laboratory were updated in 2006 by the Society for Cardiovascular Angiography and Interventions.

    (2001) 37 JAMECC 8 2170-2214 



  • Was an intravenous line established? Why is this important?
    Answer this question
    
An intravenous line should be established in all patients undergoing a cardiac catheterization.

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  • Was the patient’s vital signs monitored throughout the procedure? Why is this important?
    Answer this question
    
All patients must have pulse oximetry, with continual blood pressure, heart rate and heart rhythm evaluations recorded throughout the entire procedure.

    (2001) 37 JAMECC 8 2170-2214 



  • Which of the following arrythmias did the patient experience during the procedure? Why is this important?
    Answer this question
    
The most common complication that occurs during cardiac catheterization is the development of cardiac arrhythmias due to mechanical trauma of the endocardium by the catheter tip.

    (1999) 20 ECLCMD 2 249-267 



  • Was the algorithm for the arrhythmia followed as dictated by the advanced cardiac life support guidelines? Why is this important?
    Answer this question
    
Advanced Cardiac Life Support (ACLS) certification provides the knowledge, skill and judgment required to recognize an arrhythmia and manage it with efficiency..

    (2000) 46 ERESUS 1-3 103-107 



  • What was the outcome of the medical intervention for the arrhythmia? Why is this important?
    Answer this question
    
Prompt and precise management of a cardiac arrhythmia during the heart catheterization is essential to the safety of the patient.

    (2000) 46 ERESUS 1-3 185-193 



  • Was the pressure in the various chambers of the heart monitored and recorded? Why is this important?
    Answer this question
    
Accurate recording of pressure waveforms and correct interpretation of physiologic data derived from these waveforms are major goals of cardiac catheterization.

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  • Was the cardiac output measured and recorded before and after the procedure? Why is this important?
    Answer this question
    
There is no completely accurate method of measuring cardiac output in all patients, but it can be estimated on the basis of various assumptions.

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