Patients admitted on day of procedure, earlier if less fit. Often suitable for day case unit. Overnight stay not routinely required for diagnostic angiograms. Should stay overnight after interventions.
- Warfarin – stop 3 days in advance and check clotting on morning of procedure
- Non-steroidals other than aspirin : stop on day of procedure and for 48 hours
- Metformin – omit on day of procedure and withhold for 48 hours, restart if function ok
- All other medications including anti-hypertensive and anti-anginal to continue
- Fluids only for 2 hours prior to procedure (can have light breakfast if late am procedure)
Investigations – recent results to be available for
- FBC (Hb must be >80g/l, Pts >100)
- U&E (K must be <5, if not give IV 10% dextrose 20mls/hr and 5mg Salbutamol neb)
- Coagulation screen – only if on anticoagulant or abnormality likely
- ECG if history of IHD, glucose if diabetic
- Record BP – postpone only if very high
- Assess and document peripheral pulses
Ensure patient well hydrated and good urine output prior to contrast (if pre-dialysis) – if in doubt put up 6hrly 500mls N Saline. Do not fluid overload dialysis patients. Avoid diuretics. Beware that after stenting/angioplasty, some patients may become polyuric.
Should be done in OPD for diagnostic studies. Radiologist should obtain consent for interventional studeis, need to warn of risks of contrast, and catheter-related complications including embolism, arterial occlusion, bleeding from puncture site, loss of renal function, occasional need for surgery after intervention.
- Diagnostic studies – mobilise at 4 hours if no complications
- Interventions – mobilise at 6 hours, and overnight stay
- Pulse and BP: hourly for 4 hours, then 6 hourly overnight if an IP
- Urine output: beware polyuria post-angioplasty
- Assess pain, wound, haematuria
- Check U &E following morning if kept in
- Warfarin can be restarted the following day
- Consider aspirin 150mg if angioplasty/stent – ask radiologist if not clear
Acknowledgements: Angela Webster was the original author for this page. The last modified date is shown in the footer.