Management of post-cath complications

1
Management of post-cath complications
2

• Hematoma/bleed
• Apply direct pressure to the artery, often
  directly above the site of the hematoma
• Compress artery against pelvic brim (between ASIS
  and pubic symphysis)
• Send for help asap (cardiology fellow oncall)
• Stat CBC
• Assess patients vitals and peripheral pulses

3

• Tachycardia/hypotension
• Assess groin site for active bleeding/hematoma
• Assess for dullness in bilateral flanks
• Large quantities of blood can be hidden in
  abdomen, thighs and flanks
• Stat CBC, coags and abdominal CT r/o RP bleed
• stop heparin/IIbIIIa in consult with cardiology
  fellow (emergent echo, etc.)

4

• Persistent/New Chest Pain
• Check ECG, cycle troponins, examine patient
• DDX IST, microvascular injury post-PCIGERD,
  musculoskeletal, etc.
• Rx guided by ECG changes
• Careful hx is crucial (characterize pain and
  correlate w/current and prior ECGs, response to
  Rx (SL TNG), prior history
• Monitor hemodynamic status

5

• Rising Creatinine/Decreased UOP
• DDX embolic process, pre-renal azotemia,
  contrast nephropathy (2 days post-procedure),
  cardiogenic shock (poor forward flow), sepsis
• ?IABP, if so concern for renal ischemia
• r/o infection, ?febrile-gtsend Cxs
• May give trial of IVF, HCO3- protocol, mucomyst
  (600 PO BID x day prior to and after procedure)
• Consider RHC if persistent hypotension and
  uncertain CO and volume status

6

• Altered Mental Status/Changed Neuro Exam
• DDX CVA (embolic or hemorrhagic), metabolic,
  delerium, medications, infection
• STAT labs (CBC, Coags, Chem panel, LFTs)
• Consider STAT head CT r/o ICH
• STAT Neuro consult for new CVA
• Serial neuro exams
• UA, BCx/UCx/SPCx, especially if febrile