Atherectomy

WHAT YOU SHOULD KNOW:

Atherectomy (Inpatient Care) Care Guide

  • Atherectomy is a procedure that is done to remove plaques that block the arteries (blood vessels). Plaques are fat, cholesterol, or tissues that are clogged in the inner wall of the arteries. Although arteries are present throughout the body, plaque most often builds up in the arteries of the heart. When plaques build up inside the blood vessels, blood flow may be decreased. With a decreased blood flow, your heart muscles may not get enough oxygen. This can cause angina (chest pain), heart disease, or a heart attack.

  • Caregivers use a catheter (long, thin, bendable tube) to cut, shave, or dissolve the plaques that are blocking the arteries. This reduces the narrowing and increases blood flow back to the heart muscles.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • During atherectomy, problems that may happen include a sudden closure of the blood vessel. This decreases the blood flow further and may lead to a heart attack. An emergency coronary artery bypass graft surgery (CABG) may need to be done. Problems that may happen after atherectomy include bleeding from the incision, or infection. The blood vessel used for the procedure may tear, causing a large amount of blood loss.

  • You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • Without treatment, your symptoms such as trouble breathing, pain with walking, tiring easily, and angina may worsen. A greatly reduced blood flow may lead to a heart attack which could be serious and life-threatening.

WHILE YOU ARE HERE:

Before your atherectomy:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pulmonary artery catheter: This is a balloon-tipped catheter (thin tube) inserted through a vein in your neck or groin. The pulmonary artery (PA) catheter goes into the right side of your heart and continues to your pulmonary artery. The balloon is inflated to wedge the catheter in place. The PA catheter has a device in it that measures the pressure in your heart and lungs. The catheter is attached to a monitor that shows the pressure measurements. The measurements can also show caregivers how your heart responds to certain heart medicines.

  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

  • Medicines: You may have any of the following:

    • Antiplatelets help prevent blood clots. This medicine makes it more likely for you to bleed or bruise.

    • Calcium channel blockers: These medicines relax and open up blood vessels in your body.

    • Nitroglycerin: This medicine may also be called nitro. Nitroglycerin opens the arteries to your heart so the heart gets more oxygen. Nitroglycerin can be given in an IV, by mouth, or put on your body as a patch or paste.

    • Blood thinners help prevent blood clots. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise.

  • Tests: You may need any of the following:

    • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • Local or monitored anesthesia: Anesthesia is medicine that keeps you from feeling pain during surgery or a procedure. Local anesthesia is a shot of numbing medicine put into the skin where you will have surgery. You will be fully awake during the surgery or procedure. You may feel pressure or pushing, but you will not feel pain. Monitored anesthesia means you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the surgery or procedure.

During your atherectomy:

  • X-rays with a TV screen will be used to do the atherectomy. Caregivers will choose an artery to be used for the procedure, which is usually in your groin, arm, or wrist. Soap will be used to clean the area. If an artery in the groin is chosen for the procedure, caregivers may shave the area. This is done to see the area better and help prevent infection. Sheets will be put over you to keep the atherectomy area clean.

  • A small incision will be made through which a catheter will be inserted. The catheter is then gently pushed into the artery. You will be given an iodine dye through the IV to better see the area that is blocked. This may give you a warm feeling or a hot flash. Caregivers will then choose the type of instrument to use in clearing the plaque. You may hear a whirring noise, like a dentist's drill. You may also feel pushing movements as your caregiver cuts through the plaque. Tell your caregiver if you feel pain or chest tightness during the procedure. After the plaque is removed, the catheter is taken out of the artery, and a tight pressure bandage will be secured over the incision. Caregivers may place a small sandbag over the bandage to put pressure and prevent bleeding. The sandbag may stay in place for a few hours.

After your atherectomy:

You may be transferred to a recovery room or a cardiac care unit after your atherectomy. Caregivers will take your vital signs every 15 minutes for 1 to 2 hours. The pulses in your feet will also be checked often. If you need to cough or sneeze, you may be asked to put your fingers over the area where the catheter was inserted. Caregivers will watch you closely for problems that can happen after an atherectomy. Tell your caregiver if you have any of the following signs or symptoms:

  • You have chest pain.

  • Your leg feels cold or turns a different color, or if it hurts or feels tingly or numb.

  • Your groin is swollen or bleeding.

  • You have pain in your back, thigh, or groin.

  • You feel dizzy and nauseated (upset stomach), or if you start to sweat a lot.
  • Activity: You will need to lie flat and still in bed for a few hours. Tell your caregiver if you get tired of lying on your back. Caregivers will help you log-roll from side to side. If an artery in your groin was used for the procedure, you must keep your leg straight until your caregiver tells you it is OK to bend it. Your caregiver will also tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy after getting up, sit or lie down right away and call your caregiver.

  • Medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Tell caregivers right away if you start feeling discomfort, pressure, burning, or tightness in your chest. Tell caregivers right away if you start sweating, have trouble breathing, or feel discomfort in your arm, back, neck, or jaw. Any of these may be a sign that your heart is not getting enough oxygen, and may need medicine to help.

  • Monitoring: Caregivers may check for your pulses on your legs or feet. This may help the caregiver to learn if you have problems with blood flow after your atherectomy. You may also have the following:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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