Pediatric Nursing Demystified

Atrial septostomy (Rashkind procedure) performed during catheterization

to increase mixing and maintain cardiac output.

Arterial switch procedure to connect the main artery to the proximal

aorta and the ascending aorta to the proximal pulmonary artery.

Coronary arteries are switched from the proximal aorta to the proximal

pulmonary artery, which creates a new aorta.

Nursing Interventions for Child Undergoing

Cardiac Catheterization

Prepare the patient for cardiac catheterization:

• Take complete nursing history.


• Patient must be NPO for 4 to 6 hours.


• Complete assessment including calculation of body surface area.


• Check for allergies; allergies to iodine, contrast dyes, and shellfish
  should be relayed to the physician prior to the procedure.


• Document baseline assessment of pedal pulses and pulse oximetry.


• Utilize child life specialists to alleviate anxiety for the child and
  family.


• Arrange a tour of the lab with the child if age appropriate.


• Explain specific aspects of the procedure such as the placement of
  the IV and ECG electrodes.


• Demonstrate how the skin will be washed with brown soap and how
  the skin will be numbed.


• Explain how the contrast affects the patient and how sedation will
  make the child feel.
  Care of the patient after cardiac catheterization:


• Monitor patient with cardiac monitor and pulse oximeter prior to
  discharge.


• Monitor the patient for
  Temperature and color distal to the catheter insertion site
  A pulse of the extremity distal to the catheter insertion site


• Take vital signs every 15 minutes for the first hour and hourly
  thereafter.


• Monitor for trends and assess for possible hypotension, tachycardia,
  and bradycardia.


• Check the pressure dressing for evidence of bleeding.


• Observe for bleeding at the insertion site or evidence of hematoma.


• Monitor intake and output for diuresis from contrast material.


• The patient and family should be provided with education upon
  discharge to:
  Observe the site for signs of inflammation and infection.
  Monitor for fever.
  Avoid strenuous activities for a few days.

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CHAPTER 6/ Cardiovascular Conditions^119