Heart Catheter Procedure Through Wrist

How The Test Will Feel

The sedative will help you relax before the procedure. However, you will be awake and able to follow instructions during the test.

You will be given local numbing medicine before the catheter is inserted. You will feel some pressure as the catheter is inserted. However, you should not feel any pain. You may have some discomfort from lying still for a long period of time.

Why Do I Need Cardiac Catheterization

Your doctor uses cardiac cath to:

• Check for heart disease
• Check how your heart muscle is working
• Place a stent if a blockage is found

Common uses of cardiac catheterization

Your doctor can use cardiac cath to both find and fix problems. Procedures that might be done during your cardiac cath include:

• Angioplasty. Your doctor inserts a catheter with a tiny balloon at the tip. When this balloon is inflated, it pushes plaque out and widens your artery.
• Biopsy. Your doctor takes a small sample of tissue from your heart.
• Repair of heart defects. Your doctor closes a hole in your heart or stops a leak in a valve.
• Stent placement. Your doctor places a tiny mesh tube called a stent into your artery to help keep it open.
• Valve replacement. Your doctor may do a minimally invasive procedure called Transcatheter Aortic Valve Replacement to replace a faulty aortic valve.

What Is The Procedure Like

When a patient and their cardiologist decide to perform a cardiac catheterization they will discuss the method and location of accessing or entering one of the blood vessels of the body. Most commonly this is done in either the femoral artery in the groin or the radial artery in the wrist. From this access site the cardiologist can insert catheters that go to the heart and are able to look for heart artery blockages and also treat those blockages with balloon angioplasty and stents. These procedures are done at a hospital in the Cardiac Catheterization Laboratory . After the patient arrives at the Cardiac Cath Lab they are changed into a hospital gown and then placed on the procedure table. They are given light or moderate sedation with usually intravenous Fentanyl and Versed but are not under full anesthesia typically. If a radial or wrist artery procedure is planned the cardiologist gives local anesthetic agent to the wrist and then using a small needle is able to place a sheath in the wrist. The area that is going to be worked on is then cleaned and shaved to minimize infection. From that access site they are able to image all the arteries of the heart and perform balloon angioplasty and stents. A video screen allows the doctor to see where the catheter is going as it travels through the blood vessel to the heart. The procedure usually takes about 30 minutes to determine if there is a blockage and if a stent is necessary another approximately 30 minutes.

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What Is Heart Catheterization

Almost 1/3 of people in the US will encounter some form of heart or artery disease in their lives. Heart attack and limiting chest discomfort are often due to disease of the arteries that feed the heart. In order to diagnose and treat these problems, heart catheterization, which includes taking pictures of the arteries, is often necessary. A catheter is simply a long tube that may be manipulated to points inside of the body without a full, open surgical procedure. In many instances, the location of the coronary artery that is the source of limitation or discomfort can be identified and corrected through a catheter. Heart catheterization is performed on thousands of people every day.

What Happens During Coronary Angiography

During the procedure a long, thin, flexible tube called a catheter is inserted into a blood vessel in your groin or arm.

Using X-ray images as a guide, the tip of the catheter is passed up to the heart and coronary arteries.

A special type of dye called contrast medium is injected through the catheter and X-ray images are taken.

The contrast medium is visible on the angiograms, showing the blood vessels the fluid travels through. This clearly highlights any blood vessels that are narrowed or blocked.

The procedure is usually carried out under local anaesthetic, so you’ll be awake while the procedure is carried out, but the area where the catheter is inserted will be numbed.

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When To Call The Doctor

• There is bleeding at the catheter insertion site that does not stop when you apply pressure.
• Your arm or leg below where the catheter was inserted changes color, is cool to the touch, or is numb.
• The small incision for your catheter becomes red or painful, or yellow or green discharge is draining from it.
• You have chest pain or shortness of breath that does not go away with rest.
• Your pulse feels irregular — it is very slow or very fast .
• You have dizziness, fainting, or you are very tired.
• You are coughing up blood or yellow or green mucus.
• You have problems taking any of your heart medicines.
• You have chills or a fever over 101°F .

Heart Catheterization Performed Through The Wrist Can Result In Fewer Complications

Newswise STONY BROOK, N.Y., August 24, 2011 Each year, more than one million cardiac catheterizations are performed in the United States, and most of these procedures are performed through the groin to access the arteries that provide blood supply to the heart. Now, interventional cardiologists at the Stony Brook University Heart Center and elsewhere are performing more heart catheterizations by going through the wrist instead of the groin. Called transradial access, this emerging approach has increased advantages for patients, including reduced complications, increased patient comfort, and quicker recovery time.

We are expanding our use of transradial access for both diagnostic and interventional procedures to ensure better patient outcomes and comfort, says Luis Gruberg, M.D., Professor of Medicine, Division of Cardiovascular Medicine, Stony Brook University School of Medicine, and Interim Chief, Division of Cardiovascular Diseases, Director of the Cardiovascular Catheterization Laboratories, and Co-Director, Stony Brook University Heart Center. As a general rule, patients and their referring physicians have embraced this procedure, as it enables the patient to be mobile and sitting up much faster after the procedure and with less post-procedure pain.

For more information on transradial access catheterization at Stony Brook, please call Terry Adkins at 631-444-1066, or call 631-44-HEART .

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When You’re In The Hospital

A catheter was inserted into an artery in your groin or arm. Then it was carefully guided up to your heart. Once it reached your heart, the catheter was placed into the arteries that deliver blood to your heart. Then contrast dye was injected. The dye allowed your doctor to see any areas in your coronary arteries that were blocked or narrowed.

If you had a blockage, you may have had angioplasty and a stent placed in your heart during the procedure.

Why Might I Need Transradial Cardiac Catheterization

There are many reasons you might need this procedure. You may need it if you are having chest pain. The procedure can show whether the hearts arteries have become blocked because of coronary artery disease. It also helps your healthcare provider determine a treatment plan. This test is called coronary angiography.

If you have a known blockage in a coronary artery, you may need a cardiac catheterization using a technique called coronary angioplasty. Your provider attaches a balloon to the tip of the catheter. When the balloon is in place, it is inflated and presses the plaque to the side of the blood vessel. That increases blood flow through the artery. A stent is often placed at the blockage site to keep the vessel open.

Healthcare providers also use cardiac catheterization to do other procedures on the heart. For example, they can use it to open a narrowed heart valve. It is less invasive than open heart surgery.

If you need cardiac catheterization, your healthcare provider may recommend the transradial type. The transradial approach may have a mildly lower risk for complications compared with the method that goes through a blood vessel in the leg . Your recovery may be shorter and easier as well when compared to the transfemoral approach. Not all surgical centers use this type of cardiac catheterization regularly. Ask your healthcare provider if it might make sense for you.

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What Does A Heart Catheterization Do

Heart catheterization is a diagnostic tool used by doctors to look for heart muscle disease, heart valve disease and coronary artery disease. It can be used to determine strength of the heart muscle, measure heart valve disease and look for any blockages in the coronary or heart arteries. A catheter is placed in the artery of the wrist of the groin. This catheter reaches from there to the area of the heart. Contrast dye is injected through the catheter and into the coronary arteries and heart chambers. A special x-ray technique called fluoroscopy then shows the dye as it flows through the arteries and heart.

What Happens After Cardiac Catheterization

In the hospital

After the cardiac cath, you may be taken to a recovery room or returned to your hospital room. You will stay flat in bed for several hours. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.

Let your nurse know right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.

Bedrest may vary from 4 to 12 hours. If your doctor placed a closure device, your bedrest may be shorter.

In some cases, the sheath or introducer may be left in the insertion site. If so, you will be on bedrest until your doctor removes the sheath. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate often because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so you don’t bend the affected leg or arm.

After the period of bed rest, you may get out of bed. The nurse will help you the first time you get up, and may check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You may be given pain medicine for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

Drink plenty of water and other fluids to help flush the contrast dye from your body.

At home

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Your Risk Of Bleeding Is Lower

If your doctor goes in through your wrist, your risk of bleeding post-procedure drops significantly, Dr. Ellis says. In fact, the likelihood falls by half, and its easier to stop any bleeding that may occur.

Bleeding from the leg is a different story.

The artery in the leg is deep within the thigh, and its hard to detect any bleeding, he says. With the wrist, the opportunity to see it is right there on the surface.

Heart Catheterization / Coronary Angioplasty And Stenting

Traditionally this procedure is performed through the groin or femoral artery, but now there is a less invasive, safer, and more comfortable technique for doing these procedures: using the wrist or radial artery. The physicians at Heart and Vascular Care are experts at performing these procedures through a single needle stick in the blood vessel of the wrist .

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How Do You Get Cardiac Catheterization Results

Your doctor will tell you what they found during the procedure and whether they needed to do any other procedures, like an angioplasty or stent.

Once you get home, follow all of your doctorâs instructions about your activity level and what medications to take. You might have a bruise at the wound site. Call your doctor if you have any other problems.

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What Will Happen After A Radial Heart Catheterization

• You will be attached to a heart monitor until you are fully awake. A heart monitor is an EKG that stays on continuously to record your heart’s electrical activity. Healthcare providers will monitor your vital signs and pulses in your arm. They will frequently check your pressure bandage for bleeding or swelling.
• You may have a band wrapped tightly around your wrist. The band puts pressure on your wound and helps prevent bleeding. A healthcare provider can put air into the band or remove air from the band. A healthcare provider will gradually remove air from the band and decrease pressure on your wrist. The band may be removed in 2 hours or when your wound stops bleeding.
• You will need to keep your wrist straight for 2 to 4 hours. Do not push or pull with your arm. Arm movements can cause serious bleeding. After you are monitored for several hours, you may go home or may need to stay in the hospital overnight.

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Youll Have Less Risk Of Heart Attack

Its unclear exactly why, but if youve had a previous heart attack, youre less likely to die with a wrist catheterization, Dr. Ellis says.

We think the benefit exists because, in heart attack cases, doctors prescribe blood thinners. With the increase of bleeding with the leg, they have to back off using blood thinners, so the heart attack risk increases, he says. With the lower likelihood of bleeding, a wrist catheterization side-steps that risk.

What Happens During A Transradial Cardiac Cath

The procedure is done in the hospital or a surgery center. First, an IV line is put in your arm or hand to deliver fluids and medicines. You will likely be given medicine to relax you and make you drowsy. When the procedure begins:

• You lie on an X-ray table.

• The skin over the insertion site in your wrist is numbed.

• The doctor makes a tiny puncture or incision into the artery in the wrist. He or she then inserts a catheter and threads it through the blood vessel into your heart.

• The doctor may inject a contrast fluid through the catheter into the arteries. This fluid makes the arteries show up better on X-rays.

• Tests may be done to check the condition of your heart and arteries. If needed, the doctor can clear blockages in the arteries or do other repairs.

• When the doctor is finished, he or she will remove the catheter and put direct pressure on the site to prevent bleeding.

• You will stay for a time to recover, and then go home.

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The Wrist Is Not Always An Option

Although a growing number of hospitals and doctors are using wrist catheterization, there are still some situations where it might not work, Dr. Ellis says.

Youll want to discuss your individual situation with your doctor, but here are some instances where the wrist approach may not work as well:

• You have artery spasms in your forearm.
• The artery in your arm is too small.
• There are severe bends between your wrist and your heart, which is most common in older adults who have osteoporosis.

Whatever the case, talk with your doctor. When choosing a physician to perform the procedure, look for one who does a high number of them every year, Dr. Ellis says. This can help to ensure a higher level of expertise compared with someone who does it only once in awhile.

Always make sure to ask about the safety of the procedure in your specific case, he says. And dont ever be shy about asking about how many of these procedures he or she has done is it routine for them or is it unusual?

Why Do I Need Coronary Angiography

Coronary angiography can be used to help diagnose heart conditions, help plan future treatments and carry out certain procedures.

For example, it may be used:

• after a heart attack where the heart’s blood supply is blocked
• to help diagnose angina where pain in the chest is caused by restricted blood supply to the heart
• to plan interventional or surgical procedures such as a coronary angioplasty, where narrowed or blocked blood vessels are widened

Coronary angiography is also considered to be the best method of diagnosing coronary heart disease, where a build-up of fatty substances in the coronary arteries affects the heart’s blood supply.

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What Are The Risks Of Transradial Cardiac Catheterization

In general, the risks of this procedure are low. Some may be even lower using the transradial approach. Possible complications include:

• Abnormal heart rhythms
• Pain and swelling at the catheter insertion site
• Nerve damage to the wrist and hand
• Damage to blood vessel supplying the wrist and hand

Your own risks may differ based on your age, your health problems, and the reason for the procedure. Ask your healthcare provider about your specific risks.

What Are The Risks Of Cardiac Catheterization

Possible risks associated with cardiac cath include:

• Bleeding or bruising where the catheter is put into the body
• Pain where the catheter is put into the body
• Blood clot or damage to the blood vessel that the catheter is put into
• Infection where the catheter is put into the body
• Problems with heart rhythm

More serious, but rare complications include:

• Ischemia , chest pain, or heart attack
• Sudden blockage of a coronary artery
• A tear in the lining of an artery
• Kidney damage from the dye used

If you are pregnant or think you could be, tell your doctor due to risk of injury to the fetus from a cardiac cath. Radiation exposure during pregnancy may lead to birth defects. Also be sure to tell your doctor if you are lactating, or breastfeeding.

There is a risk for allergic reaction to the dye used during the cardiac cath. If you are allergic to or sensitive to medicines, contrast dye, iodine, or latex, tell your doctor. Also, tell your doctor if you have kidney failure or other kidney problems.

For some people, having to lie still on the cardiac cath table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

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