Ken,
I work in a Cardiac Cath Lab. Our lab performs on average over 100 procedures a week, to include diagnostic testing, coronary stent placement, peripheral vesse angiography and permanent pacemaker/internal defibrillators.
Most of my patients come through the procedure without any significant pain. Many say that it's nowhere near as bad as going to a dentist. SOPs will vary from lab to lab, but here's a general rundown.
Outpatients will have come into the lab. After being connected to all monitoring equipment (ECG, Pulse Ox, BP), the patient is prepped. You can do part of this at by shaving yourself. After the area is shaved it will be prepped with a solution. Our lab uses Betadine, but we also have chlorhexidine available for patients with an iodine allergy. After prepping you get covered up with a procedure drape that has holes on each groin.
The actual procedure begins with a local by the physician. After the groin is numb an 18 ga needle is used to access (usually the right) common femoral artery. After aterial access is established an arterial sheath is inserted. This device keeps the artery open for catheter insertion and features a one-way valve to prevent bleeding.
Protocal dictates in which order the images are taken. Some labs image the coronary arteries first, while other labs, including the one I work in, imagine the Left Ventricle first. For the LV angio, a pigtail catheter is inserted and a power injection of contrast is made. Prepare for the hot flash! It'll start in the back of the throat and work its out through the body. Sorta like a shot of liquor.
After that the coronaries are engaged and images are taken from multiple projections to completely view the arteries. Normally about 6 images are taken of the Left Coronary Artery system. They'll focus on the Left Main artery, the Left Anterior and Left Circumflex. Then the Right Coronary artery is imaged. Usually about 3 images are taken, again, in multiple projections.
If no blockages are found that, in most labs, will conclude the procedure. If stenting is warranted that can be done immediately, or can be elected to postponed to later.
Post procedure the arterial sheath will be removed and hemostasis attained. This can be done with direct manual compression or through an aterial closure device. In our lab if no intervention (angioplasty or stenting) is done, manual compression is our first choice. After a 10-15 minute hold a bandage is placed over the puncture site. Patient is then required to remain flat, with head elevated to a maximun of 30 degrees, for 1 hour if no complications are present. After the hour the patient can sit with feet over the edge of bed. If no dizziness or weakness the patient can walk with assistance to the restroom. As I said above protocal will vary, but after 3 hours post procedure observation, generally the patient is released home.
Post procedure advice: rest. No lifting. Lots of fluid. Barring no problems normal activity can be resumed in 2-3 days.
Any questions feel free to ask and I'll try to answer.
JUST KIDDING!
