04. The Procedure
During a Percutaneous Coronary Intervention (PCI) procedure, a catheter is inserted into an artery through the groin or arm. The tip of the catheter will have one of several different devices such as a balloon, stent, or cutting device, depending on the patient’s needs. The catheter is advanced inside the artery and guided, using and x-ray camera and special dyes, to an areas that is narrowed or blocked. The device is then used to open the artery and restore blood flow.
This section describes the steps prior to a PCI procedure (angioplasty, stent implantation, or atherectomy).
Before the Procedure
While general preparation instructions are provided here, each hospital and doctor may have more individualized, detailed instructions which will be provided to the patient before the procedure.
It is most likely that you will be asked to not eat or drink anything after midnight the night before the procedure. Patients will also be asked to stop smoking prior to being admitted to the hospital. Be sure to tell the doctor the following:
- Complete list of medications the patient is currently taking
- If the patient has allergies to any metals, medications, x-ray dyes, or iodine as this will determine if additional medication is needed for the procedure
- If the patient cannot take aspirin as this and other medications are begun before the procedure and continue afterwards
The Day Of the Procedure
Upon admission to the hospital, tests may be performed such as an ECG, x-rays, and routine blood tests. The doctor will go over the procedure in detail, and answer any last-minute questions.
If the patient wears dentures or glasses and would like to wear them during the procedure, be sure to consult with the doctor or nurse. Some hospitals do not allow patients to wear them during the procedure.
Just before leaving the room, the patient will be asked to empty their bladder. A mild sedative may be given to help the patient relax. An intravenous (IV) tube may be placed in the hand or arm so fluids or medications can be administered quickly.
The patient will not be asleep during the procedure. The doctor may need the patient to take a deep breath while x-rays are being taken to improve the quality of the picture. Most patients find they can cope quite well with any discomfort.
When ready, the patient will be moved to the Catheterization Laboratory (cath lab) where the procedure will be performed. This room contains a specialized x-ray table that the patient will lay on, and an x-ray camera that will move over the patient during the procedure.
During the Procedure
The procedure lasts about 90 minutes, and the patient will be asked to remain very still. The patient’s heart will be monitored by electrodes attached to their chest with wires linking the electrodes to a specialized ECG recorder and monitor. The areas where the catheters are to be inserted will be shaved if needed, then scrubbed with an antiseptic solution to prevent infection.
A local anesthetic will be administered to numb the area where the catheters will be inserted. This may cause a stinging sensation while being administered, but after the medication takes effect the patient should only feel dull pressure. Tell the doctor if any pain is felt.
If the catheters will be inserted into the groin area, a small incision is made on the inside of the patient’s upper thigh. A short tube called an Introducer Sheath will be inserted to hold the incision open. The doctor will insert a long, flexible tube called a Guiding Catheter into the introducer sheath and move it to the affected area of the artery.
Other options for catheter insertion are: the arm where an incision is made on the inside of the elbow, and the transradial approach where the incision is made on the inside of the wrist.
Once the Guiding Catheter is in place, a dye or contrast material will be injected through it, into the artery. This helps the doctor diagnose and measure the narrowing or blockage on an x-ray monitor.
At this point, a second catheter will be introduced. This catheter will be inserted into the Guiding Catheter and moved to the affected area. This catheter will have a specialized tip like a balloon, stent, or cutting device, depending on the patient’s needs. The doctor will then activate the catheter tip to open the artery and restore blood flow. You can read more about how each of these tips work in chapters 5, 6, and 7.
During this part of the procedure, the doctor may ask the patient to take a deep breath and hold it for a few seconds. The patient may also be asked to cough after the x-ray picture is taken to help with the removal of the dye from the artery.
Information presented in this Patient Healthcare Guide is for educational purposes only and is not intended to diagnose, treat, or prevent disease, and should not be used in place of a visit to your doctor or healthcare provider. Discuss this information with your physician or healthcare provider to determine what is right for you.