Top 20 Cardiovascular Procedures: Techniques, Nursing Interventions, and Complications Management
The American College of Cardiology/American Heart Association guidelines identify the top cardiovascular procedures as essential diagnostic and therapeutic interventions for managing cardiovascular diseases, with specific nursing care requirements for each procedure to optimize patient outcomes and minimize complications. 1
1. Selective Coronary Angiography
Description: Recording of images of coronary arteries using selective injection of radiographic contrast material.
Technique:
- Access via femoral, radial, or brachial artery
- Catheter advancement to coronary ostia under fluoroscopic guidance
- Selective injection of contrast while recording images
Nursing Interventions:
- Pre-procedure: Assess for allergies, obtain consent, ensure NPO status, monitor vital signs
- During procedure: Monitor vital signs, observe for arrhythmias, administer medications as ordered
- Post-procedure: Monitor access site for bleeding, check distal pulses, maintain bed rest as ordered
Complications:
- Vascular access complications (bleeding, hematoma)
- Contrast-induced nephropathy
- Arrhythmias
- Coronary dissection
Management of Complications:
- Manual compression or closure devices for bleeding
- IV hydration for contrast nephropathy prevention
- Antiarrhythmic medications for arrhythmias
- Immediate stenting or surgical intervention for coronary dissection
2. Percutaneous Coronary Intervention (PCI)
Description: Inflation of a balloon-tipped catheter at coronary artery stenosis site to enlarge lumen diameter, often with stent placement.
Technique:
- Coronary angiography to identify lesion
- Guidewire advancement across stenosis
- Balloon inflation to dilate stenosis
- Stent deployment when indicated
Nursing Interventions:
- Pre-procedure: Administer antiplatelet medications, assess renal function
- During procedure: Monitor for chest pain, ST changes, arrhythmias
- Post-procedure: Monitor for bleeding, maintain dual antiplatelet therapy, cardiac monitoring
Complications:
- Acute stent thrombosis
- Restenosis
- Coronary perforation
- Access site complications
Management of Complications:
- Emergent repeat PCI for stent thrombosis
- Antiplatelet therapy adjustment
- Covered stents or emergency surgery for perforation
- Compression for access site complications
3. Right Heart Catheterization
Description: Insertion of catheter into venous system to record right heart/pulmonary pressures, perform angiography, or obtain blood samples.
Technique:
- Access via internal jugular, subclavian, or femoral vein
- Advancement of catheter through right heart chambers to pulmonary artery
- Pressure measurements and oxygen saturation sampling
Nursing Interventions:
- Pre-procedure: Explain procedure, assess coagulation status
- During procedure: Monitor for arrhythmias, assist with pressure recordings
- Post-procedure: Monitor access site, maintain catheter patency if left in place
Complications:
- Arrhythmias
- Pulmonary artery rupture
- Pneumothorax (with internal jugular/subclavian access)
- Thrombosis
Management of Complications:
- Antiarrhythmic medications
- Lung isolation, fluid resuscitation for PA rupture
- Chest tube placement for pneumothorax
- Anticoagulation for thrombosis
4. Left Ventricular Angiography
Description: Recording of images of the left ventricle using radiographic contrast material.
Technique:
- Arterial access (usually femoral)
- Catheter advancement to left ventricle
- Power injection of contrast during image acquisition
Nursing Interventions:
- Pre-procedure: Assess for heart failure, explain breath-holding technique
- During procedure: Monitor for ectopy during catheter manipulation
- Post-procedure: Monitor for heart failure exacerbation, access site care
Complications:
- Ventricular arrhythmias
- Acute heart failure
- Embolism
- Valve damage
Management of Complications:
- Antiarrhythmics for arrhythmias
- Diuretics for heart failure
- Anticoagulation for embolism
5. Intra-Aortic Balloon Counterpulsation
Description: Insertion of intra-aortic balloon pump device to mechanically augment cardiac output, unload left ventricle, and improve coronary perfusion.
Technique:
- Femoral artery access
- Advancement of balloon catheter to descending thoracic aorta
- Timing of inflation/deflation with cardiac cycle
Nursing Interventions:
- Maintain proper timing of balloon with ECG
- Assess distal pulses hourly
- Keep extremity straight
- Monitor for signs of limb ischemia
Complications:
- Limb ischemia
- Balloon rupture
- Aortic dissection
- Thromboembolism
Management of Complications:
- Immediate balloon removal for rupture
- Surgical intervention for severe limb ischemia
- Anticoagulation for thromboembolism
6. Percutaneous Catheter Balloon Valvuloplasty
Description: Inflation of balloon-tipped catheter in cardiac valve to reduce valvular stenosis.
Technique:
- Access via femoral vein (for mitral) or artery (for aortic)
- Transseptal puncture for mitral valve
- Balloon positioning across valve and inflation
Nursing Interventions:
- Monitor hemodynamic parameters
- Assess for acute valvular regurgitation
- Monitor for cardiac tamponade
Complications:
- Acute valve regurgitation
- Cardiac tamponade
- Embolic events
- Arrhythmias
Management of Complications:
- Emergency surgery for severe regurgitation
- Pericardiocentesis for tamponade
- Anticoagulation for embolic events
7. Permanent Cardiac Pacing
Description: Use of electrode catheter and implantable generator to initiate cardiac contractions by electrical stimulation.
Technique:
- Venous access (subclavian or cephalic)
- Lead advancement to right heart chambers
- Testing of pacing parameters
- Generator implantation in subcutaneous pocket
Nursing Interventions:
- Monitor vital signs and rhythm
- Assess pacemaker function
- Restrict arm movement on implant side
- Wound care
Complications:
- Lead dislodgement
- Pocket hematoma
- Pneumothorax
- Infection
Management of Complications:
- Lead repositioning for dislodgement
- Evacuation of significant hematomas
- Chest tube for pneumothorax
- Antibiotics/device removal for infection
8. Temporary Pacing
Description: Use of electrode catheter and external generator to temporarily initiate cardiac contractions.
Technique:
- Venous access (femoral, internal jugular, or subclavian)
- Advancement of pacing wire to right ventricle
- Connection to external pacing generator
Nursing Interventions:
- Secure pacing wire
- Monitor pacing thresholds
- Prevent wire dislodgement
- Monitor for capture
Complications:
- Loss of capture
- Ventricular arrhythmias
- Perforation
- Infection
Management of Complications:
- Wire repositioning for loss of capture
- Antiarrhythmics for induced arrhythmias
- Wire removal for perforation
9. Pericardiocentesis
Description: Removal of pericardial fluid by inserting needle or catheter into pericardial space.
Technique:
- Subxiphoid or apical approach
- Needle advancement into pericardial space under echocardiographic guidance
- Fluid drainage and possible drain placement
Nursing Interventions:
- Position patient (semi-Fowler's)
- Monitor vital signs and ECG
- Measure and document fluid output
- Observe drainage characteristics
Complications:
- Cardiac puncture
- Arrhythmias
- Pneumothorax
- Reaccumulation
Management of Complications:
- Emergency surgery for cardiac puncture
- Chest tube for pneumothorax
- Pericardial window for recurrent effusion
10. Transcatheter Aortic Valve Replacement (TAVR)
Description: Percutaneous implantation of prosthetic aortic valve.
Technique:
- Femoral artery access (most common)
- Advancement of delivery system to aortic valve
- Balloon valvuloplasty followed by valve deployment
Nursing Interventions:
- Monitor for conduction abnormalities
- Assess peripheral pulses
- Monitor for signs of stroke
- Strict blood pressure control
Complications:
- Vascular complications
- Stroke
- Heart block
- Paravalvular leak
Management of Complications:
- Permanent pacemaker for persistent heart block
- Vascular repair for access complications
- Stroke protocol activation if neurological symptoms develop
11. Catheter Atherectomy
Description: Use of catheter-based device to selectively remove atheroma from artery wall.
Technique:
- Arterial access
- Advancement of atherectomy device to lesion
- Controlled removal of plaque
Nursing Interventions:
- Monitor for distal embolization
- Assess distal pulses
- Monitor for arrhythmias
- Assess for perforation
Complications:
- Distal embolization
- Perforation
- No-reflow phenomenon
- Dissection
Management of Complications:
- Aspiration thrombectomy for embolization
- Covered stents for perforation
- Vasodilators for no-reflow
12. Endomyocardial Biopsy
Description: Removal of portion of endomyocardium using catheter bioptome.
Technique:
- Venous access (internal jugular preferred)
- Advancement of bioptome to right ventricle
- Sample collection from interventricular septum
Nursing Interventions:
- Monitor for arrhythmias during procedure
- Assess for signs of perforation
- Monitor vital signs
- Observe for bleeding
Complications:
- Perforation with tamponade
- Tricuspid valve damage
- Arrhythmias
- Pneumothorax
Management of Complications:
- Pericardiocentesis for tamponade
- Antiarrhythmics for sustained arrhythmias
- Chest tube for pneumothorax
13. Percutaneous Cardiopulmonary Support
Description: Insertion of venous and arterial catheters connected to external pump oxygenator for cardiac output augmentation and arterial oxygenation.
Technique:
- Femoral vein and artery cannulation
- Connection to extracorporeal circuit
- Initiation of support with blood flow adjustment
Nursing Interventions:
- Monitor circuit for clots or air
- Assess distal limb perfusion
- Monitor anticoagulation parameters
- Maintain circuit integrity
Complications:
- Bleeding
- Limb ischemia
- Thromboembolism
- Hemolysis
Management of Complications:
- Transfusion for significant bleeding
- Distal perfusion catheter for limb ischemia
- Anticoagulation adjustment for thrombosis
14. MitraClip Procedure
Description: Percutaneous edge-to-edge repair of mitral valve leaflets to reduce regurgitation.
Technique:
- Femoral venous access
- Transseptal puncture
- Clip delivery system advancement to mitral valve
- Grasping and clipping of valve leaflets
Nursing Interventions:
- Monitor for signs of heart failure
- Assess for arrhythmias
- Monitor for signs of stroke
- Assess transseptal puncture site
Complications:
- Clip detachment
- Mitral stenosis
- Stroke
- Cardiac perforation
Management of Complications:
- Surgical intervention for clip detachment
- Anticoagulation for thromboembolism
- Pericardiocentesis for perforation
15. Left Atrial Appendage Closure
Description: Percutaneous placement of device to occlude left atrial appendage for stroke prevention.
Technique:
- Femoral venous access
- Transseptal puncture
- Device advancement and deployment in left atrial appendage
Nursing Interventions:
- Monitor for signs of pericardial effusion
- Assess for arrhythmias
- Monitor for signs of stroke
- Maintain anticoagulation as ordered
Complications:
- Device embolization
- Pericardial effusion
- Air embolism
- Stroke
Management of Complications:
- Percutaneous retrieval of embolized device
- Pericardiocentesis for effusion
- Stroke protocol for neurological symptoms
16. Renal Denervation
Description: Catheter-based procedure to ablate renal sympathetic nerves for treatment of resistant hypertension.
Technique:
- Femoral artery access
- Catheter advancement to renal arteries
- Radiofrequency ablation of sympathetic nerves
Nursing Interventions:
- Monitor blood pressure
- Assess for pain during ablation
- Monitor renal function
- Assess access site
Complications:
- Renal artery stenosis
- Post-procedure hypotension
- Vascular complications
- Renal dysfunction
Management of Complications:
- Renal artery stenting for stenosis
- Fluid resuscitation for hypotension
- Vascular repair for access complications
17. Pulmonary Angiography
Description: Recording of images of pulmonary arteries using radiographic contrast material.
Technique:
- Venous access
- Catheter advancement to pulmonary arteries
- Contrast injection during image acquisition
Nursing Interventions:
- Monitor for respiratory distress
- Assess for contrast reaction
- Monitor vital signs
- Observe access site
Complications:
- Contrast reaction
- Pulmonary artery perforation
- Arrhythmias
- Renal dysfunction
Management of Complications:
- Treatment protocol for contrast reactions
- Fluid resuscitation for perforation
- Antiarrhythmics for arrhythmias
18. Atrial Septostomy
Description: Creation or enlargement of intra-atrial shunt using catheter-mounted balloon.
Technique:
- Femoral venous access
- Catheter advancement to atrial septum
- Balloon inflation to create or enlarge septal opening
Nursing Interventions:
- Monitor oxygen saturation
- Assess for signs of hypoxemia
- Monitor for arrhythmias
- Observe for bleeding
Complications:
- Excessive shunting
- Cardiac perforation
- Stroke
- Arrhythmias
Management of Complications:
- Oxygen therapy for hypoxemia
- Pericardiocentesis for perforation
- Antiarrhythmics for arrhythmias
19. Transcatheter Ablation of Arrhythmia Foci
Description: Delivery of electrical stimulus to specific portion of conduction system using intracardiac catheter techniques.
Technique:
- Venous access
- Mapping catheter placement
- Identification of arrhythmia focus
- Radiofrequency or cryoablation energy delivery
Nursing Interventions:
- Monitor cardiac rhythm
- Assess for pain during ablation
- Monitor for complications
- Maintain immobility during mapping
Complications:
- Cardiac perforation
- AV block
- Stroke
- Vascular complications
Management of Complications:
- Pericardiocentesis for tamponade
- Temporary pacing for AV block
- Stroke protocol for neurological symptoms
20. Hemodynamic Assessment
Description: Recording of pressure data from cardiac chambers and vasculature, including cardiac output determination.
Technique:
- Venous and/or arterial access
- Catheter advancement to specific chambers
- Pressure recording and waveform analysis
Nursing Interventions:
- Maintain transducer at phlebostatic axis
- Zero transducers appropriately
- Monitor for arrhythmias during catheter manipulation
- Document pressure readings
Complications:
- Arrhythmias
- Vascular complications
- Air embolism
- Infection
Management of Complications:
- Antiarrhythmics for sustained arrhythmias
- Compression for vascular complications
- Antibiotics for suspected infection
Key Nursing Considerations Across All Procedures
- Pre-procedure preparation: Patient education, informed consent, medication review, NPO status
- Procedural monitoring: Vital signs, ECG, oxygen saturation, access site, neurological status
- Post-procedure care: Access site monitoring, activity restrictions, medication administration
- Complication prevention: Early mobilization, hydration, anticoagulation management, wound care
The American College of Cardiology/American Heart Association guidelines emphasize that proper nursing care before, during, and after these procedures is essential for optimal patient outcomes and complication prevention 1.