How to assess a patient after a cath lab procedure?

Post-Catheterization Patient Assessment

Systematically assess the patient returning from the cath lab using a structured checklist that evaluates procedural complications, vital signs, access site integrity, neurological status, and medication administration before determining disposition.

Immediate Post-Procedure Assessment

Procedural Complications Review

• Determine if any complications occurred during the procedure, including stroke, bleeding, vascular complications, allergic reactions, persistent slow/no flow, side branch compromise, dissection, perforation, or contrast anaphylaxis 1
• Verify PCI success (defined as <50% residual stenosis with TIMI-3 flow) if intervention was performed 1
• Document procedure time and any episodes of chest pain or hemodynamic instability during the case 1

Vital Signs and Hemodynamic Monitoring

• Check blood pressure, pulse, and distal pulses every 15-30 minutes for the first 2 hours, then hourly 2
• Monitor for signs of hemodynamic instability or acute heart failure 1
• Assess oxygen saturation and respiratory status 3, 4
• Evaluate for persistent ischemic ECG changes or new dysrhythmias 1

Access Site Examination

• Inspect the access site for hematoma, bleeding, or vascular complications at each vital sign check 1, 2
• Palpate distal pulses to ensure adequate perfusion 2
• Document any difficulty with hemostasis or development of access site complications 1

Neurological and Mental Status

• Confirm the patient's mental status matches baseline presentation 1
• Assess for any signs of stroke or neurological changes 1

Clinical Status Evaluation

Symptom Assessment

• Evaluate for unresolved or severe chest pain that may indicate incomplete revascularization or procedural complication 1
• Screen for dyspnea, which may signal heart failure, pulmonary edema, or other cardiopulmonary complications 1
• Assess for signs of contrast reaction or allergic response 1

Underlying Disease Exacerbation

• Check for exacerbation of heart failure, uncontrolled hypertension, diabetes, or COPD 1
• Review whether pre-existing conditions remain stable or have worsened 2

Medication and Treatment Verification

Antiplatelet Therapy

• Confirm loading dose of P2Y12 inhibitor was administered if PCI was performed 1
• Verify prescriptions for at least 30 days of dual antiplatelet therapy (DAPT) 1
• Confirm aspirin and statin prescriptions are provided 1

Anticoagulation Status

• Review activated clotting times (ACTs) if heparin was administered during the procedure 1
• Adjust anticoagulation management based on access site and bleeding risk 2

Patient Education and Discharge Planning

Access Site Monitoring Education

• Provide in-person training, handouts, or videos on how to monitor the access site for bleeding, hematoma, or other complications 1
• Emphasize the importance of taking DAPT as prescribed and the specific risks of premature discontinuation 1

Follow-Up Arrangements

• Provide an emergency contact number for the patient to call with concerns 1
• Schedule follow-up appointment and confirm cardiac rehabilitation referral 1
• Designate a team member responsible for calling the patient the day after discharge 1

Disposition Decision Algorithm

Criteria for Overnight Observation

Keep the patient overnight if ANY of the following are present:

• Procedural complications (dissection, perforation, slow flow, side branch loss) 1
• Post-procedure complications (stroke, bleeding, vascular issues, allergic reaction) 1
• Unresolved chest pain or persistent ischemic ECG changes 1
• Hemodynamic instability or acute heart failure 1
• Access site complications or difficulty achieving hemostasis 1
• Mental status changes from baseline 1
• Exacerbation of underlying disease (heart failure, COPD, uncontrolled hypertension) 1
• STEMI or NSTEMI presentation 1
• Patient or care team concern about same-day discharge 1

Criteria for Same-Day Discharge Consideration

Same-day discharge may be reasonable if ALL of the following are met:

• No procedural or post-procedure complications 1
• Successful PCI with good angiographic result 1
• Stable vital signs and no new symptoms 1
• Mental status at baseline 1
• No access site complications 1
• DAPT loading and prescriptions confirmed 1
• Patient education completed and follow-up arranged 1
• Patient willing to be discharged same day (shared decision-making) 1

Documentation Requirements

Procedural Report

• Complete a structured procedural report within 24 hours including indications, procedures performed, access site, equipment used, medications, contrast dose, fluoroscopy time, radiation dose, diagnostic findings, interventions, complications, and conclusions 1
• Provide immediate post-procedure chart documentation if the complete report is not immediately available 1

Complication Registry

• Enter every complication, minor or major, into the laboratory's complication registry for quality monitoring 1
• Maintain prospective tracking of complications for regular review by the laboratory director 1

Common Pitfalls to Avoid

• Do not rely solely on vital signs—always perform a comprehensive clinical assessment including symptoms, mental status, and access site examination 1
• Do not discharge patients with any unresolved procedural complications or post-procedure symptoms, even if vital signs are stable 1
• Do not overlook access site complications, particularly in patients who had difficult hemostasis or radial artery spasm 1
• Do not skip medication reconciliation—verify DAPT loading and prescriptions before discharge 1
• Do not discharge without confirmed follow-up arrangements and patient education on access site monitoring and medication adherence 1