【体外膜肺ECMO精品课件】 CARDIAC EMERGENCIES AND POST-PROCEDURAL CARE IN THE NICU.ppt

CARDIAC EMERGENCIES AND POST-PROCEDURAL CARE IN THE NICU NICU Cardiac Series - November, 2005 Jade Forlidas, MSN Jackie Smith, RN CARDIAC CATHERIZATION Cath and angiography are used as definitive diagnostic tests or therapeutic interventions. Procedures include Balloon Atrial Septostomy, Balloon Valvuloplasty and Angioplasty, Blade Atrial Septostomy, embolization, and stent placement. Cardiac Catherization Risks R/T catheter insertion and manipulation : arrhythmias, heart block, cardiac perforation, hypoxic spells, arterial obstruction, hemorrhage, infection, venous obstruction. R/T contrast injection: reaction to contrast, intramyocardial injection, renal complications (hematuria, proteinuria, oliguria, anuria) R/T exposure and sedation : hypothermia, acidemia, hypoglycemia, seizures, hypotension, respiratory depression. Cardiac Catherization Post Procedural Care Monitor vital signs continuously and document Q 15 min. X 1 hour, Q 30 min.x2, Q 1 hour x3. Check color, pulses , temperature, and perfusion in affected extremity and document Q 15 min x 1 hour and then hourly . Signs of arterial occlusion - the pale , cold white leg. Signs of venous occlusion - the purple leg. Cardiac Catherization Post Procedural Care Monitor dressing for signs of bleeding - remove the dressing and apply pressure if bleeding occurs and notify H.O. Keep patient flat and extremity straight for 4-6 hours. Add to Flowsheet - check boxes for pulse check and capillary refill time. Report increasing venous congestion or deteriorating arterial perfusion. BALLOON ATRIAL SEPTOSTOMY For palliation of TGA, selected patients with TAPVR, PA with IVS, MA/MS, HLHS and other conditions in which a larger atrial communication is desirable. A special balloon-tipped catheter is introduced into the LA from the RA through the PFO or existing ASD. The balloon is inflated with contrast material and rapidly pulled back to the RA creating a larger opening in the septum. BAS - Bedside Emerge