Clinical meaning
The nurse manages the complete peri-procedural cardiac catheterization process including pre-procedure preparation, intra-procedure monitoring in some settings, and comprehensive post-procedure surveillance. Understanding the hemodynamic data obtained during catheterization is essential. Left heart catheterization measures aortic pressure (normal 120/80), LV end-diastolic pressure (LVEDP, normal 5-12 mmHg; elevated above 18 mmHg indicates LV diastolic dysfunction or volume overload), and aortic valve gradient (transvalvular pressure gradient). Right heart catheterization (Swan-Ganz) measures right atrial pressure (RAP, normal 0-8), RV pressure (normal 25/0-8), pulmonary artery pressure (PAP, normal 25/10, mean 10-20), and pulmonary capillary wedge pressure (PCWP, normal 6-12, reflects left atrial and LVEDP). Cardiac output is measured by thermodilution or Fick principle. PCI-specific complications include coronary dissection (intimal flap that may require additional stenting), no-reflow phenomenon (microvascular obstruction despite patent epicardial vessel, treated with intracoronary adenosine or nitroprusside), stent thrombosis (acute within 24 hours, subacute 1-30 days, late 1-12 months, very late beyond 12 months), and in-stent restenosis (gradual neointimal hyperplasia causing recurrent stenosis over months). The nurse implements evidence-based protocols for each complication and manages complex post-PCI antiplatelet regimens.