PCI

PCI - Percutaneous Coronary Intervention (Angioplasty)
	Waiting List	Length of Procedure	Hospital Entry	Hospital Stay	Location
	3 Months	30mins/2hrs	Same day as procedure	Discharge same day unless procedure is done late in which case discharge next day	Cardiac Cather Lab Ward 16

In this page : Description, Procedure, Risk, Benefits, After the procedure, discharge

Description: Name given to a collection of techniques used to reduce the narrowing of the coronary arteries. There are several different techniques to accomplish this such as use of balloon or stent. The treament is delivered via an entry site at the groin or sometimes the arm.

Patients will first have had an angiogram before undergoing this procedure (unless emergency case)

Consultants : Fath Ordoubadi, Bernard Clarke, Lundwig Neyses, Rajdeep Khattar, Majdi El-Omar
Team : Working with the Consultant is a team of specialists including : Operator & Assistant, Nurse, Circulation Nurse,Technician and Radiographer.

Pre-Admission Information : About 2 months prior to entry to hospital you will attend a pre-admission clinic. This is based in Specialist Cardiac Services Outpatients, Orange Zone, Main Medical Corridor, MRI. Here you will meet a specialist nurse and if required, a doctor. You will have several tests including blood screening, ECG and MRSA screening . The nurse will also provide you with more procedure information and pre-procedure medication. This is an opprtunity for you to ask questions about the procedure and any other aspects of your treatment.

Preparation Prior to Admission: If you suffer from diabetes or hypertension you should have your condition under control (by your General Practitioner) prior to your admission.

Admission : Patients for PCI procedure are admitted on the same day their procedure is due to take place. No guarentee can be made about what time during the day the procedure will take place. There may be emergency cases which take priority.

Where do patients go : You should report to the nurse on Ward 16 at the time indicated on your appointment letter.

What happens before procedure ? On arrival the patient will meet the nursing staff. The patient will be shown to a bed and be provided with a gown to change into. Blood samples will be taken and a needle will be put into the arm for a drip (fluids). Medication will also be given - such as aspirin or clopigogrel. A sedative may be administered if necessary.

Procedure

When the time arrives for your procedure you will take a short walk from Ward 16 to the Cardiac Catheter Lab (escorted by a porter).

The lab is adjacent to the ward. Here you will be greeted by a nurse who will ask you to wait in an ante room. At this point the nurse will check all your details and provide information and instructions about your procedure.

When the lab is ready you will be then transferred on to an x-ray table. This is very narrow and firm and can be moved up and down. An ECG monitor will be attached to you so your heart rhythm can be monitored. It is normal practice to have a small amount of sedation while in the catheter laboratory. This will make you sleepy but is not a general anaesthetic. You may be required to wear an oxygen mask. This is nothing to be alarmed about.

The area of your groin or arm will be cleaned with an anaesthetic solution and then covered with sterile towels. The doctor will numb your groin or arm area with an injection of local anaesthetic. This does not take the sensation of touch away, but does remove the feeling of pain.

An entry point is made and the catheter will be guided up to the heart with the aid of a dye under x-ray screening. This enables the doctor to manoeuvre the catheter to the narrowed artery. You will not feel this .

The x-ray equipment will at times be brought very close to the you and sometimes it it necessary for you to rest your arms above your head and to turn your head from left to right.

While the balloon is being inflated you are likely to experience chest discomfort (angina), you should inform the doctor or nurses straight away. This is due to the balloon causing a temporary blockage of blood through the artery and is to be expected. The procedure takes from 30 minutes to 2 hours depending on the complexity and number of narrowings in the coronary arteries.

Cardiac Catheter Lab

Lab 1

Balloon Catheter (inflated).

Balloon catheter connected to inflation device

Balloon catheter with stent in place

Risk
Any procedure or operation has an element of risk and an angioplasty is no exception.
There is a less then 1% chance of dying during an angioplasty procedure. (i.e. less than 1 in 100 patients).
There may be complications that patients should be aware of.

Complication	Risk	Action
The coronary artery may tear or become blocked.	The risk of this occurring is approximately 1% (1 in 100 patients)	This may require emergency by-pass surgery.
Blood clot	1%	If this occurs the patient will have a heart attack. This can occur up to month after the procedure
After the procedure there is a chance of the artery re-narrowing within the within the first six months post of the angioplasty. Angina may be experienced again	10-15% chance	Treatment for this depends on the individual case but it can mean further PCI
The stent that is put in can get clotted up. This can occur up to a month afterwards.	The chances of this happening are 0.5% to 1% if the patient is on aspirin and clopidogrel.
Bruising around groin area where the catheters were passed	small chance	Small bruise will disappear following rest. Large bruise (haematoma) - may require a stay in hospital for a couple of nights

Benefits of the procedure Unlike Coronary Artery Bypass surgery, which involves opening up the chest wall, the P.T.C.A. is simpler and the recovery shorter than for a standard by-pass operation. The aim is to improve you quality of life by removing or reducing the number of angina attacks. It has been shown to be effective even in the long term. Angioplasty can be used in people who have just sustained a heart attack (myocardial infarction) and where thrombolytic therapy (clot busting treatment) has failed. Long-term survival may be improved after coronary angioplasty.

After the procedure
You will return to Ward 16 and returned to bed. It is important to listen to the nurses and follow their instructions. You will be in bed for a period of time. Whilst in bed you will monitored (heart rhythm and blood pressure). When the tube is removed the nurse or doctor will push on the puncture site for about 15-20 minutes or until the bleeding has stopped. You should then lie flat. When appropriate the nurse will slowly sit you up and later that evening or the following day the you will be allowed out of bed.

Normally you are asked to lie flat for four hours after the tube is removed from the leg.

Discharge and recovery
You can expect to be released later the same day as your procedure. However there may be circumstances when an overnight stay is required ie. a late start for the procedure or extended time for the procdure.

Recovery Area - Cardiac Catheter Lab