原題目為接受小兒心導管檢查之照護(英文)變更為小兒心導管檢查(英文)

Care of Children with Cardiac Catheterization變更為Pediatric Cardiac Catheterization

【Major Point】

1. Fasting (such as food, water, and milk etc.) at least 4-8 hours and skin should be cleaned before cardiac catheterization. 
2. Child must lie flat for 6-8 hours after the examination. The limb receiving the puncture must be kept straight and not bent, and the sandbag is pressurized on the puncture site for 2-4 hours.
3. When child wakes up, try to drink a small amount of water first. If there is no nausea or vomiting, she/he can eat gradually.
4. After the examination,  child should be closely observed for signs of infection, such as fever, redness, swelling, and pain of the puncture wound. If there is any abnormality, please go to the hospital for further examination immediately.

What is a cardiac catheterization:

Cardiac catheterization refers to the delivery of a cardiac catheter  to the heart through the femoral vein or femoral artery to examine the structures and functions of the heart and blood vessels, in order to provide the basis for further diagnosis and treatment.

Pre-cardiac catheterization preparation:

1. The doctor will explain the purpose, process and potential risk for parents, and they have to complete the inform consent before examination.
2. According to the child's cognitive development, explain the purpose and process of cardiac catheterization, the reason for fasting (such as food, water, and milk etc.), the location of the wound after the examination and the purpose of pressing the sandbag for child and family.
3. Child has to fast at least 4-8 hours before cardiac catheterization (such as food, water, and milk etc.) to prevent aspiration pneumonia caused by vomiting during process.
4. Need to take bath before examination, especially to strengthen the cleansing of inguinal area.

Examination process: 

1. After receiving the notice from the cardiac catheterization room, nurse will ask your child to empty the bladder or change the diaper, and then accompany with child to the cardiac catheterization room.
2. The doctor will perform general anesthesia, in order to relieve discomfort and fear, before the cardiac catheterization.
3. Physiological monitors will be used throughout the whole process for monitoring heart beat, respiratory rate and oxygen saturation.
4. After child falls asleep, the doctor will deliver cardiac catheter by the heart via the femoral vein or femoral artery, inject the contrast medium at the appropriate site, check the structures and functions of the heart, or perform the necessary treatments.
5. The duration of examination will depend on the condition of child, approximately 1 to 2 hours. During the examination, please wait outside and do not leave because the doctor may explain the condition or discuss further treatment options with you at any time.

Precautions for post-examination:

1. After the cardiac catheterization, the child should lie flat for approximately 6-8 hours. The puncture site is usually pressed by sand bag for 2 to 4 hours. Please keep the same limb of the puncture site straight. Do not bend to avoid bleeding.
2. Within 24 hours after examination, avoiding excessive movement of the limb which perform examination, to prevent bleeding.
3. When child awake, try to drink some water. If there is no nausea or vomiting, then can take food gradually.
4. Twenty four hours after cardiac catheterization, nurse will change puncture site dressing for the child.
5. After returning home, here are the wound care and precautions to take:
   1. After discharge, just keep the wound clean and dry. Please keep child clean by wiping with damp towel. Shower can be started two days after procedure. The child cannot bath in tub until the wound is healed completely.
   2. Bruise may appear around wound area and will be absorbed after a few days. If the range of bruise is gradually enlarged, please seek medical attention immediately.
   3. If the wound is bleeding, please immediately use a clean dry cloth to press on the wound for 3 - 4 minutes. If bleeding continues, please seek medical attention immediately.
   4.  If abnormal conditions, such as redness and swelling of the wound, fever above 38 ℃, or pale, painful and numb limbs, please seek medical attention immediately.
   5. If a stent is inserted, do not pat the chest or back hardly to prevent loosening.

1.  Avila, M. L., Shah, P. S., & Brandão, L. R. (2020). Different unfractionated heparin doses for preventing arterial thrombosis in children undergoing cardiac catheterization. Cochrane Database of Systematic Reviews, (2). https://doi.org/10.1002/14651858.CD010196.pub3
2. Brown, L., Hinsley, K., Hurtig, M., Porter, C. L., & Connor, J.A. (2018). The current practice and care of paediatric patients post cardiac catheterisation. Cardiology in the Young, 29(2),146-151. https://dio.org/10.1017/S104795111800197X
3. Chang, Y. L., & Su, W. C. (2019). A project to reduce back discomfort in post-percutaneous coronary intervention patients. National Taiwan University Hospital Journal of Nursing, 15(2), 187-202. https://doi.org/10.6740/NTUHJN.201907_15(2).0017
4. Zhou, L. N., & Chen, J. Y. (2019). Children's cardiology technology. In S. X. Li (Ed.), The Skills of Obstertic and Pediatric Nursing (4th ed., pp. 244-248). Hua Xing.