There are many reasons that may lead to someone needing a heart catheterization in the cardiac cath lab. Should it be an abnormal stress test, positive cardiac enzymes, or an acute myocardial infarction, the next step may be a heart cath. Even if your procedure is scheduled, or “routine,” it can be a scary experience. Our hope is this article will help alleviate the fear and uncertainty of what to expect as a patient in the cath lab.
First Things First
When you arrive to the hospital, the first step is registration. A representative from the facility will meet with you either in a dedicated registration area or in the emergency department should you arrive emergently. The registrar will enter your information into the facilities’ system and you will be assigned a medical record number. This medical record number allows your care team members to place orders and follow your care during your stay. An armband will be placed on your wrist. This band is very important as it is used to verify who you are for procedures, tests and medications. Even though this does not normally happen in the cath lab, it is part of being a patient in the cath lab.
Next step: Pre-procedure
From the point of registration, you will be taken to a pre-procedure area. If you arrive to the facility emergently, your pre-procedure tasks may be done either in the emergency department or the cath lab itself.
In the pre-procedure area, you will be evaluated by the staff and assisted into gown. The staff will have you remove all of your clothes, including your under-garments. Other pre-procedural items may be performed:
- A 12-lead EKG may be obtained
- An IV will be established
- Pre-procedural blood work will be drawn
- Consent for the procedure will be obtained.
You will stay in the pre-procedural area until a staff member transports you to an available catheterization lab. While you wait, a staff member may explain what to expect as a patient in the cath lab.
In the Cath Lab – What Should I Expect now?
A Modern Cath Lab
The cath lab can be very overwhelming and intimidating as many people don’t know what to expect as a patient in the cath lab. There are large pieces of equipment, monitors and lots of cables and tubes. The lab staff will assist you onto the procedure table from your stretcher. Once on the table, which can be flat and uncomfortable, the staff will place you on monitoring equipment and supplemental oxygen. Your vital signs will be monitored continuously during the procedure. A staff member will prepare your groin by removing hair with electric clippers.
After these preparations are complete, the sterile scrub assistant will begin “prepping” you. They will clean the area the physician will use to gain arterial access, either your groin or wrist. The antiseptic solution used will feel very cold. After you are “prepped,” it is very important to keep your hands down by your side. This helps reduce your chance of infection. A sterile drape will then be placed over top of you. The sterile scrub assistant will then continue preparing the equipment that will be used for your procedure.
Once the physician arrives, the staff may give you some IV medications to help you relax. The sterile scrub will assist the physician into a sterile gown and gloves. The physician will numb the area that will be used with a local anesthetic. This small injection typically is the most uncomfortable part of the procedure. It has been described as a “bee sting” or a “burning” sensation. The sensation is similar to that of dental work.
After numbing the area, a small needle is used to locate the artery. Through this needle, a small wire is inserted and a small tube is placed into the vessel. This tube, or sheath, allows the use of other catheters while minimizing bleeding. From here, the physician and staff will run small catheters up to your heart. Through these catheters, X-Ray dye is injected to outline the vessels of your heart and the blood pressure is measured.
Wait? You said they could use my wrist? The radial, or wrist artery, is a newer approach to heart catheterizations. The technique is similar to groin access. After inserting the sheath into the artery, a small amount of medication is given in the sheath to help keep the artery from becoming irritated. The sheath allows the same catheters to be run to the heart as from the groin. The radial approach is preferred by many physicians and patients as the patient in the cath lab does not have to lay flat after the procedure.
The physician may elect to measure the “pumping ability” of your heart, known as the ejection fraction. You may experience a warm sensation or the feeling that you have urinated when this is performed. This is perfectly normal.
After gathering the pictures needed, the physician will review all of the images. Should a problem be found, your physician will discuss the options for treatment. These may include: stenting of the vessel, surgical treatment, or management with medications.
I Need a Stent – Hows That Work?
If your physician decides a stent is the best course of treatment, it normally can be taken care of while you are on the procedure table. Using the same sheath, a specialized catheter is inserted and guided to the artery that needs attention. A small wire is threaded into the artery past the blockage. This wire, known as a guidewire, is used to direct the equipment needed to fix the blockage.
Typically, a small balloon is passed over the guidewire to the blockage. This balloon is inflated to open a small “channel” and increase blood flow in the artery. After ballooning the artery, a stent is chosen to hold the artery open.
There are currently two types of stents: “bare metal” and “drug eluting.” A drug eluting stent is coated with a special polymer and a medication. This medication helps keep the stent from clotting or “blocking up.” Stents are carried on a balloon similar to the ones used to open arteries. Once the physician has placed the stent where it is needed, the balloon is inflated and the stent expands, holding the vessel open. After a stent is placed, additional pictures are taken of the artery to make sure everything is open as it should be. If all is well, the wire and catheter are removed.
What Should I Expect as a Patient in the Cath Lab Now That I’m Done?
If your procedure was done through your wrist, a small band may be placed on the access site. This band will hold pressure to keep you from bleeding. You will be given instructions by the lab staff on how to care for your wrist. It is generally advised to treat the wrist like it is broken for about a day.
If your procedure was done through your groin, a picture may be taken of the artery used. Dependent on your physician, a device may be used to close the hole made in the artery during the procedure. There are many different types of closure devices, and most are relatively pain free. The general benefit of a closure device is you will be able to sit up and walk sooner.
If your physician decides against or cannot use a closure device, a staff member will remove the sheath manually. They will then hold pressure by hand for around 20 minutes. Generally, you will have to lay flat for a few hours. The staff and your physician will give you specific instructions for your post-procedure care. Many people have said after being a patient in the cath lab that the procedure wasn’t uncomfortable, and the waiting to get started was the worst part.
Typical Recovery Area
After this is finished, you may be transported to a recovery area or a room. The staff will continue to monitor you, your vital signs, and your access site. After you have recovered from any relaxing medications, you will be transferred out of the recovery area. Your care team will determine the next step of your care. Generally if you received a stent, you will remain in the hospital overnight for observation.
Really good info Helped me expect what will occir
Not so informative as to my own concerns. I was exposed completely nude in the presence of members of the opposite sex. That was humiliating and a violation of my privacy rights. If I had it to do over, I would refuse the cath since such a violation of my dignity is more important to me than having staff gape at me nude on a table. I have serious religious convictions that were violated.
Concerns such as yours are typically handled by a representative of the respective facility such as a patient advocate.
I have been involved in emergency medicine for over 25 years. I can assure you, it’s a rare individual who takes any delight in seeing a naked patient. There’s just no thrill there, we are mostly concerned with protecting the patients dignity and focused in the specific tasks at hand.
The naked human body is just that, and not much of a thrill.
I too was completely naked for a short time also, maybe a couple of minutes. I was there for a cardiac ablation. There was a sizable team (4 or 5) getting me ready, so I don’t think its possible for a hospital to have a team of all of the same sex. They did have a male shave me. I assume a female would shave the women. They have to put on all sorts of pads and EKG leads for an ablation so you have to be exposed until that’s finished. I told them I didn’t want to hear any laughing which of course got a laugh. My biggest issue with it was its freezing in there which is required for the equipment. Once everything was hooked up they draped me and put warm blankets on. All of this is a very small price to pay, since they rid me of my A-Fib.
Thank you for your comment! Glad to hear your procedure went well. Every facility and physician have preferences surrounding access, some foregoing femoral access altogether. Again thank you for your time and best of luck staying in sinus rhythm!
I completely understand how you feel about being exposed and vulnerable to those in your care staff, especially those of the opposite sex! But would you rather be dead?!!! These people SAVED YOUR LIFE!!!
Yup went just the way you explained. Thank you for calming my fears.
Thank you Paul. I’m glad to hear this helped calm your fears. Hope all went well with your procedure!
Thank you Brad, this help more than you know. I was horrified when I heard that I needed heart cath, however after reading this my nerves are a little calm. My procedure is coming up in a week and you have calmed my anxieties.
Thank you!
Dorothy
Thank you Dorothy! I hope your procedure goes well.
Mine is scheduled for the 16th. Thank for the info. I hate going in blind.
Thanks for the comment! Hope all goes well and you receive good news!
This info was very helpful. I still hate hospitals and needles, but I do feel a bit more at ease
Im going in Friday at 7am. Trying to stay positive. Doing lots of praying.
Thank you Kristine. Hope your procedure goes well!
What about pretreatment for the possible allergic reaction to contrast dye? How long will that medicine last before it wears off? If it goes well over the 13 hours, does it have to start all over again due to the staffs negligence?
Every facility and physician have specific policies and practices regarding contrast allergy pretreatment.
I have to start prednisone Pepcid and Benadryl the day before my cath to address dye allergy. I think it’s kind of funny I’ll be simultaneously high on roids and in a fog from the Benadryl because it really knocks me out. Fun times ahead. Mine is this Thursday and due to spinal stenosis issues I want mine through my wrist.
Thank you it updated them since my first up the groin-and don’t move 6 hours now much better going work up trying to get lung transplant!
My husband is having this done in 2 days. I’m a nervous wreck. Thank you for sharing this. I find the more I learn, the calmer I feel.
This wasn’t how it went for my husband. They pre-drugged him bc he didn’t want a cath so they did that so he couldn’t object. The 4 cath lab women left him completely naked & exposed for over 20 minutes before the procedure & for 30 minutes after the procedure. The only time his he wasn’t exposed was during the procedure. Afterwards the cardiac nurse left his genital exposed for 6 hours bc she said she didn’t know how to cover his genitals. She also kept him isolated from family by telling us we were outside of visiting hours except for a ten minute period. She allowed his genitals to be viewed by everyone including IT tech staff, the girl who drew blood, and the social worker who at the same time was asking him if he was ever sexually abused by his spouse as the social worker was participating in sexually abusing him. They though it was funny. Please read his story of what can happen in a cath lab. Also, this same hospital completely falsified his records so they are unusable.
That is very unfortunate experience. Most facilities have a patient advocate or other designee for concerns such as yours.
This was generally a good explanation in understandable terms for non-healthcare professionals, but you more or less skipped over the degree of genital exposure a patient should expect. Also what you refer to as “relaxing medications” is a misnomer in that versed and similar drugs are amnesiacs that serve to erase the patient’s memory of the event rather than simply relax them. This plays back to the exposure concern than some have.
Thank you for your comment Brian. Every lab has “their way of doing things” and some now forego groin preparation altogether! The same rings true for the type and dosage of medications given and couples with the individual’s response to said medications. Above all, I feel everyone involved in cardiac cath labs ultimately want the best for their patients. Thanks again!
I was told I’d be given something to relax. It did NOT relax me. I eas tense and very uncomfortable throughout the entire procedure.
The “relaxing” medicine didn’t hit me until I was back in my cubicle, and even then, it made me feel tired, definitely not relaxed.
I would not want to go through another one because of this.
Hello Brad Richardson,
My question for you is I had a cardiac catheterization performed on 3/10/2020 & a stent was inserted in the Right main artery
It has been 28 days since the procedure & I still have pain/discomfort around the incision area. The pain is about a one but it makes me worry if something is wrong. My cardiologist said it should have healed within two weeks & sent me for a ultrasound of the area. The technician basically stayed near the incision only. & said everything was fine..is it normal to still have this pain/discomfort 28 days after. I am retired, have lifted nothing heavy & have been recovering at home. I would love to hear your opinion or from others that have had this experience. (Worried)
Billy,
I am sorry to hear you are having discomfort after your procedure. Each patient may heal differently following a procedure. Following up with your cardiologist or primary care physician would be the best approach.
All the best. -Brad
I recently had a cardiac cath in my right neck (they call it an IJ which means they went through my jugular vein.) You failed to mention a few things: the degree of exposure, the fact that some docs don’t want you to receive any medication for the procedure, some have you bicycle while lying down with your head turned to the left while the vast majority of your body is exposed except your head because the sterile field is lying over your neck and head, the bicycle exercise they have you perform has you wearing a neoprene mask which Closes your nose to any air and has a hole in the front for them to hook up to a measurement machine, and the arterial line they try to put in your arm is extremely painful even with numbing. There’s approximately 6 people in the room and 1-2 behind glass watching and talking to the staff via speakers in our set up. It’s very cold in there. If you have any side problems they are not focused on that.
Jennifer, I’m sorry you had this experience. This article is meant to serve as a general overview. Each lab/team prepares patients for and performs the procedures slightly differently. I can speak to all of the teams I have worked with that patient safety is always priority. Given the displeasure you encountered during your procedure, you could discuss your case with a patient advocate or hospital administrator for the facility.
All the best, Brad.
Jennifer, my first experience as a hospital tech goes back over 50 years. I was a teen, seriously considering medical school. So I wore a short lab coat and carried bed pans in a smallish county hospital. (Inserting a urinary catheter in an obese male is a pleasure no one looks forward to.) Also worked behind the nurses in the OR,ER and the delivery room. Naked patients are no thrill. These are highly embarrassed, vulnerable humans requiring lots of assistance. Whenever a patient was embarrassed, I was too. Genitals get glancing notice but never in a lurid way. Even as a hormonal teen aged male it was never interesting. Not an image one recalls (or cares to recall) 10 minutes later. More of the body the staff sees, the sooner they’ll pick up on problems like low blood flow circulation. Also sites where an IV might be injected in a rush. Not a topic of break room chatter. Expression around the hospital was “Who the hell cares?” Were we wheeled into the emergency room from a traffic accident, we’d hope for the same skilled level of care. (BTW I became a microbiologist instead.)
I had a port put in my chest after a previous operation and I’m wondering why that is not mentioned as an option since it is very close to heart.
I’m going to ask about the naked situation………not happening, I will insist on the wrist if naked is mentioned: OMG, that would give me a heart attack.
Accessing an implanted vascular port for IV access is typically performed if one is present.
Most teams will take requests into consideration. All you have to do is ask!
I was left uncovered and totall nude in the cath lab also. Scrub nurse could have easily covered my genitals but made no effort at all to do so. There were about 7 or8 people in the lab. I was in full view of all of them, totally nude. This was a violation of my privacy rights and extremely inappropriate behavior by the nurses and technicians. I complained to the hospital and was sent a letter which did nothing but cover up the problem. It’s a shame these people are not held accountable for their inappropriate behavior so it will continue as usual.
Mr. Clark, I understand your frustration. Given that you have already voiced your complaint to the facility, it would generally be recommended for you to escalate your complaint within the facility via their patient advocate or other designated representative. Should a satisfactory resolution not be obtained, that representative should be able to direct you to the next course of action.
Hello! If you are allergic to Iodine, how to do the procedure of Heart stenting?
Each facility has it’s own measures to treat those with Iodine allergies that require cardiac caths. Typically an anti-histamine and a steroid are given before the procedure. Some physicians have patients take the steroid by mouth for a few days prior to the case. The newer contrast medium used by most labs has a lower Iodine content and is tolerated well by most patients. Just make sure to talk with your physician prior to the procedure to see how they plan to address the allergy.
Is there a need for the body to be exposed if it is done in the wrist?
Ultimately this is up to the performing physician and the facility where the procedure will be completed. Some labs have moved to only preparing the arm if radial access is their standard. The downside to only “prepping” the radial is if emergent access is needed via the femoral artery for advanced support devices such as a balloon pump, pLVAD or ECMO. Many physicians I work with have the team prepare both radial and femoral access even if done through the wrist as a “bail-out” if there are problems. We operate on the “plan for the worst, hope for the best” mindset.
I am having a heart cath on Tuesday the 13th of Oct. Had one before many years ago. I remember that one and how uncomfortable it was laying on my back for so long since I am not a back person. I am hoping this goes well. The information written is pretty acurate from my memory and I to was naked and it was cold. Hope this experience will be a bit better. Still concerned though.
Ms. Hilliard,
My apologies for the delayed response. I hope your procedure went well!
Interesting comments. I am a Registered Nurse and have had 2 cardiac caths sine 2018. Yes, I was naked under a drape for the procedure. A female tech shaved my groin. The doctor who did my cath was a female, and one of the few in the country who said she could get the blockage in an artery in the back of my heart. She saved my life. I do not care how many people saw me naked. It makes no difference in the big scheme of life…My life was saved and that is ALL I care about. Now I am facing my third cardiac cath on Thursday (10/22/20) for new onset on chest pain. Again, I will be exposed to people of the opposite gender. It does not matter, as this is a life or death matter. It is not like I am doing it on the town square. My concern in that it will be cold, and I will have to lay on my back for a couple of hours post procedure. I will just be glad to have it over,
Thank you for your insight Gary! Hope all goes well!
I recently had a heart Cath on October 16, 2020. I was in so much pain in my right leg. I came home from the hospital in pain. My leg is numb from the knee to my calf. I have a huge blood bruise on my thigh and a large knot on my groin. I went to the cardiologist on the 25th for a follow-up, an MRI was done and I was told that the knot was on a lymph node and the bruising would heal soon. Needless to say It’s been almost 3 weeks since the procedure I am in pain. Has anyone else had this problem?
Audrey, sorry to hear of your troubles. The performing physician should be able to continue following your case. Hope you heal quickly!
I had a heart cath on Dec. 4 2020. I noticed an x in marker on the top of each foot and a small bruise about an inch above the x on my right foot. What’s that all about?
The cath was done through my right wrist.
The “x” marking is most likely marking the location of the pulses in your feet. Even if the groin is not used for access, teams typically grade and mark the pulses pre-procedure. This allows them to note any changes if a closure device is used. As to the bruise, it could be multifactorial. If you’re concerned, I would discuss it with the physician who performed the cath or your primary care. All the best – Brad
Hello, i hope your day is going well. Tomorrow, the 3rd of February, i will have my 8th cath. Im concerned as im only 14 and a male. This is the first time in years and im not prepared to be naked. The last time i did this was when i had 3 years of age. Also i cant take much medication which includes numbing medicines such as advil. Im scared their going to keep me waiting there for at least an hour while being naked because of my needs. Also was wondering if i had to groom down there before the precedure to reduce the time or would it do nothing?
Very informative. I have been searching for this type if info and now am better prepared for the experience. Thank you
Thank you, glad you found this useful.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
You did an excellent job of explaining the procedure and I should know since l have had TEN heart caths. My last one was only three days ago. The healthcare workers are all very professional and I have never felt like they were interested in the least if I was naked or dressed in the latest fashion. They were talking to me and putting me at ease when I told them until I heard someone say “She’s baacckk!” then they were all too young for me which started a conversation about movies. I love that they make that much effort to keep my mind busy on other things than what is fixing to happen. Seems like most comments are concerned with being naked. We came into the world naked with hospital workers chances are we will go out naked with hospital workers then moved to the morgue workers. We’re just one more body to them; I too cared until I realized that wasn’t even a thought in their minds and it was overblown in mine. Now I relax and enjoy the repartee with the guys and gals before I am put to sleep.