Pre-Procedure Regimen for Cardiac Catheterization

Patient Assessment and Risk Stratification

The American College of Cardiology recommends that the performing physician critically review the patient's complete history, physical examination, and laboratory data ideally the day before the procedure to identify high-risk features requiring inpatient observation, such as congestive heart failure, unstable angina, acute MI, renal insufficiency, frequent ventricular arrhythmias, severe COPD, bleeding diathesis, uncontrolled hypertension, recent stroke, severe pulmonary hypertension, ejection fraction ≤35%, and age >75 years 2, 3, 4, 5, 6
The American College of Cardiology suggests that the procedure should be performed when arrhythmias, heart failure, or azotemia are stable or improving, as unstable conditions yield misleading data and increase procedural risk 2, 3, 7

The American College of Cardiology recommends that the physician performing the procedure must personally obtain informed consent, including reasons for the study, potential benefits, and specific complications, as well as the potential need for ad hoc PCI with its additional risks 1, 3
The American College of Cardiology suggests that all elective PCI procedures must mention the possible need for surgical intervention 8, 9

The American College of Cardiology recommends using a standardized checklist that includes patient identification, procedure planned, consent status, physical exam findings, ASA classification, planned access site, medications, allergies, laboratory findings, and proposed contrast limit 8, 9, 1
The American College of Cardiology suggests estimating glomerular filtration rate and adjusting renally cleared medications accordingly, as well as assessing bleeding risk before the procedure 1

The American College of Cardiology recommends continuing aspirin 81-325 mg before the procedure for patients already on aspirin, and administering non-enteric aspirin 325 mg before the procedure for patients not on aspirin 1

The American College of Cardiology suggests that patients on warfarin can be continued at modified doses for most cardiac catheterizations, but high-risk procedures require stopping oral anticoagulants and performing bridging anticoagulation 1

The American College of Cardiology recommends minimizing contrast volume for patients with chronic kidney disease (creatinine clearance <60 mL/min) 1

The American College of Cardiology recommends using gloves, gowns, and laboratory coats as standard procedures, and more rigorous sterile technique for complex/lengthy procedures 3, 1
The American College of Cardiology suggests that hepatitis B vaccination should be mandatory for all catheterization laboratory personnel 8, 9, 3

The American College of Cardiology recommends routinely administering heparin when nonionic contrast agents are used for angiography 3, 1

The American College of Cardiology recommends standard orders, including blood pressure, pulse, distal pulses, and bandage site checks every 15-30 minutes for 2 hours, then hourly, as well as catheterization team member examination later that day and subsequently as indicated 1

The American College of Cardiology recommends absolute contraindications (Class III) for ambulatory catheterization, including geographic remoteness, interventional procedures, fever/active infection, severe anemia/electrolyte imbalance, bleeding diathesis, recent stroke, suspected severe pulmonary hypertension, severe peripheral vascular disease, and severe insulin-dependent diabetes 4, 5, 6