GCC Cardiac Catheterisation & Cath Lab Nursing Guide

📐 Cardiac Catheterisation Procedures

Diagnostic Coronary Angiography

Indications: chest pain / stable angina, ACS risk stratification, pre-operative cardiac assessment (major non-cardiac surgery), heart failure with ischaemia query
Radiopaque dye (iodinated contrast) injected into coronary arteries via catheter
Fluoroscopic X-ray imaging reveals stenosis, occlusion, collateral vessels
Guides decision for PCI vs CABG vs medical management

Percutaneous Coronary Intervention (PCI)

Balloon angioplasty (PTCA): inflated balloon dilates stenotic segment
BMS (Bare Metal Stent): metal scaffold; shorter DAPT (1 month); higher restenosis risk
DES (Drug-Eluting Stent): polymer-coated antiproliferative drug (sirolimus/paclitaxel); DAPT 6–12 months; lower restenosis; stent thrombosis risk if DAPT stopped early
Modern practice: DES preferred in most PCI

PPCI (Primary PCI) — STEMI Emergency

Reperfusion strategy of choice for STEMI
Door-to-balloon (D2B) target: <90 minutes
First Medical Contact (FMC) to balloon: <120 min
Nursing role: rapid triage, ECG within 10 min, cath lab activation, pre-medication (aspirin, heparin, P2Y12 loading)
Every minute of delay = myocardial loss ("time is muscle")

Structural Heart Procedures in Cath Lab

Valvuloplasty: balloon dilation of stenotic valve (mitral, pulmonary, aortic)
TAVR / TAVI: Transcatheter Aortic Valve Replacement/Implantation — for severe AS in high surgical risk patients; transfemoral or transapical approach
Requires general anaesthesia or conscious sedation + echocardiography guidance
Complex team: interventionalist, anaesthetist, cardiac surgeon on standby, echo, scrub, circulating

Right Heart Catheterisation (RHC)

Uses Swan-Ganz (pulmonary artery) catheter
Measurements: PCWP (pulmonary capillary wedge pressure), CO (cardiac output), SVR (systemic vascular resistance), PVR (pulmonary vascular resistance)
Indications: pulmonary hypertension assessment, pre-transplant haemodynamic profiling, complex cardiogenic shock, constrictive pericarditis vs restrictive cardiomyopathy
Access: right internal jugular or femoral vein

Electrophysiology Studies (EPS) & Ablation

Arrhythmia mapping: identify re-entrant circuits (AF, flutter, VT, SVT, WPW)
Radiofrequency or cryoablation to destroy arrhythmogenic tissue
Typically performed in dedicated EP lab (specialised nurses — EP trained)
ICD/pacemaker implantation also performed in cath lab / EP lab setting

🏭 Hybrid Procedures

EVAR / TEVAR (Endovascular Aortic Repair)

EVAR: Endovascular Aneurysm Repair — abdominal aortic aneurysm stent-graft via femoral access
TEVAR: Thoracic EVAR — thoracic aortic aneurysm or dissection
Performed in hybrid operating theatre / hybrid cath lab (surgical + fluoroscopy capability)
Joint team: vascular surgeon, interventional radiologist, cath lab nurse, OT scrub nurse

GCC Context: High PCI Volume Centres

UAE: Cleveland Clinic Abu Dhabi, Sheikh Khalifa Medical City, Rashid Hospital — very high PCI volumes; high ACS burden due to diabetes, smoking, sedentary lifestyle
Saudi Arabia: King Faisal Specialist Hospital & Research Centre (KFSH) Riyadh — one of highest PCI volumes in MENA
Qatar: Hamad Medical Corporation (HMC) Heart Hospital — designated STEMI network with pre-hospital ECG activation
Kuwait: Sabah Hospital, Ibn Sina — active cath lab programmes

D2B Goal (STEMI)

<90 min

FMC-to-Balloon

<120 min

ACT Target (PCI)

250–350 s

DAPT Post-DES

6–12 months

DAPT Post-BMS

1 month

📋 Consent & Patient Preparation

Consent Requirements

Procedure-specific informed consent: risks include bleeding, contrast reaction, nephropathy, vascular injury, MI, stroke, death
Sedation consent (if conscious sedation planned)
In emergency PPCI: consent may be implied (life-saving) — document clearly
GCC context: family involvement in consent decisions common; interpreter required if language barrier

Fasting (NPO) Guidelines

Clear fluids: 4 hours before procedure
Solids: 6 hours before procedure
Local protocol may specify longer fasting for elective cases
Emergency PPCI: proceed regardless of fasting status (aspiration precautions)
Diabetic patients: monitor BSL; hold oral hypoglycaemics on morning of procedure

💊 Medication Management Pre-Procedure

Metformin — HOLD

Hold 24–48 hours before contrast use
Risk: contrast-induced nephropathy + metformin = lactic acidosis
Restart only when creatinine confirmed stable (48–72h post-procedure)

Anticoagulants

Warfarin: usually held 5 days pre-elective procedure; check INR <1.5 before access; in PPCI continue and use radial access if possible
DOACs (rivaroxaban, apixaban, dabigatran): hold 24–48h pre-elective depending on renal function and specific agent; check local protocol
Bridging LMWH: per haematology/cardiology guidance for high-risk patients

Aspirin — Usually Continue

Continue aspirin unless specific instruction to stop
For PCI: loading dose aspirin 300mg if not already on it
P2Y12 loading pre-PCI: ticagrelor 180mg or clopidogrel 600mg (as per protocol)
Statins: continue — have pleiotropic benefit peri-PCI

Contrast Allergy Premedication

Indicated if: previous contrast reaction (moderate or severe), high allergy risk
Hydrocortisone 200mg IV + Chlorphenamine 10mg IV
Oral regimen (elective): prednisolone 50mg at 13h, 7h, 1h before procedure
Document allergy history clearly; inform cath lab team
Anaphylaxis kit must be in cath lab at all times

Renal Protection — CKD Patients

IV pre-hydration: 0.9% NaCl 1 mL/kg/hr for 6–12h before and 6–12h after procedure
N-acetylcysteine (NAC): evidence weak but sometimes used (600mg BD oral)
Use minimum contrast volume; iso-osmolar contrast preferred
Baseline creatinine / eGFR documented; post-procedure creatinine at 24h and 48h
Nephrology referral if eGFR <30 mL/min — benefits vs risks discussion

📋 Baseline Assessment & Access Preparation

Baseline Documentation

Vital signs: BP (bilateral arm), HR, RR, SpO2, temperature
Pulses: bilateral radial pulses + bilateral femoral pulses — document strength and character (for post-procedure comparison)
12-lead ECG on admission / pre-procedure
Allen's test if radial access planned (assess dual hand circulation)
Weight (for contrast dose calculation and medication dosing)
Baseline GCS / neurological status

Blood Tests Required

U&E / Renal function (creatinine, eGFR)
Coagulation: INR, APTT (especially if anticoagulated)
FBC: Hb, platelets
Group and Save (crossmatch if high-risk)
Cardiac biomarkers: troponin, BNP if indicated
Random blood glucose (especially diabetic patients)

IV Access & Skin Preparation

IV Cannula

Size: 18G or larger (large bore for contrast and emergency medications)
Preferred site: right antecubital fossa or forearm (left arm if radial access on right planned)
Flush and confirm patency

Groin Preparation (Femoral Access)

Skin prep: clean with antiseptic solution
Hair removal if required per local protocol (clippers preferred over razor)
Drape as per sterile field protocol

Wrist Preparation (Radial Access)

Document radial pulse strength and Allen's test result
Position: arm abducted, slightly extended on arm board
Remove jewellery from wrist/hand

🔧 Vascular Access Sites

Feature	Radial Artery (TRA)	Femoral Artery (TFA)
Preferred for	Most PCI, elective angiography, obese patients	Complex PCI, structural procedures, haemodynamic instability
Bleeding risk	Lower — accessible compression site	Higher — retroperitoneal haematoma risk
Ambulation	Immediate (1–2h post-procedure)	4–6h bed rest required
Patient comfort	Higher (can sit up)	Lower (flat in bed)
Access size limit	7F max typically	Up to 12–14F (structural procedures)
Complications	Radial artery spasm, occlusion (1–5%)	Pseudoaneurysm, AV fistula, haematoma
Post-care	TR Band / Terumo Band haemostasis device	Manual pressure or closure device

ℹGCC practice: Radial access (TRA) is now the standard of care for PCI in most GCC centres (Cleveland Clinic Abu Dhabi, KFSH, HMC). Femoral access retained for complex TAVR, EVAR, Impella, large-bore procedures.

💉 Anticoagulation in the Cath Lab

Heparinisation for PCI

Unfractionated heparin (UFH): 70–100 units/kg IV bolus at time of PCI
ACT (Activated Clotting Time) target: 250–350 seconds
ACT check 3–5 min post heparin bolus; additional boluses as needed
Bivalirudin: direct thrombin inhibitor — alternative to UFH (lower bleeding risk)
PPCI: heparin given as soon as possible (ED or ambulance if STEMI network)

ACT Monitoring

ACT machine (Hemochron or similar) in cath lab
Sample from arterial sheath or venous line
Nurse role: draw ACT sample, run test, document and report to physician
If ACT <250s during PCI: additional heparin bolus required
Protamine sulfate reverses UFH if needed at end of procedure (rarely used in radial cases)

💤 Conscious Sedation Monitoring

Agents Used

Midazolam (Benzodiazepine)

Dose: 1–2mg IV titrated (elderly: 0.5–1mg)
Anxiolysis + anterograde amnesia
Reversal: Flumazenil 0.2mg IV

Fentanyl (Opioid)

Dose: 25–50 mcg IV titrated
Analgesia for access site discomfort
Reversal: Naloxone 0.4mg IV/IM
Monitor for respiratory depression

Monitoring Requirements

Continuous: SpO2, ECG (3 or 5-lead), HR
BP: every 3–5 min (automated NIBP)
End-tidal CO2 (capnography) if available / per protocol
Sedation level: verbal response assessment (Ramsay scale)
Oxygen delivery: nasal cannula 2–4 L/min throughout
Resuscitation equipment: crash cart, defibrillator in room

⚠Escalate immediately (ISBAR) if: SpO2 <94%, RR <8 or >25, BP drop >20% from baseline, arrhythmia on monitor, patient unresponsive.

🔵 Contrast Media Management

Types of Contrast

Type	Characteristics	Use
Ionic (high-osmolar)	Higher side effect profile; nausea common	Largely replaced
Non-ionic (low-osmolar)	Better tolerated; less nephrotoxic	Standard for coronary
Iso-osmolar (iodixanol)	Least nephrotoxic; preferred in CKD	Renal protection priority

Contrast Reaction Grading & Response

Grade	Signs	Action
Mild	Nausea, warmth, flushing, urticaria (localised)	Observe; reassure; antihistamine if needed
Moderate	Generalised urticaria, bronchospasm mild, vomiting	Stop contrast; antihistamine IV; bronchodilator; observe
Severe	Anaphylaxis: hypotension, bronchospasm, angioedema, cardiac arrest	Adrenaline 0.5mg IM; stop contrast; O2; resuscitate

☢ Radiation Protection in the Cath Lab

Personal Protective Equipment

Lead apron: 0.25–0.5mm Pb equivalent (wrap-around preferred)
Thyroid shield (collar) — mandatory
Lead glasses — recommended for high-volume operators
Lead gloves: optional; reduce scatter to hands

Dose Monitoring & Limits

Dosimetry badge (TLD or OSL): worn at collar level outside apron
Annual effective dose limit: 20 mSv/year (occupational)
Monthly dose report: reviewed by radiation safety officer
Fluoroscopy time and KAP (kerma-area product) documented per case

Pregnancy & Special Rules

Pregnant staff: declare pregnancy early; additional lead apron (double-front) required
Foetal dose limit: 1 mSv for whole pregnancy
Reassignment to non-fluoroscopy duties may be appropriate in first trimester
Distance principle: dose decreases with square of distance from source

ALARA Principle & Practical Tips

As Low As Reasonably Achievable — minimise exposure time, maximise distance, use shielding
Step back from X-ray source during prolonged fluoroscopy runs when not required to be at table
Use ceiling-mounted lead screen and under-table lead drape
Last-image hold and low-dose fluoroscopy modes reduce dose significantly
Cine acquisition (for final images) delivers higher dose than fluoroscopy — minimise runs

📝 Intra-Procedure Documentation

Required Documentation

Total contrast volume (mL) — tracked throughout procedure
Total fluoroscopy time (minutes)
Radiation dose: KAP / DAP (dose-area product)
Access site (radial L/R, femoral L/R); sheath size (French)
Heparin dose and ACT results (with times)
Medications administered (sedation, intracoronary agents)
Any adverse events (contrast reactions, arrhythmias, haemodynamic changes)

Patient Communication (Awake Patient)

Explain each step before it occurs — reduces anxiety and vasovagal reactions
Warn patient of warmth/flushing sensation when contrast injected — "normal feeling"
Breath-hold instructions: "take a deep breath in and hold" for image acquisition
Keep patient informed of progress: "procedure going well, nearly done"
Arabic-speaking patients: ensure interpreter or Arabic-speaking staff available in GCC centres
Post-procedure: confirm patient comfort before transfer

💉 Radial Access Post-Care

TR Band / Terumo Band Protocol

Applied at time of sheath removal in cath lab
Initial inflation volume: per manufacturer (typically 15–18 mL air in standard adult)
Haemostasis check: small bleed allowed (patent haemostasis) — preserves radial patency
Deflation schedule: remove 2–3 mL air every 1–2 hours; full removal typically at 4–6 hours post-procedure
Document each deflation step with time, volume removed, site assessment

⚠Over-tightening risks radial artery occlusion. Patent haemostasis (patent = keeps radial artery open) preferred over occlusive haemostasis.

Radial Artery Occlusion Monitoring

Signs of Radial Artery Occlusion (RAO)

Absent or diminished radial pulse post-band removal
Plethysmography: loss of waveform with TR Band compression of ulnar artery (Barbeau test)
Swelling, pallor, or decreased sensation in thumb — urgent review

Finger Perfusion Assessment

Capillary refill <2 sec in all fingers
Thumb and index finger colour and warmth
SpO2 probe on same-hand finger: waveform present = perfusion intact

📐 Femoral Access Post-Care

Haemostasis Methods

Manual Compression

Direct pressure above puncture site for 20 minutes minimum
Mechanical compression device (FemoStop) for prolonged haemostasis
Confirmed haemostasis before bed rest

Vascular Closure Devices

Angioseal: collagen plug + anchor — no compression needed; 30 min to ambulation
Perclose ProGlide: suture-mediated; immediate haemostasis; can be used for large bore
Mynx: extravascular sealant; low profile
Still requires 30–60 min monitoring post-deployment

Bed Rest & Monitoring Protocol

Manual compression: 4–6 hours bed rest (flat or head-of-bed <30°)
Closure device: 2–4h bed rest depending on device and anticoagulation
Monitor access site: q15 min x4, then q30 min x4, then q1h
Assess: haematoma size (mark border with pen), bleeding, ecchymosis
Distal pulses: femoral, popliteal, dorsalis pedis — bilateral comparison
Neurovascular check: sensation and movement in leg

🚨Expanding haematoma: Apply immediate manual pressure, call physician, prepare for emergency imaging (retroperitoneal haematoma: back/flank pain, falling Hb, hypotension — activate vascular surgery).

📊 Post-PCI Monitoring Protocol

Vital Signs & ECG Monitoring

VS Frequency (First 2h)

q15 min

VS Frequency (2–6h)

q30 min

VS Frequency (>6h stable)

q1h

12-lead ECG: on return from cath lab, at 1 hour, at 6 hours post-PCI, and prn for symptoms
Continuous cardiac monitoring for 12–24h post-PCI (particularly post-PPCI)
SpO2 continuous for first 2h; then as clinically indicated
Urine output: hourly if CKD, contrast load >200mL, or haemodynamic concern

Biomarkers & Blood Tests

Troponin

Post-PCI troponin elevation: expected periprocedural rise — "PCI-related MI" if >5x URL
Serial troponin: baseline (pre-procedure) and 6h post-PCI
Rising troponin at 6h + symptoms: consider new ischaemic event

Contrast Nephropathy

Definition: creatinine rise >25% or >44 mcmol/L within 48–72h post-contrast
Risk factors: CKD, diabetes, large contrast volume, dehydration, NSAID use
Management: IV fluid hydration; hold nephrotoxic medications; nephrology alert if significant rise
Check creatinine at 24h and 48h in high-risk patients

💊 DAPT & Discharge Education

Dual Antiplatelet Therapy Post-Stent

Stent Thrombosis — Critical Risk

Sub-acute stent thrombosis (1–30 days): most dangerous; often fatal
Caused by: DAPT non-compliance, under-expansion, dissection
Prevention: strict DAPT adherence — patient education is paramount

DAPT Regimens

Stent Type	Regimen	Duration
DES (elective)	Aspirin 75–100mg + Ticagrelor 90mg BD or Clopidogrel 75mg OD	6–12 months
DES (ACS)	Aspirin + Ticagrelor (preferred) or Prasugrel	12 months
BMS	Aspirin + Clopidogrel	1 month minimum
Post-PPCI	Aspirin + Ticagrelor 180mg loading then 90mg BD	12 months

Discharge Instructions

Activity & Driving Restrictions

Radial access: no driving for 24 hours
Femoral access: no driving for 2–3 days (groin flexion risk)
No heavy lifting >5 kg for 1 week (femoral); 2–3 days (radial)
Shower allowed after 24h if site dry; no bath/swimming for 1 week

Medication & Follow-Up Education

NEVER stop antiplatelet medications without cardiology advice — stent thrombosis risk
Carry stent card (type, date, vessel) at all times — important for any future procedure
Report immediately: chest pain, access site swelling/bleeding, shortness of breath
Follow-up: cardiology clinic 4–6 weeks post-PCI
Medication reconciliation: restart metformin only after creatinine confirmed stable
Lifestyle: smoking cessation, cardiac diet, exercise programme

🚨 Cath Lab Emergency Management

🚨All cath lab nurses must be ACLS-certified and able to initiate resuscitation independently. Emergency equipment (crash cart, defibrillator, pericardiocentesis kit) must be immediately accessible in every cath lab.

Definition: Impaired myocardial perfusion despite successful mechanical opening of the epicardial coronary artery. Microvascular obstruction persists.

Presentation: ST changes after stenting, chest pain, haemodynamic deterioration despite TIMI 3 flow on angiography

Causes: Distal embolisation of plaque/thrombus, microvascular spasm, reperfusion injury, pre-existing microvascular disease

Treatment:

Intracoronary adenosine: 100–200 mcg bolus (vasodilation)
Intracoronary verapamil: 100–200 mcg (calcium channel blocker)
Intracoronary nitroprusside: alternative vasodilator
GP IIb/IIIa inhibitor (abciximab): if thrombus burden high
Support haemodynamics: IABP or Impella if cardiogenic shock develops

⚠Nurse role: prepare intracoronary medications rapidly; monitor haemodynamics continuously; alert team to BP/HR changes.

Coronary Dissection: Wire or balloon creates a tear in the arterial wall; can propagate and cause acute occlusion.

Coronary Perforation (Ellis Classification):

Type I: extraluminal crater — usually benign
Type II: myocardial blush — moderate risk
Type III: free perforation into pericardium — emergency (tamponade risk)
Type III cavity: perforation into cardiac chamber or coronary sinus

Emergency Responses:

Balloon inflation over perforation site (tamponade perforation)
Covered stent (Jostent / PK Papyrus): seal perforation — nurse prepares urgently
Protamine sulfate: reverse heparin if anticoagulation contributing
Pericardiocentesis kit: prepare immediately if tamponade signs develop
Cardiac surgery activation (standby or emergency)

🚨Monitor for tamponade: falling BP, rising HR, muffled heart sounds, equalising pressures on haemodynamic monitoring.

Cause: Coronary perforation, right ventricular perforation (pacemaker wire), guidewire exit

Classic Signs (Beck's Triad):

Hypotension
Elevated JVP / CVP
Muffled heart sounds

On fluoroscopy: Enlarged cardiac silhouette; loss of pulsation; pericardial effusion on echo

Pulsus paradoxus: >10 mmHg SBP drop on inspiration

Emergency Pericardiocentesis at Cath Lab:

Immediate preparation of pericardiocentesis kit
Subxiphoid approach under fluoroscopy or echo guidance
18G needle with J-wire and pigtail catheter
IV fluids and vasopressors to maintain perfusion while preparing
Autotransfusion of drained blood (clean field) if required
Cardiac surgery activation for haemopericardium from perforation

🚨Nurse role: Call for help immediately, have kit open, connect drainage system, monitor pressure response after drainage.

Causes in cath lab:

Contrast injection into coronary artery (bradycardia / VF)
Wire / catheter stimulation of ventricle
Reperfusion arrhythmia (post-PPCI)
Air embolism
Haemodynamic collapse during high-risk PCI

Defibrillator: must be immediately available and charged in all cath labs at all times

Response Algorithm:

Recognise VF/pulseless VT on monitor
Immediate CPR — cath lab table allows (remove drapes)
Defibrillation: 200J biphasic — charge while CPR continues
Adrenaline 1mg IV q3–5 min
Amiodarone 300mg IV after 3rd shock
Identify and treat reversible cause (4Hs and 4Ts)
Consider mechanical chest compression device (AutoPulse / LUCAS) to allow continued fluoroscopy

Recognition: Generalised urticaria, bronchospasm, angioedema, hypotension, cardiovascular collapse. Onset: seconds to minutes after contrast injection.

Risk factors: Previous anaphylaxis to contrast, shellfish allergy (iodine association debated), asthma, multiple allergies

Emergency Treatment:

STOP contrast immediately
Adrenaline (epinephrine) 0.5mg IM (anterolateral thigh / deltoid)
Call for help — activate resuscitation team
High-flow oxygen 15 L/min (non-rebreather mask)
IV fluids: 500–1000mL 0.9% NaCl bolus for hypotension
Chlorphenamine 10mg IV slow + hydrocortisone 200mg IV
Salbutamol nebuliser if bronchospasm
Repeat adrenaline every 5 minutes if no improvement

Mechanism: High femoral puncture (above inguinal ligament) allows bleeding into retroperitoneal space; not accessible by manual compression.

Presentation:

Back pain / flank pain
Falling haemoglobin (may be rapid)
Hypotension without visible groin haematoma
Ipsilateral femoral nerve compression: numbness/weakness in thigh (femoral neuropathy)

Response:

Immediate vascular surgery activation
IV large-bore access x2; rapid fluid resuscitation
Group and crossmatch; prepare blood products
CT angiography of abdomen/pelvis (if haemodynamically stable)
Reversal of anticoagulation (protamine / specific reversal agents)
May require surgical haematoma evacuation or endovascular balloon tamponade

🚨Do NOT attempt manual pressure on retroperitoneal haematoma — it is not effective and delays definitive management.

👥 Cath Lab Team Roles

Scrub Nurse / Cath Lab Tech

Maintains sterile field
Passes catheters, wires, balloons, stents to operator
Contrast syringe management
Documents contrast volume and devices used

Circulating / Runner Nurse

Retrieves equipment from stock (stents, closure devices, emergency supplies)
Manages medications: draws up heparin, sedation agents
Coordinates with pharmacy and blood bank
Documentation support

Monitoring Nurse

Continuous haemodynamic monitoring: BP, HR, SpO2, ECG
Conscious sedation administration and assessment
ACT testing
Patient communication and comfort
First responder for patient deterioration

🎓 GCC Exam High-Yield: Cardiac Catheterisation

PPCI Door-to-Balloon (D2B) — Must Know

Target: <90 minutes from hospital arrival to first balloon inflation
FMC (First Medical Contact) to balloon: <120 minutes
ECG acquisition within 10 minutes of arrival (STEMI recognition)
Every 30-minute delay in D2B = 7.5 additional deaths per 1,000 patients (literature)
GCC STEMI networks: pre-hospital ECG transmission to cath lab in UAE/Qatar reduces time

Stent Thrombosis — Critical Exam Point

Timing: acute (<24h), sub-acute (1–30d), late (30d–1yr), very late (>1yr)
Most dangerous period: sub-acute (1–30 days)
Primary cause: DAPT non-compliance
Presentation: sudden-onset chest pain, STEMI pattern, haemodynamic collapse
Treatment: emergency repeat PCI (aspiration + re-stenting)
Nurse duty: reinforce NEVER stop antiplatelet without cardiology advice

Contrast Nephropathy Prevention (Exam Format)

Pre-hydration: 0.9% NaCl 1 mL/kg/hr for 6–12h pre and post
Minimum contrast volume (iso-osmolar preferred in CKD)
Hold metformin 24–48h
Check creatinine at 24h and 48h post-procedure
Avoid NSAIDs and other nephrotoxins peri-procedure

GCC Licensing Body High-Yield Questions

DHA Dubai DOH Abu Dhabi SCFHS Saudi QCHP Qatar

D2B time for STEMI (90 min)
Most common cause of stent thrombosis (DAPT non-compliance)
First drug for contrast anaphylaxis (adrenaline IM)
Why hold metformin before contrast (lactic acidosis risk)
TR Band deflation: patent haemostasis method
Retroperitoneal haematoma: back pain + falling Hb + hypotension

📈 Radial vs Femoral Access — Comparison Table

Parameter	Radial (TRA)	Femoral (TFA)
Major bleeding risk	Lower	Higher
Ambulation post-procedure	Immediate (1–2h)	4–6h bed rest
Retroperitoneal haematoma risk	No	Yes
Access size (max sheath)	5–7F typically	Up to 14F (structural)
Haemostasis method	TR Band / Terumo Band	Manual compression / closure device
Patient satisfaction	Higher	Lower
Specific complication	Radial artery occlusion (1–5%)	Pseudoaneurysm, AV fistula
Learning curve	Steeper (operator)	Less steep
GCC current preference	Default for most PCI	Complex / structural cases

⚡ Quick Reference Summary

Emergency Numbers (Know Instantly)

D2B target: <90 min
FMC-to-balloon: <120 min
ECG acquisition: <10 min
ACT target PCI: 250–350 s
Metformin hold: 24–48h
DAPT post-DES (ACS): 12 months

Drugs You Must Know

Anaphylaxis: Adrenaline 0.5mg IM
Contrast premedication: Hydrocortisone 200mg IV + Chlorphenamine 10mg IV
Midazolam reversal: Flumazenil 0.2mg IV
Opioid reversal: Naloxone 0.4mg IV/IM
Heparin reversal: Protamine sulfate
No-reflow: Adenosine IC / Verapamil IC

Clinical Red Flags (Report Immediately)

Expanding groin haematoma
Back pain + falling Hb post-femoral
Absent radial pulse post-TR Band
Chest pain post-PCI
New ST changes on ECG
Rising creatinine at 24–48h (contrast nephropathy)

📋 Post-PCI Monitoring Checklist & Alert System

Select procedure details to generate a personalised post-PCI monitoring schedule with red flag alerts.

Access Site

Stent Type

Indication

Pre-Procedure Creatinine

Cardiac Catheterisation & Cath Lab Nursing Guide InterventionalGCC Edition