Today our topic of discussion is PPI and Pm Care.
PPI and Pm Care
Pre-PPI Care
- Explain procedure to patient and relative with help of audiovisual aids and handouts
- Get consent for procedure
- Explain that procedure will be performed in cardiac catheterization laboratory and patient will be transferred to CCU for 1 day for close monitoring
- Explain about starvation required for 8 to 10 hours prior to procedure
- Enquire whether patient has allergy to drug or food and report to doctor if any
- Shave following areas:
- Anterior chest from neck to umbilicus
- Nape of neck to loins of back
- Both arms and axillae
- Advise to take bath with antiseptic scrub and water for 2 days before procedure and on day of procedure
- Provide clean gown
- Remove jewelry, dentures/contact lens if any
- Start IV line with heparin lock
- Administer pre-medications and first dose of antibiotics
- Explain that one relative can stay in CCU waiting area
- Send patient to cath lab with following items:
- Normal saline I pint, disposable needle 21G. Dynaplast 1 roll, Betadine solution 100 mL x 2 bottles, injection gentamicin and injection cefazolin 1 dose, if not administered with premeditation.
Post-PM Care
- Keep patient in supine position and ask to maintain adduction of affected extremity
- Explain about bed rest for 24 hours and reduced activity for another 48 hours
- Connect patient to cardiac monitor and check rhythm
- Take 12 leak ECG with and without magnet Check wound for excess swelling or bleeding
- Get chest X-ray done
- Be alert for complications of procedure:
- Bleeding
- Infections
- Cardiac tamponade Diaphragm stimulation
- Failure to capture..
- Inform the doctor if any complication occurs
- Check vital signs and observe wound hourly 4 hours then if stable, 4 hourly for 24 hours
- Discourage patient from vomiting, coughing or rolling into affected side
- Patient may gently roll into left side for pressures are care
- Roll a patient immediately onto left side, if failure to capture occurs. If unsuccessful and patient is asymptomatic inform and administer IV atropine 0.6 mg as ordered
- Allow the patient to sit up slightly to eat (30-45 degrees)
- Administer analgesic as ordered Administer IV antibiotics usually 3 doses then remove IV cannula
- Transfer to ward after 12 to 24 hours
- Remove tight bandage after 48 hours and d dressing if required
- Allow to walk after 48 to 72 hours of rest .
- Assist and encourage beginning range of motion exercises for affected shoulder as ordered, usually 5 to 7 hours after pacemaker insertion
- Remove sutures after 72 hours and patient is discharged with proper follow-up arranged
- Patient usually does not require any follow-up drugs
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