What is a Percutaneous Coronary Intervention (PCI)?
PCI is a procedure that unblocks narrowed coronary arteries without performing any surgery.
PCI may include one or more of the following treatments:
Balloon Catheter Angioplasty
During procedure, the doctor will insert a cardiac catheter with a small balloon around it into the coronary artery.The doctor then places the balloon in the narrowed area of the artery and expands it with liquid. This pushes the plaque (blockage) to the sides of the artery where it remains. This technique reduces the narrowing in the artery and restores the size of a normal artery. The doctor removes the balloon catheter at the end of procedure.
The doctor places a small, hollow metal (mesh) tube called a ‘stent’ in the artery to keep it open following a balloon angioplasty. The stent prevents closing of the artery during and after the procedure. Drug-eluting stents are commonly used now. These stents are coated with medication that helps prevent narrowing of the artery.
Preparations before the procedure
Usually, aspirin or plavix are prescribed prior to the procedure and to be taken few days earlier. You may advised to stop your diabetic medications (Metformin) before the procedure and re-start these medications after the procedure as directed by the doctor.
Be sure to inform the doctor if you have had an allergic reaction to X-ray dye (contrast), iodine or seafood, or have a history of bleeding problems.
The night before
DO NOT eat or drink anything after midnight, the night before procedure.
Day of procedure
Take medications that your doctor has instructed you to take on the day of your procedure with sips of water. Arrive at least 2 hours earlier before your scheduled procedure. Do bring along your admission letter and consent form if any to the reception area for admission.
In the ward
Empty your bladder. Change into the hospital gown. You will need an intravenous (IV) plug inserted into a vein on your hand. This is needed to give medications to help you relax and make sure that you are comfortable throughout the procedure. The nurse shaves either your groin and / or arm area (the insertion site for the procedure) to remove hair and prevent infection.
During the procedure
Medication will be given through your IV to help you relax, ensuring your comfort throughout the procedure.The nurse cleans your groin / arm with a special anti-bacterial soap / iodine and covers you with sterile drapes to prevent infection. The doctor injects a numbing medication (local anesthesia) into the groin/arm area. This will keep the area pain free.
The doctor then places a small plastic tube called a sheath through the skin and into the artery. You may feel a slight pressure at that moment. Immediately report any chest pain or discomfort during the procedure. Once sheath is in place, the doctor inserts a catheter into the sheath and advances it toward the heart. X-ray pictures are taken as contrast is injected.
You may feel a ‘hot flash’ or a flushing sensation during contrast injection.
After the Procedure
You will be send back to the ward for observation. The sheath will be removed by a doctor. The timing of the sheath removal depends upon the results of your blood tests (bleeding time) and other considerations. Manual pressure / compression is used to seal the artery puncture site. If insertion is on your arm / groin, a compression band will be placed around the puncture site.
The nurse will slowly release the compression band and place a dressing over the area. If you have PCI done, you need to stay overnight in high dependency unit. The nurses will continue to monitor your condition closely. You will need to remain flat in bed for 6 or more hours to prevent bleeding from the catheter / sheath insertion site. You may not sit up until several hours after the sheath is removed and the blood vessel is sealed by manual pressure.
The nurse may raise the head of your bed slightly to allow you to eat and drink beginning one hour or more after your procedure. Call the nurse immediately if you have any chest pain / bleeding from the insertion site. If you have to cough or sneeze, apply gentle pressure at the site with your hand.
Slight bruising is common at the incision site. Bathe and do other activities as usual. Bleeding, swelling, numbness or tingling around the spot where the catheter was placed. These are common and usually go away in 2-3 weeks. Refrain from lifting heavy objects or engaging in strenuous exercise for a few days after the procedure.
If there is increased swelling, gently compress on the incision site and refrain from putting excessive pressure on the affected limb.
You should go A & E if:
The incision site is increasingly painful, swollen, red or bleeding.
There is discharge from the incision site or you develop fever (more than 38 degree).
Unusual bleeding e.g.blood in your urine or black stools.
*Your should arrange for a relative or friend to fetch you home.
*You are discouraged from driving home yourself.
*You are advised to keep your follow-up appointment with your doctor.