Discharge Instructions for Patients and Families after Percutaneous Coronary Intervention (PCI) and stent procedure.

The heart is a muscular pump the size of a fist. Its normal functioning is closely linked to its oxygenation. His precious fuel is delivered to him by the coronary arteries. Any reduction in oxygen supply can have serious and sometimes irreversible effects on the heart.

To better understand the coronary arteries and their role, read "coronary arteries".

 

What is PCI / Angioplasty

Coronary angioplasty is a non-surgical procedure, performed under local anesthesia to open a blocked coronary artery.

A catheter with a special balloon is inserted through the groin or wrist and advanced to the heart. By inflating the balloon, the cholesterol plaque is pushed back to the artery wall.

 

The procedure is usually supplemented by the placement of a stent, a coronary artery stent, which acts like scaffolding to keep the artery open and reduce the possibility of recurrence called restenosis.

Read more: "About coronary stent"

 

Puncture site care

• Before you leave the hospital, please become familiar with how your puncture site looks and feels. The site should be soft, flat and dry, without any signs of bleeding.
• If the puncture site starts to bleed, please apply direct pressure with two finger pads for ten minutes. Take extra precaution and do not put too much weight on your affected arm or leg for the next four hours. If the bleeding cannot be controlled by direct pressure, CALL 911. Do not drive yourself to the hospital.
• An arm or leg that feels cold, looks pale or blue, or becomes painful could be a sign of compromised circulation. This is rare, but it is a medical emergency and you should seek medical attention immediately.
• Bruising at the site can be normal. This will improve gradually and can take up to two weeks to disappear entirely. If you notice significant bruising that has started after your discharge, you should seek medical attention to assess the bruising.
• If the puncture site has swelling, discharge, drainage, or redness, or if you have fever or chills, this is not normal. Please seek medical attention.
• To prevent infection, you should not submerge your puncture site into water for three days after your procedure. This includes a bathtub, hot tub or swimming pool.

 

Wrist or forearm procedure:

• Do not bend your wrist/forearm for eight hours after your procedure.
• You may remove the bandage from your wrist/forearm 24 hours after your procedure.
• Don’t lift anything over 10 pounds for the first two days after your procedure. This includes children, grocery bags, backpacks, etc.

 

Groin procedure:

• You may remove the bandage from your groin 24 hours after the procedure.
• Walk slowly and climb stairs slowly for the first three days.
• Avoid strenuous activities or exercises that can strain the affected leg for a minimum of 48 hours following the procedure.
• If you have more than an hour to drive home, it is recommended that you stop to stretch your legs after 1 hour on the road and after each hour thereafter, if this is the case.

 

 

Medications considerations

 

Antiplatelet Agents:

Prevent clots from forming inside the stent(s) you received and reduces the risk of heart attack.

• Antiplatelets are prescribed 2 in number for a certain period. One of them is aspirin and the other is ticagrelor, prasugrel or clopidogrel.
• Do Not Stop Aspirin without speaking to your cardiologist
• Do Not Stop or Skip a dose of Clopidogrel, Ticagrelor or Prasugrel without speaking to your cardiologist.
• Some possible side effects of antiplatelet agents include bruising, nose bleeds or shortness of breath.

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Other cardio-protective medications that your cardiologist may prescribe include:

Your usual medication can be continued unless your doctor tells you otherwise.

 

Anticoagulant

If you regularly take a blood thinner, such as Warfarin, Rivaroxaban, Apixaban or Dabigatran, ask your physician when it is safe to restart these medications and whether you need a dose adjustment.

 

Metformin

If you regularly take Metformin (a diabetic medication), have your creatinine (a biomarker for kidney function) checked within 48-72 hours after the procedure. Do not resume your Metformin until instructed by your family physician or your cardiologist. In most cases, it is safe to restart Metformin 48 hours after the procedure.

 

Chest pain

Chest pain during the procedure is possible. Stretching of the arteries by a stake and / or blockage of small secondary branches at the stake can cause pain. However, it usually wears off within an hour.

Chest pain that worsens or appears after the procedure should be reported immediately to the responsible medical personnel.

After angioplasty, some patients may continue to have the same symptoms on exertion without any improvement. All this is to be discussed with his doctor.

Sudden and persistent chest pain that does not respond to nitroglycerin and that is accompanied by cold sweats, nausea and / or vomiting should be reported immediately. -Call 911. Do not drive yourself to the hospital.

 

Exercise

Resumption of physical activity after a short-stay coronary angioplasty can be done quickly, depending on the entry site used for the procedure.

• The wrist: more intense physical activities can be resumed gradually after 3 or 4 days.
• The groin: more intense physical activities can be resumed gradually after 7 to 10 days.

 

Sexual Activity

Activities can be resumed quickly. In fact, there is no specific recommendation on this subject for short-stay angioplasty. A procedure using a groin entry will require a few adjustments at most.

 

• Some medications may affect your sexual function. Speak to your health care team about your concerns but do not stop any medications without talking to them.
• Medications for erectile dysfunction may interact with certain cardiac medications. Never take any medication to treat erectile dysfunction without discussing it with your family physician or cardiologist.

 

Healthy lifestyle

Such a procedure must have a favorable impact on the life of the patient. It opens the door to a significant lifestyle change in people at risk for recurrent heart events:

• Stop smoking.
• Balanced diet.
• Regular exercise.
• Better control of diseases such as high blood pressure and diabetes.

 

Driving

It is recommended not to drive during the 2 days following a short stay angioplasty.

 

Travelling

It is best not to travel immediately after angioplasty and the installation of a stent. Talk to your doctor before planning a trip.

Thereafter, one can travel safely after a successful procedure. However, patients should disclose this information when purchasing travel insurance.

Coronary artery stents do not trigger metal detector alarms in airports, and you can walk through them safely.

 

Follow up

Usually, medical follow-up is done with a cardiologist or other health professional within one month of the procedure. A summary of your intervention is sent to him.

A copy of the summary is also made available to the patient's general practitioner; the latter only has to provide the medical staff of the hospital with the contact details of the health professional to whom he wishes to send this copy of the summary of the intervention.