Adult following Percutaneous Coronary Intervention: Balloon Angioplasty and Intracoronary Stent Insertion Challenges

Adult following Percutaneous Coronary Intervention: Balloon Angioplasty and Intracoronary Stent Insertion Challenges
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Percutaneous Coronary Intervention: Balloon Angioplasty and Intracoronary Stent
Introduction
Using Balloon Angioplasty and Stent insertion has gained recognition over the past several years as a means of treatment for Coronary Artery blockages. However, studies have indicated that utilization of these stents may possibly create disorder in the aortic wall or aneurysm at the ends of the stents.
A patient Michael, who is 56 years old, has been put to the high dependency acute cardiac unit after developing complications after a Balloon Angioplasty and Stent insertion into his coronary arteries. He is under Percutaneous Coronary Intervention, his coronary arteries give reduced blood flow to his heart muscles, which leads to a reduction in the oxygen needed by the muscles. This is as a result of the thickening of the arteries walls. The Balloon Angioplasty and Stent insertion procedures aimed to restore sufficient blood flow within his arteries by expanding the thickened walls. The treatment procedure involves the use of a local an aesthetic that has a mild sedation effect allowing the patient to stay awake during the whole operation. A sheath was inserted into his femoral artery in his groin region to insert the stent in his artery by use of catheters. It was removed while he was still in theatre. The coronary artery with the blockage or atheroma was widened and his blood flow restored. The site was compressed and the wound dressed with an opposite dressing on his groin’s left side. He was taken to out of the ICU to the ward to heal slowly but he developed complications of bleeding and groin pain. He had to be returned to the high dependency acute cardiac care unit for intervention.
Angioplasty and stent insertion procedures were initially performed on Michael by inserting a sheath into his femoral artery found in the groin area. Many people resume their usual activities after 7–10 days past the procedure. The patient was lying comfortably and his recovery was under telemetry monitoring. An initial observation had recorded his blood pressure (120/80), pulse (80/min), respiratory rate (18/min) and temperature (36.9°C). An afterward observation indicated a change to 100/70, 110/min, 20/min and 37˚C respectively. His limbs have turned pale, moist and cold. This information indicates that his vital signs are unstable and that Michael has fallen more ill. An observation of the sheath insertion site has revealed severe bleeding in the groin area. The bleeding has to be controlled in order to avert adverse physiologic effects that could result from the blood loss. It is apparent that the natural course of blood clotting has not occurred. As a result, Michael is in serious need for immediate intervention to achieve and maintain haemostasis to stop the arterial bleeding.
The sheath had better remain in the groin for like 3–4 hours after the procedure before being removed. Had this been the case, the plastic sheath would have remained stationary in the femoral artery and Michael would have kept his leg out straight for the whole time to avoid kinking it. However, it had been removed back in the Theatre and the artery had been sealed. All the same, Michael was still supposed to keep his leg out straight while lying flat on the bed (Phillips 2007).
the bleeding will be countered by first applying significant pressure on the site. Michael will have to keep his head raised on a pillow. I will also raise the back of the bed up to a close of 30 degrees. It is vital that the patient does not sit up or even try to leave the bed so I will help him to relieve himself while still on the bed using a specialized container. The patient will take a bunch of painkillers to help with the groin pain. Drugs to aid in clotting will also be administered to Michael as the groin area remains under pressure. The pressure must be firm and needs to be sustained for about 10 minutes. I will use Fabric pads and or gauze sponges to hold the direct pressure on the wound created by the sheath. Once clotting is achieved, he will be monitored closely to make sure the clot remains in place and that no fresh bleeding occurs. The tube had been inserted in his left groin it shall be sealed once again after the blood clots using a special piece of equipment called angioseal (Phillips 2007). During and after the sealing, his blood pressure and the catheter site will be monitored and checked regularly. In some acute cases, a radiologist places a unique ‘plug’ into the opening created by the sheath in the artery at the last part of the treatment procedure to bring to a standstill the bleeding. If this were the case, supplementary puncturing of that particular blood vessel should not be done for at least 3 months.
The Drugs to aid in clotting improve the process by using several mechanisms like escalating platelet function as well as reversing anticoagulation. They enhance the natural mechanisms of coagulation. Administering Vitamin K will give support to the coagulation process, and it will ensure the effects of warfarin together with potentially avoiding a need for blood transfusion involving fresh plasma.
A very low dose will be administered to Michael orally because since this means guarantees the most conventional response. In addition, another option might involve using Intra-venous (IV). This will administer vitamin K be slowly for over 30 minutes, though it will prevent the likelihood of anaphylactic reactions by the patient. It must not be administered subcutaneously (intra -muscularly) however as this will cause erratic absorption. Reversal of the important international normalized...