What nurses should know about carotid stents.

First approved in 2004, carotid stenting is becoming a common feature of today's clinical practice. Information about carotid stent insertion and nursing care concerns is presented.

Synergy and peripheral percutaneous transluminal angioplasty.

Peripheral percutaneous transluminal angioplasty with endovascular stent is a procedure to improve the symptoms of claudication caused by peripheral vascular disease. There is evidence to show that upward of 30% of patients seek further intervention for recurring symptoms in 1 year. This high rate of recidivism necessitates nursing intervention postprocedure in the hospital to promote a lifestyle change. The Synergy Model is useful to develop a relationship between the patient and the nurse that promotes a lifestyle change. The outlined patient who underwent peripheral percutaneous transluminal angioplasty and the nurse characteristics within the Synergy Model lend themselves to frame a short, intense hospital stay inclusive of thorough, patient-centered teaching.

Percutaneous interventions.

The catheterization laboratory is no longer limited to coronary arterial interventions. Physicians have been striving to make more interventions less invasive that now can include carotid, renal, and peripheral arterial stenting, as well as less invasive repair of atrial septal abnormalities. Even cardiac assist devices can be implanted percutaneously to bridge a critically ill patient to other modes of treatment. This article will give a brief overview of each intervention and identify important nursing care.

Identification of the perceived learning needs of balloon angioplasty patients.

Percutaneous transluminal coronary angioplasty (PTCA) is currently well recognized as a successful treatment for some coronary artery occlusions. Minimal research is available in the literature related to the identification of the perceived learning needs of the PTCA patient population. The first objective of this study was to identify what patients' view as their learning needs when undergoing PTCA. Secondly, this study sought to compare the patients' view to the perceptions of cardiac nurses about the learning needs of PTCA patients. Two hundred and fifty-one patients and thirty-three nurses completed a PTCA Learning Needs Inventory (PTCALNI). Both the patients and the nurses scored all items "moderately" to "very important" to learn. The items "need to know the results of my angioplasty," "what to do if my heart symptoms come back," and "what lifestyle changes are needed to prevent future build-up in my arteries" were among the highest scored items for both groups. As the length of stay for angioplasty patients decreases, in-hospital education for this population must be streamlined to concisely and efficiently address the learning needs identified by patients as most important to know in relation to having a balloon angioplasty. Therefore, as a result of this survey, nurses can feel satisfied that by focusing their time on topics identified as most important, they will have met most of the educational priorities for angioplasty patients.

Reducing costs and improving processes for the interventional cardiology patient.

The cardiology unit at the University of Chicago Hospitals developed a cost-saving mechanism in the care of postinterventional cardiology patients, reducing time spent in the coronary care unit. Increased nursing education and training and better identification of patient outcomes made this collaborative effort a cost-saving and effective pilot.

Strategies for effective patient education material design.

In the current health care system, written patient education tools are important. Well-written and easy-to-understand materials are essential to assist the patient in recovery and increasing compliance. The purpose of patient education is to provide the patient with the knowledge needed for self-care. This article discusses strategies to design effective written patient education material.

Patient preparation and monitoring for carotid stenting: the operating room nurse's perspective.

Endovascular procedures should be performed by a trained surgical staff in a surgical suite equipped with a high-resolution fluoroscopic unit. The operating room nurse must be skilled in the handling and preparation of specialized instruments and equipment necessary for carotid angioplasty procedures. Patient preparation and postprocedural wound care techniques are particular to the cervical approach for carotid angioplasty; the operating room nurse should be well trained in these areas in order to provide optimum assistance during the procedure.

Angioplasty with stent placement in peripheral arterial occlusive disease.

Percutaneous transluminal balloon angioplasty (PTBA) is a minimally invasive and effective adjunct treatment for patients with atherosclerotic peripheral vascular disease. This surgical technique involves placing an intraarterial balloon within an obstructing arterial lesion and forcibly dilating the balloon under fluoroscopy. The PTBA technique has become an accepted interventional therapy for iliac artery stenoses. In selected patients with stenotic lesions of the iliac artery, percutaneous transluminal angioplasty (PTA) with the use of an intravascular stent may be an alternative to traditional aortofemoral bypass surgery. The PTA procedure involves only a needle entry site in one or both groins as opposed to an incision exposing the entire abdomen. The hospital stay for the average patient undergoing PTA of the iliac artery is three days as opposed to seven days for the patient undergoing aortofemoral bypass, and the patient may return to normal activity in a much shorter period of time after a PTA procedure.

Perioperative nursing interventions for intravascular stent placements.

Keeping abreast of changing surgical technologies is among the more challenging aspects of perioperative nursing. Because peripheral vascular disease is a leading cause of lower extremity disabilities that require surgical interventions, new procedures and techniques are being developed continually. These procedures involve the insertion of intraluminal structural supports into patients who have had mixed or unsuccessful results from angioplasty. Perioperative nurses are an integral part of vascular surgery teams performing the insertion of intravascular stents. To function effectively, perioperative nurses must understand the concepts of intravascular stent procedures, nursing diagnoses, and nursing interventions that promote optimal patient outcomes.

Alternatives for revascularization: peripheral atherectomy devices.

In the ongoing search for newer methods of treating arterial occlusive disease, endovascular devices have emerged as potential alternatives to distal bypasses and/or balloon angioplasty. There are a variety of peripheral atherectomy devices on the market, four of which are discussed in this article. A description of each device including components, method of operation, advantages and disadvantages is provided. Nursing care following an atherectomy procedure is similar to that following a balloon angioplasty in the lower extremities. Early results indicate that atherectomy devices (in their current state) cannot compare with autogenous femoropopliteal bypasses in their rate of restenosis. However, if patency rates can be improved, the future of these devices will be more encouraging and their indications more clearly defined.

Cerebral angioplasty: a new treatment for vasospasm secondary to subarachnoid hemorrhage.

The potential benefit of cerebral angioplasty for patients with delayed cerebral ischemia secondary to vasospasm is promising. Cerebral angioplasty has the potential for positively affecting patient outcome and quality of life. Further, cerebral angioplasty may lead to a reduction in long-term care needs for patients who experience severe cerebral vasospasm from an aneurysmal subarachnoid hemorrhage. The challenge to the neuroscience nurse begins with the early detection of neurological changes signaling the onset of progressive delayed cerebral ischemia despite conventional therapies for vasospasm. The nurse's sagacious management of neurologic, hemodynamic and pulmonary status and the ongoing support of the patient and family throughout the angioplasty procedure is crucial to a positive outcome.

Laser assisted balloon angioplasty: bypassing the traditional methods.

No two procedures will be identical as each patient will have different needs. Therefore, knowledge of sizes and limitations of catheters and laser probes is imperative to facilitate the LABA procedure. Advance preparation of the OR suite facilitates the procedure, which can proceed quickly after guidewire passage. Laser safety guidelines must be established and enforced throughout the procedure. A laser nurse, not responsible for circulating the case, should be identified and is responsible for laser safety during the procedure.