A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure?
A. Intake and output
B. Baseline peripheral pulse rates
C. Height and weight
D. Allergy to iodine or shellfish
Correct Answer: D. Allergy to iodine or shellfish
This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure. Allergic reactions can be related to the use of local anesthetic, contrast agents, heparin or other medications used during the procedure. Reactions to the contrast agents can occur in up to 1% of the patients, and people with prior reactions are pretreated with corticosteroids and antihistamines.
Option A: Patients with documented allergy to radio-iodinated contrast material will need premedication with corticosteroids and antihistamines. Patients with chronic kidney disease will also need adequate planning and pre-hydration to reduce the risk of worsening of the renal function.
Option B: Preparation for the cardiac catheterization procedure starts with a thorough history of the patient along with a detailed examination. After defining the clinical question, the performing interventional cardiologist will decide on the access for the procedure. These procedures may need either arterial or venous access or both.
Option C: Physical examination should specifically focus on assessing the suitability of the patient for the planned procedure. Special attention has to be paid in reviewing drug allergies of the patient and routine lab work. Basic workup includes a complete blood count (CBC), basic metabolic panel (BMP), prothrombin time, electrocardiogram, and chest x-ray.
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