Durgical
EN
Open the app

Care after cardiac catheterisation and PCI: access site, distal pulses, bleeding and lying-flat time

  • Procedure

After a catheter through the groin or wrist, the nurse checks the site, the pulse and colour of the limb beyond it and the vital signs, and acts on bleeding.

Updated

What it is

After a diagnostic catheterisation or a coronary angioplasty with a stent, the main risks in the first hours are bleeding or a haematoma at the puncture, reduced blood flow to the limb, rhythm problems, chest pain and, later, a reaction to the contrast or kidney injury. The nurse checks the access site and the limb beyond it at the intervals the protocol sets, keeps the limb still for the ordered time, and mobilises the patient when the order allows. Studies in nursing show that short bed rest after a femoral puncture does not increase bleeding and causes less back pain. The patient goes home knowing how to care for the site and when to call.

Indications

  • The first hours after diagnostic coronary angiography or a coronary angioplasty with a stent.
  • Femoral (groin) or radial (wrist) arterial access, with or without a closure device or compression band.
  • Patients who received antithrombotic medicines during the procedure.
  • Preparing the patient and family for discharge and care of the site at home.

Contraindications and precautions

  • Antiplatelets and anticoagulants given during the procedure raise the bleeding risk: avoid unnecessary punctures.
  • Do not lift the head of the bed or bend the femoral leg before the time ordered.
  • Follow the protocol for the radial compression band: too much pressure can block the artery, too little causes a haematoma.
  • Kidney disease, diabetes and older age raise the risk from contrast: urine output and the fluids ordered matter.
  • Know the access site, the closure method and the bed-rest order before the patient arrives on the ward.

Equipment

  • Monitor for blood pressure, pulse, rhythm and saturation.
  • Gloves, gauze and the dressing the protocol uses.
  • Doppler, if the pulse is hard to feel.
  • A pen to mark the distal pulse and the edge of any bruise or haematoma.
  • The observation chart with the check intervals.

Step by step (and why)

  1. Receive the handover: access site, closure method, medicines given and bed-rest time — sets how the site is watched.
  2. Measure vital signs and check the rhythm at the ordered intervals — low pressure or a fast pulse can mean bleeding.
  3. Inspect the dressing and feel around the site for swelling or hardness — finds bleeding and haematoma early.
  4. Compare the distal pulse, colour, warmth and sensation with the other limb; mark the pulse — finds reduced blood flow.
  5. Keep the femoral leg still, or the wrist still with its band, for the ordered time — protects the closed artery.
  6. Ask about chest pain, pain at the site, numbness or tingling — symptoms can come before visible signs.
  7. If the site bleeds, press firmly just above the puncture and call for help — direct pressure stops most bleeding.
  8. Give the fluids ordered and record urine output — the contrast can harm the kidneys.
  9. Mobilise when the order allows, checking the site again after the first walk — movement can restart bleeding.
  10. Teach site care, activity limits and warning signs before discharge — complications can appear at home.

Complications

  • Bleeding or a haematoma at the puncture site.
  • Hidden bleeding: falling blood pressure and a fast pulse even when the site looks dry.
  • Reduced blood flow to the limb: a cold, pale or blue limb, numbness or a weak pulse.
  • Chest pain, rhythm problems or a blocked stent.
  • A reaction to the contrast or reduced kidney function; a vasovagal reaction with a slow pulse and low pressure.

Next step: when to call for help

  • Call at once for bleeding that does not stop with pressure, a growing haematoma, or falling pressure with a rising pulse.
  • Call for a limb below the site that is cold, pale, blue or numb, or a pulse that weakens or disappears.
  • Call for chest pain, breathlessness, a new irregular rhythm, dizziness or fainting.
  • Call for a rash, itching or breathing difficulty after the contrast, or for little urine.
  • At home: call for bleeding that does not stop after pressing, redness or discharge at the site, fever, or chest pain that does not ease with rest.

Test yourself

Think of the answer, then tap the question to see it.

What is checked on the limb below the puncture after catheterisation?

The distal pulse, colour, warmth and sensation, compared with the other limb, at the intervals the protocol sets.

What does the nurse do if the access site starts bleeding?

Presses firmly just above the puncture, stays with the patient and calls for help at once.

Why can falling blood pressure with a fast pulse matter even if the site looks dry?

Because vital-sign changes can be the first sign of internal bleeding; the nurse calls at once.

Does a short bed rest after femoral catheterisation increase bleeding?

Nursing trials found no increase in bleeding or haematoma with shorter bed rest, and less back pain; the order and protocol set the time.

Add to my cards (4)

Elsewhere in DurgiPedia

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Cardiac catheterization - discharge: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial. Rev Latino-Am Enfermagem 24:e2796 (Revista Latino-Americana de Enfermagem (PubMed Central, open access), 2016); Busca E et al. Bed rest duration and complications after transfemoral cardiac catheterization: a network meta-analysis. Eur J Cardiovasc Nurs 22(5):454-462 (European Journal of Cardiovascular Nursing (PubMed Central, open access), 2023); Angioplasty and stent placement - heart: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.