What to ask after percutaneous coronary intervention
- After a cardiac or vascular procedure, nurse handoff should include details about the access site, medications, and any complications during the procedure.
- Focused nursing assessments should include close monitoring of the access site, cardiac rhythm, respiratory status, and signs of internal bleeding.
- To ensure patient safety, nurses can provide early education focused on activity restrictions and clear instructions on when to report concerning symptoms.
MATEO TORRES*, a 68-year-old man, arrives in the emergency department with chest pain. An ECG shows ST elevation in leads V1–V4 and elevated initial troponin, indicating myocardial infarction. Mr. Torres is transferred to the cardiac catheterization lab for percutaneous coronary intervention (PCI).
After the PCI, Mr. Torres is transferred to the stepdown unit where you work. The cardiac catheterization lab report tells you that Mr. Torres received three stents, two to the left anterior descending (LAD) artery and one to the diagonal branch. He has a femoral site with a closure device. The report tells you that the patient’s vital signs are stable; you observe that he’s awake and alert. After 30 minutes, the site appears stable, so you leave to pass medications to other patients.
An hour after Mr. Torres arrives on the unit, you note a large bruise at the femoral site. Further assessment reveals leg and back pain, as well as oozing at the site. Mr. Torres tells you that the pain started about 20 minutes ago. You hold pressure at the site and notify the provider.
The American College of Cardiology (ACC) and the American Heart Association (AHA) estimate that more than 1 million cardiac catheterizations occur in the United States per year. Left heart catheterization with percutaneous coronary intervention (PCI) is the treatment of choice for patients presenting with symptoms of acute coronary syndrome (ACS) per the ACC/AHA Care System Pathway.
Although ACC/AHA guidelines provide procedural guidance, case-specific nuances are not always clearly communicated during nurse-to-nurse handoff. Asking targeted handoff questions can improve patient care during post-PCI monitoring.
Anatomy and physiology
Coronary arteries arise from the base of the aorta and split into left and right branches. The LAD artery delivers oxygenated blood to the anterior of the heart. The right coronary artery feeds the right atrium and ventricle, as well as the posterior septum. Both right and left coronary arteries have side branches, which provide flow to lateral, posterior, and inferior surfaces of the heart.
Coronary syndromes occur when blockages, resulting from plaque or clot accumulation, lead to a lack of oxygen availability for cardiac cells. This requires timely revascularization in the cardiac catheterization lab. Understanding the procedure and potential for complications can help nurses know what’s important during handoff.
Heart catheterization
A left heart catheterization serves as a diagnostic and interventional tool for coronary artery occlusion. Ejection fraction and cardiac valves also may be evaluated. To access the heart, the provider chooses an artery, such as the radial or femoral artery, based on vessel size, patency, and tortuosity. The provider inserts a sheath into the artery, which creates a stable access point for the procedure, and a catheter over a guidewire, which is advanced to the coronary arteries. Using fluoroscopy, the provider maneuvers the catheter until a coronary vessel is cannulated, at which point contrast injected into the artery aids identification of occlusions. ACC/AHA guidelines recommend using intravascular imaging tools during the procedure to assess the severity of lesions and determine the size for appropriate intervention (balloon, stent, treatment device).
Intervention options
An occlusion found during contrast injection may warrant intervention, such as balloons, stents, or atherectomy.
Typically, a provider inserts a balloon in preparation for stent placement. The provider inserts the balloon over a wire and into the vessel with the lesion, then dilates the balloon to a specific pressure based on vessel size and extent of the lesion. This dilation packs the lesion to the sides of the vessel wall to improve blood flow.
The provider can then place stents to hold the newly dilated vessel segment open. Sorajja and Lim describe the types of coronary vessel stents, including bare metal and drug-eluting. The provider deploys the stents via balloon inflation.
With atherectomy, the provider drills through or shaves off hardened occlusions. Although generally reserved for chronic, calcified occlusions, atherectomy may be used in acute situations. Contrast and intravascular imaging aid in determining vessel needs and successful deployment. (See Interventional tools.)
Interventional tools
Interventions in the case of coronary artery occlusion include placing balloons and/or stents or performing an atherectomy.
- Size
- Compliance*
- Type
- Vessel length and diameter (typically 2 mm to 4 mm)
- Semi-compliant (used for most PCI) or noncompliant (fixed diameter at higher pressure, for more difficult lesions)
- Standard, drug-eluting, cutting (for hardened lesions to allow expansion)
- Flatten plaque against vessel walls for optimal blood flow.
- Size
- Type
- Length and diameter
- Drug-eluting, bare-metal, covered
- Hold vessel open by keeping plaque against vessel wall and out of the lumen.
- Type
- Rotational
- Orbital
- Excisional
- Laser
- Drill or shave off hardened plaques, often for chronic occlusions.
*How well the balloon can maintain stable diameter even at high pressures
Closure
After revascularization, the provider removes all wires and catheters and selects the sheath site closure device. Accessed arterial flow requires applied pressure or temporary closure by collagen plug or stitch to achieve and maintain hemostasis. For example, the provider would place trans-radial bands on radial artery sites. A femoral artery site may be closed via manual pressure, or by closure device. The type of closure device will determine how it’s deployed.
Closure device failure requires manual pressure. Post-procedure monitoring depends on site location, intervention, and provider orders. An insertion site that hasn’t achieved effective hemostasis is at high risk for hematoma or hemorrhage.
Potential PCI complications
Sugiharto and colleagues note that PCI comes with the risk of complications, which contribute to extended lengths of stay and poor patient outcomes. Vessel dissections can occur when a device (such as a stent) causes a tear to the inner lumen, which may continue down the remainder of the vessel. Reperfusion arrhythmias and chest pain can occur as the areas of the cardiac muscle previously deprived of oxygen are suddenly flooded with blood flow after the intervention.
Ventricular fibrillation and ventricular tachycardia (VT) are the most common reperfusion arrhythmias. Although these usually occur during or immediately after the procedure, some literature, such as the AHA ACS guideline, suggests arrhythmia can occur for up to 48 hours post-procedure. Medications used to manage heart rate and blood pressure during the procedure, such as nitroglycerin or phenylephrine, also may have negative effects post-procedure, including bradycardia or hypotension.
Coronary vessel re-occlusion occurs when the body perceives the intervention as an injury, leading to platelet aggregation at the site of the balloon or stent. ECG changes, new onset chest pain, and shortness of breath post-procedure may indicate vessel re-occlusion.
Bleeding at the arterial access site is another potential complication of PCI. Femoral access sites have the highest risk for bleeding because femoral arteries are large and prone to excess pressure from position changes, ambulation, and toileting. The manipulation of wires, balloons, and stents inside small vessels and I.V. anticoagulants administered to prevent clots during the procedure increase the risk for bleeding, including retroperitoneal bleeding and hematomas that may not be recognized until extensive damage occurs.
To maintain patient comfort during the procedure, providers may elect to perform a cardiac catheterization under conscious sedation. This poses potential risk to respiratory drive and level of consciousness. Signs of respiratory distress may include shallow breathing, sudden change in oxygen saturation, or decreased respiratory rate. Capnography can assist in determining breathing effectiveness with sedation. (See Medication considerations.)
Medication considerations
The following medications used during percutaneous coronary interventions may lead to complications.
- Adenosine
- Amiodarone
- Diltiazem
- Nitroglycerin
- Nitroprusside
- Phenylephrine
- Ativan
- Benadryl
- Fentanyl
- Propofol
- Versed
- Aspirin
- Bivalirudin
- Cangrelor
- Clopidogrel
- Eptifibatide
- Heparin (I.V.)
- Ticagrelor
Patients who’ve undergone PCI may be admitted to a variety of floors ranging from critical care to observation. Asking focused questions during nurse handoff can lead to more directed monitoring and improved patient outcomes.
Learn specific about the heart catheterization procedure using the SBAR (Situation, Background, Assessment, Recommendation) format. This can help you understand what happened during the procedure and the patient’s pre- and post-procedure baseline. SBAR also can help you determine additional monitoring needs and the appropriateness of admission to the unit (or necessity for a higher level of care), ultimately ensuring patient safety during initial recovery. (See SBAR questions.)
SBAR questions
Using the SBAR (Situation, Background, Assessment, Recommendation) format, you might ask the following questions during nurse handoff when caring for a patient after a percutaneous coronary intervention.
- Different vessels lead to different types of arrhythmias.
- Knowing the affected vessels may help explain associated symptoms such as shortness of breath.
- Some vessels may have been repaired, while others may not be viable or were surrendered for the sake of a larger vessel (such as in a vessel bifurcation blockage).
- Multiple stents could lead to a variety of symptoms, such as reperfusion pain and arrhythmias.
- Consecutive or covered stents in a single vessel might indicate vessel dissection, tortuosity, or a noncompliant vessel.
- Multiple intravascular images, difficulty passing or deploying a stent, or extensive atherectomy can increase the risk for clots, vessel irritability, and arrhythmia.
Anticoagulants/antiplatelets
Vasoactive medications
Sedatives/opiates/anxiolytics
I.V. fluids
- I.V. heparin or other anticoagulant dosing might be accumulatively high, which could increase the risk of bleeding.
- Manipulation of coronary vessels can lead to bradycardia or hypotension, which may require treatment during the procedure.
- Conscious sedation is given throughout the procedure and could have a cumulative neurological or respiratory effect.
- Ask about the administration of any reversal agents.
- Patients may require a fluid bolus depending on hemodynamic stability.
- Fluids usually are used judiciously during a procedure, but high volumes might result in symptoms of fluid overload.
- High volumes of contrast dye can lead to acute kidney injury.
- A patient might have an allergic reaction to high doses post-procedure.
- The answer will help you understand the extent of cardiac damage.
- This information provides a historical pain baseline.
- Vital sign trends demonstrate a patient’s hemodynamic stability and appropriateness for unit assignment.
- Diagnostic labs like troponin, ACT, or aPTT can help you evaluate trends.
- Renal labs (BUN, Cr) pre- and post-procedure can help you determine kidney injury after contrast.
- Is it radial or femoral?
- How many access attempts were made?
- If multiple sites, did radial access fail, did the team move to larger access because of hemodynamic instability, blockage, or patient intolerance?
- Are all sites arterial? Did any venous punctures (accidental or for diagnostic right heart) occur?
- Are there any bleeding/shadowing, or areas that feel hard or taut?
- Were closure devices used and were they successful?
- Severity
- Characteristics (ache, sharp, impending doom)
- Onset
- Aggravating/alleviating factors
- Vital signs should reflect patient baseline or be explained by treatment measures.
- Find out the last time the patient received any medications that could affect blood pressure, heart rate, or respirations.
- Neurologic changes could indicate a stroke, respiratory distress, or oversedation.
- Patients with atrial fibrillation may be at risk for re-occlusion, pulmonary embolism, or stroke.
- Ventricular arrhythmias or frequent premature ventricular contractions could progress to cardiac arrest.
- Femoral sites require bedrest depending on closure device.
- Radial sites require caution while the body forms a clot at the site.
- Serial troponins, repeat 12-lead ECG, etc., may be warranted to monitor and evaluate for new or worsening injury.
- BUN/Cr may be ordered to monitor for renal injury after contrast.
- Specific notification requests (parameters to call physician and PRN medications) can help assess provider concerns.
- Intended length of stay (same-day discharge, observation, admission) indicates severity of patient situation.
- Knowing when to resume medications (anticoagulants, metformin) can prevent complications.
Nursing implications
When you speak to Mr. Torres’ provider, you learn that extensive calcification of the femoral artery led to multiple attempts at femoral access. As a result, the closure device failed, requiring the team to hold manual pressure. Mr. Torres received high doses of I.V. heparin during the procedure, which was reversed with protamine post-procedure.
Based on your clinical assessment and this information, you and the provider agree that Mr. Torres has a retroperitoneal bleed.
While receiving report, asking about the number of access attempts, the use of a closure device and its success, and anticoagulant or reversal medications would have painted a clearer picture of what happened during the PCI. With this information, you could have prioritized monitoring for bleeding and assessing the access site, while also educating the patient to report any sudden changes in site comfort.
Mr. Torres’ case illustrates how procedural details that might seem irrelevant are, in fact, clinically significant. Key nursing actions after PCI include nurse-to-nurse handoff, thorough patient assessment, and patient safety instructions.
Ensure that nurse-to-nurse handoff includes information about the access site and how hemostasis was successfully achieved; the anticoagulants administered, along with doses and whether they were reversed; post-procedure lab results, including aPTT or ACT; stents inserted, including how many, where, and what type; arrhythmias or ECG changes; procedure complications; vasoactive drugs; and procedure length.
This information supports a more individualized plan of care for the patient that extends beyond the standard protocol. Focus your assessment on potential risk areas identified by the SBAR. For example, if a run of VT was reported when you asked about arrhythmias, monitor for frequent PVCs or runs of VT post-procedure. If the handoff includes abnormal lab values, consider following up with the provider for repeat labs to ensure patient safety.
Effective questions
Understanding the cardiac catheterization procedure and asking effective questions during handoff can help you more adequately determine the need for interventions during post-PCI care. Ask clear, focused questions using the SBAR format during handoff. Then use responses to establish assessment, monitoring, and patient education priorities.
*Name is fictitious.
Jacqueline Stearns is a nursing professional development specialist at University Hospitals in Cleveland, Ohio.
American Nurse Journal. 2026; 21(7). Doi: 10.51256/ANJ072627
References
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;145(3):e18-112. doi:10.1161/CIR.0000000000001038
Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-862. doi:10.1161/CIR.0000000000001309#sec-8-2-1
Sorajja P, Lim MJ eds. Kern’s Cardiac Catheterization Handbook. 8th ed. Philadelphia, PA: Elsevier; 2025.
Sugiharto F, Trisyani Y, Nuraeni A, Mirwanti R, Putri AM, Armansyah NA. Factors associated with increased length of stay in post primary percutaneous coronary intervention patients: A scoping review. Vasc Health Risk Manag. 2023;19:329-40. doi:10.2147/vhrm.s413899
Truesdell A, Alasnag MA, Kaul P, et al. Intravascular imaging during percutaneous coronary intervention: JACC state-of-the-art review. J Am Coll Cardiol. 2023;81(6):590-605. doi:10.1016/j.jacc.2022.11.045
Keywords: post-cardiac procedure care, handoff communication, patient safety
