Recovering from Heart Catheterization
Jon W. Wahrenberger, MD
What should you expect upon completion of your heart catheterization? Are there any special precautions you should take? While the recovery from a heart catheterization is generally quite simple and involves little more than common sense, the following information might help you lessen the already small chance of a complication.
Cardiac catheterization and other procedures done in the Catheterization and Electrophysiology Lab involve accessing your heart via tubes (catheters) and other devices that are inserted through the femoral artery and/or vein in the groin area. In the process, a small hole or defect is made in these blood-carrying vessels. At the completion of the procedure, when the devices are removed from the blood vessel , there is a tendency for blood to leak from them . Bleeding from the hole created by these devices is prevented by a number of mechanisms including:
- Direct pressure upon the area, either manually (by hand) or with a clamp
- Use of a closure device that uses a small suture or stitch to close the hole
Through either of these means, a temporary fix to the artery occurs and oozing of blood from the previous puncture site is quite rare. Over the course of several days to a week, the arterial wall will continue to strengthen and regain its usual integrity and strength.
What You Can Expect:
- It is very common for the groin site to be sore for a few days following heart catheterization. Immediately following the procedure your nurse will generally administer a gentle narcotic such as oxycodone if the pain is significant. At home, it is generally recommended that you take acetaminophen (Tylenol) or aspirin for the minor pain you might experience. Pain occurring more than a few days following the procedure is uncommon and if associated with redness in the area, fever, or other symptoms may indicate an infection and is reason for you to contact your doctor.
- It is very common to develop a black and blue area (bruise) around the groin site following heart catheterization. This is not from bleeding following the procedure, but rather from blood that seeped into the area during the procedure and which migrates to the skin and causes the discoloration afterwards. In some cases the bruised area may extend quite a ways down the leg, sometimes reaching the knee or even lower. Black and blue discoloration like this is considered normal and is not a reason for concern. It may continue to enlarge for several days or even a week or two following the procedure, but thereafter will start to gradually fade and disappear over a few weeks. Don't let the black and blue area concern you.
- It is very common to feel a small lump or knot at the groin puncture site. This is normal and related to minor inflammation and repair resulting from trauma to the area. This generally decreases in size over the weeks following the procedure. You should avoid touching the skin puncture area during the first few days following the procedure.
What Can Go Wrong:
1. Bleeding: The complication we work the hardest to avoid is bleeding from the arterial puncture site. This occurs only rarely and generally in the first hour or two following the procedure (while you're still being observed in the hospital). When it does occur, it usually does not involve visible bleeding, but rather bleeding under the surface of the skin and which leads to a painful and rapidly growing "mound" in the groin area. Although rare, such bleeding is considered an emergency and should be treated by:
- Putting firm steady pressure on the area with your fingers or the palm of your hand (or preferably by a spouse or family member
- Seeking emergency medical attention (calling 9-1-1)
2. Infection: This is exceedingly rare but happens once in a while, so you should be aware of this and monitor for it. Infection at the groin puncture site is manifested in the same way an infection of the skin and related tissues does anywhere:
- Increasing pain
- Production of pus
If you have reason to suspect an infection following heart catheterization, you should call your doctor's office and ask to be seen immediately, or, alternatively, stop by your local Emergency Room. The treatment is antibiotics and recovery is usually quite rapid.
3. Kidney damage: in rare cases, the iodine-containing x-ray dye can cause damage to the kidneys. The outward sign of this is reduction in urine output during the day or two following the procedure. While in most cases this problem will resolve over a few days, in rare cases it does not and such cases can lead to a dangerous fluid build-up in the body. For this reason it is important to keep an eye on your urine output. If you notice that the quantity of urine you produce drops inappropriately or stops, you should bring this to your doctor's attention immediately.
4. Vascular Complications: there are several complications which can occur following catheterization and which are related to manipulation of the artery at the groin through which the catheter is inserted and the arteries through which the catheter must pass en route to the heart. Although reviewing the exact cause and possible manifestations of such complications is beyond the scope of this brief overview, you should be on guard for these general types of signs or symptoms:
- loss of usual color of the toes or foot
- pain in the toes or feet
- a pulsatile swelling at the catheter insertion site at the groin
If you notice either of these signs, you should contact your physician immediately.
Steps to Minimize Problems Following Heart Catheterization
1. Limit your activity on the day of the heart catheterization. Upon arrival home, you should find a comfortable chair or couch and literally plant yourself. You should be on your feet for only three things:
- To use the bathroom
- En route to the dinner table
- Going to bed
2. During the first two days following the procedure you should avoid activities that will pull or stress the groin area. In particular you should avoid lifting objects more than 20 lbs, other activities that cause you to strain your belly, and excessive crouching (deep knee bends).
3. Patients are generally advised not to drive during the two days following the procedure, although being a passenger in a car is OK.
4. Keep the groin site clean and dry. It is generally fine to bathe or shower. The skin puncture site should be patted dry. It is generally not necessary to cover the area with a band-aid since it is so small, however if you are obese and have a fold of fat that extends over the groin puncture area, it is a good idea to keep the site covered with a band-aide or piece of sterile gauze until it is healed.
5. Watch for any signs of infection as described above.
6. Drink plenty of fluid during the first two days following your procedure to help your kidneys flush out the x-ray dye.
For the vast majority of people undergoing heart catheterization, recovery is unremarkable and the only action required is to significantly limit activity on the night of the procedure and mildly limit it for the next two days.
It will take a month or more before your groin area and leg heal completely.
Immediate medical care should be sought if you notice any of the following:
- Signs of active bleeding at the groin site
- Evidence of infection
- Indications of dramatically reduced urine output