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Off to the cath lab.

February 18, 2012

Once my STEMI was diagnosed in the emergency room, I was taken in short order to the cath lab.  That is the cardiac catheterization lab.  The goal in current guidelines is less than 90 minutes from onset of symptoms to “balloon” or when the angioplasty balloon is inflated within a blocked artery.  I was told by the nursing supervisor later that 23 minutes elapsed from the time I entered the hospital to balloon time in the cath lab.  I know I was impressed.  This was after hours, too.  I arrived at the hospital around 10pm.

I had received a couple of doses of fentanyl for pain, so I actually felt almost euphoric.  I was excited and fascinated by what was going on because I was a critical care nurse and I’ve always enjoyed getting to see new procedures.  I worked at this hospital so I knew some of the staff and had seen the cardiologist around before.  Also everything looked different from my perspective, lying on a stretcher.

The nurses from the cath lab told me where we were going and what we were doing as we traveled the back hallways.  They let me know the room would be cold and repeated the phrase we tell everyone as we take them into procedures and surgery, “we’re going to take good care of you.”  It was such a relief from the time the doctor announced, “STEMI.”  I knew I would be cared for and my symptoms taken seriously.

Inside the cath lab, I remember the room being on the small side (for a procedure room) with kind of dim lighting and lots of equipment everywhere.  There were people all around me getting me ready for the procedure.  A sheet was covering me and it was discretely pulled aside for my “bikini shave.”  My groin on both sides was shaved and a sterile towel placed over my pubic area.  Warm blankets were piled on my upper body and sterile drapes were placed over my lower body.  My stretcher was next to some monitor screens hanging down.  There was a large X-ray machine positioned over my chest.  One of the nurses stayed close to my face with me.  She was in charge of giving me any medications the doctor ordered and reassuring me if I needed it.

I remember thinking, “Don’t they give you any sedation in here?” I felt wide awake.  I could hear every thing.  The only part up to then that was uncomfortable was the injection of the local anesthetic into my groin area.  I figured if I got uncomfortable, I would ask for something.  I found out at the end that I had been given more fentanyl and some Versed.  I just hadn’t noticed.  I felt warm and comfortable.  Then I felt more pain in my chest.  The nurses had instructed me to tell them if I had pain in my chest so I did.  They told me to hang on.  The doctor was inflating the balloon and the pain would get better soon.  The pain got better after a few seconds (though it felt longer).  I still felt relaxed.

Next I was taken to ICU.  I used to work in ICU at a different hospital, so I knew what to expect.  When you arrive in the ICU as a patient, first thing you are surrounded by every available nurse.  You are moved from the stretcher to the ICU bed and hooked up to the monitor and immediate needs assessed.  I just let all this happen.  I think I still felt comfortable from the meds.  Eventually I was all settled in and my husband and sister came in to be with me.  I was still awake, not sleepy at all.  I had to lie pretty flat for the next several hours to prevent bleeding from the femoral artery puncture site.  I remember just visiting with my family.  I was in pretty good spirits.  The chest pain started to come back and I found myself sweating and feeling nauseated again.  We called the nurse and two or three of them came in to assess me.  I was given morphine and Zofran.  My cardiologist was paged.  I felt palpitations and looked up at the monitor in time to see the end of a run of SVT (supraventricular tachycardia – a very fast heart rate).  They had someone come in and do another 12-lead EKG.  After a few minutes the pain and nausea got better.  I wasn’t sweating any more.  They hadn’t been able to reach the doctor, but it seemed like I was doing ok.

You know how on TV, nobody ever goes to the bathroom?  Here’s the part that almost every patient experiences, but you don’t see it on TV shows or movies.  I had not been to the bathroom since 9PM.  By now it was at least 2AM.  I had received quite a bit of IV fluid.  I knew I needed to pee.  Since I was still on bed rest following the heart cath, I would have to use a bed pan.  We called the nurse and she got me set up.  Everyone left the room to give me some privacy.  The nurse left water running in the sink.  With all the pain medication I had received I just couldn’t get it going.  I finally gave up and figured I would either wait until the need was more urgent or I could get up to the bedside commode.

My husband and sister headed home and I tried to rest.  I didn’t do more than doze.  My chest still had some pain, but not like earlier.  My rhythm mostly stayed steady but I could see PVC’s on the monitor now and then.  I was still on oxygen.  I watched the clock waiting for my bedrest time to be over.  Someone came in and did another 12-lead EKG.  At some point more blood was drawn for labs.  Finally 6AM arrived and I got myself up to the bedside commode right next to my bed.  I was amazed at how weak I felt.  Around 7AM, I realized they were probably expecting me to show up at work.  I called the recovery room and talked to my charge nurse.  He was blown away.  Then I ordered breakfast.

Breakfast arrived and I sipped a little coffee.  I wasn’t too hungry, but the oatmeal I ordered did look kind of good.  My cardiologist walked in and asked me how I felt.  I told him about the episode during the night and that I still had some chest pain.  He called the nurse in and asked for another 12-lead right away.  I could hear him outside the room asking the nurse why he hadn’t been called.  They were explaining that they had paged twice and not heard back.  I think it ended up having been a problem with his paging service.  This kind of thing had happened to me many times as a nurse.  I didn’t fault how the nurses handled the situation.  I probably would have done the same.  My doctor called the cath lab to tell them I needed to go back in.  Away went my breakfast tray.  I figured it was just desserts for all the times I had had to do that to my patients!  Within moments I was surrounded by the cath lab nurses again and off we went.

3 Comments leave one →
  1. February 18, 2012 10:58 am

    Your experience is so different from mine but I’m loving your detail. I’m also a nurse, (NP) but not in any critical care mode. I always ask to not be medicated in the cath lab so I can watch and learn, plus I’m just very curious. I’m time constrained today but may return to summarize my very different experience. I’m goingstrong on Insight!

    • February 18, 2012 11:50 am

      I have had sedation for all four of my trips to the cath lab, but still remember pretty much everything. I like the warm fuzzy from the versed, I think it helps me be more present!

  2. Ruth permalink
    February 18, 2012 9:01 pm

    this is so cool!

    Thank you so much for sharing this. I go in this week for my defibrillator replacement, and I feel very reassured!!

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