Post-Angiography Nursing Care: Monitoring, Complication Prevention, and Discharge Criteria

Post-catheterization care focuses on access site integrity, hemodynamic stability, contrast nephropathy prevention, and early mobilization.

Access Site Management

Site	Immobilization	Key Monitoring
Femoral	Bedrest 2–6 hrs (closure device: 1–2 hrs); HOB ≤30°; affected leg straight	Pulse, hematoma, bleeding, retroperitoneal signs (flank pain, Hb drop)
Radial	Immediate ambulation; TR band 2–4 hrs; no compression on ulnar side	Radial pulse, patency (Barbeau test), hematoma, hand perfusion

Systemic Monitoring

• Vitals q15min×1hr, q30min×1hr, q1hr×2hr, then q4hr (per protocol).
• Neurovascular checks distal to site q1hr×4hr.
• ECG monitoring if cardiac cath; ST changes, arrhythmias.
• Urine output q1hr (target >0.5 mL/kg/hr).

Contrast-Induced Nephropathy (CIN) Prevention

• Risk stratification: Mehran score (age, CHF, anemia, diabetes, contrast vol, CKD).
• Hydration: IV 0.9% NaCl 1–1.5 mL/kg/hr 3–12h pre + 6–24h post (or oral 2L if low risk).
• Hold nephrotoxins (NSAIDs, ACEi/ARB, metformin 48h post).
• NAC: Not routinely recommended (mixed evidence).
• Low/iso-osmolar contrast; minimize volume.

Complication Surveillance

• Bleeding/Hematoma: Manual pressure, ultrasound, transfusion, surgical consult.
• Pseudoaneurysm/AV Fistula: Duplex US; thrombin injection vs surgery.
• Retroperitoneal Bleed: Flank/back pain, hypotension, Hb drop; CT angio.
• Stroke/Embolism: NIHSS q1hr×24hr.
• Vasovagal: Bradycardia, hypotension; atropine, Trendelenburg.

Discharge Criteria

• Stable vitals 4–6 hrs post-procedure.
• Access site hemostasis; no expanding hematoma.
• Ambulating without syncope.
• Urine output adequate; creatinine stable/trending down.
• Responsible adult escort; written instructions (activity, meds, follow-up, red flags).