PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
PTCA involves opening a narrowed or blocked segment of coronary artery by insertion of a small balloon catheter via the femoral artery in the groin (or occasionally the brachial artery located in the arm). This is performed under sedation and local anaesthetic.
A fine guidewire is introduced through a guide into the coronary artery. A balloon catheter is then inserted over the wire and positioned across the narrowed / blocked segment. The balloon is then inflated. This procedure opens the narrowed artery
by compressing the fatty material (plaque) against the wall of the artery and restores blood flow to the area of the heart previously deprived by the narrowed or occluded artery.
It is not uncommon to experience some angina during inflation of the balloon as the coronary artery is temporarily occluded and the heart muscle is deprived of oxygen.
This only lasts for a very brief period of time and resolves as soon as the balloon is deflated.
At the same time a stent may be placed in the coronary artery. A stent is a small stainless steel mesh tube that supports the coronary artery and maintains patency.
- Following your visit to your Cardiologist the secretary will schedule a booking at the earliest time available.
- You will be sent a letter of confirmation from The Sutherland Heart Clinic or Sutherland Hospital detailing your instructions.
- You will be required to phone the Clinic the day before your procedure between 10am and 3pm for your admission time and any further instructions regarding fasting and medications. For Monday procedures call the prior Friday.
- If you have any special dietary needs let the Clinic know e.g vegetarian or gluten free.
- Please inform the secretary if you need an interpreter preferably at least a week before your procedure.
- You will be required to stay in hospital overnight in the Coronary Care Unit.
You will be required to fast for 6 hours prior to your procedure. Fasting means no food or fluids- except a sip of water with medications.
You may be allowed to have a light early breakfast and tea/coffee on the morning of your appointment. You will be informed when you phone.
No special requirements – shower or bath as per usual.
All usual medications (including Aspirin, Clopidogrel -Plavix or Iscover)) must be taken on day of procedure with a sip of water with the exception of the below medications:
If you take the medication Warfarin you will need to consult with your referring cardiologist who will advise you if you need to stop taking your Warfarin 3 days before your procedure. Your cardiologist may also advise that you need to take a substitute anticoagulant (blood thinner). It is very important that you do not stop taking your Warafin until you have discussed this with your cardiologist.
If you are prescribed insulin we suggest you eat a light early breakfast and take half your regular insulin dose. Remind the booking staff that you are on insulin and we will attempt to schedule your procedure as early as possible.
||You should have early morning breakfast (i.e. 06:00 hours) Half (½) regular insulin (please bring in insulin)
||You should withhold your oral agent on the morning of the procedure.
(Metformin – and its other name: Diabex, Diaformin, GenRx Metformin, Glucohexal, Glucomet, Glucophage and Metformin BC - should be ceased 48 hours prior to the morning of the procedure).
You may have a light early breakfast if not fasting from midnight.
|NIDDM: Diet Controlled
||You may have a light early breakfast if not fasting from midnight.
Lasix (or other diuretic)
- If your procedure is scheduled for after 12:00 pm you may take Lasix.
- If the your procedure is scheduled for before 12:00 pm you are to withhold your Lasix and bring in your tablets so that staff can give them to you after the procedure when you are mobilising
|Clopidogrel (Plavix or Isocover) 75 milligrams (mg)
If you are already on Clopidogrel you should continue it as per normal.
If you are commencing Clopidogrel
- Your doctor will give you 6 tablets
- 2 days prior to the procedure – take 4 tablets in the morning
- The day before the procedure – take 1 tablet in the morning
- Morning of the procedure- take 1 tablet in the morning
- Example: if a patient is scheduled for a PTCA on Wednesday
- Monday - take 4 tablets in the morning
- Tuesday - take 1 tablet in the morning
- Wednesday - take 1 tablet in the morning
REMEMBER - ALL PATIENTS ARE TO BRING IN WITH THEM THE MEDICATIONS THEY ARE ON AS WELL AS THEIR BLOOD RESULTS
What to bring with you:
- A list of your current medications
- Your appointment schedule and any other pertinent papers we have sent you
- Health insurance details, Medicare card, Veteran affairs details if applicable or Worker’s Compensation Third Party details including insurance claim numbers
- X-rays and pathology results
- Items to pass the time, such as reading material, knitting, crosswords etc
- Reading glasses
- A small overnight bag and toiletries
- Referral letters
- Do not wear nail polish
On The Day :
Privately Insured Patients
All patients coming to Sutherland Heart Clinic as private patients come directly to the clinic for their admission.
Public Hospital Patients
All patients coming to Sutherland Heart Clinic as public patients must first go to the Public Admissions office of The Sutherland Hospital before being directed to the Sutherland Heart Clinic.
On a typical day events will occur in the following stages:
Stage 1. Check in: When you arrive at the clinic reception you will be asked
to fill in some admission forms.
Stage 2. Initial preparations: Nursing staff will call you in and show you
where to change into a hospital gown and where to store your belongings.
Stage 3. Pre Op: A detailed nursing and medical admission will be taken. An
electrocardiogram (ECG) will be performed and an intravenous needle (IV)
will be inserted into your arm for fluids and medications. You will be required
to read your consent form and sign it with your cardiologist.
Stage 4. The procedure: You will be taken into one of the procedure rooms
on your bed. Members of the team will ask you to lie down on the table while
they carry out various preparations such as attaching monitoring cables to
your chest and preparing equipment. You will then be covered with sterile
surgical drapes. We will respect your privacy at all times. A number of
procedures performed at the clinic require only local anaesthetic whereas
others require a general anaesthetic. The nursing and medical staff will
inform you of your level of anaesthetic prior to the procedure.
Stage 5. Clean up and transfer to Recovery: Once the procedure is
completed the surgical drapes will be removed and the insertion site
cleaned. You will then be transferred to the recovery unit.
Stage 6. Recovery: After arriving in recovery the staff will attach you to our
cardiac monitors and assess your vital signs. If you are a day only patient
you will undertake a controlled recovery and mobilisation process. If you are
staying in hospital overnight you will be in the recovery area until you are
stable and transferred for ongoing care.
DAY STAY PATIENTS SHOULD EXPECT TO BE AT THE CLINIC FOR AT LEAST 6 – 8 HOURS FROM TIME OF ADMISSION TO TIME OF DISCHARGE
Stage 7. Discharge: Once you are ready for discharge the nursing staff will
ask you to get changed and will then take you through the discharge
process. You will have your intravenous needle removed from your arm,
your X-rays will be returned and the nursing staff will give you your
discharge instructions. It is good if a relative/carer/ custodian can be with
you at this time to hear these instructions.
IT IS ADVISABLE THAT ALL DAY STAY PATIENTS HAVE SOMEONE STAY WITH THEM OVERNIGHT ON THE DAY OF THEIR DISCHARGE. PLEASE ENSURE YOU TAKE ALL YOUR BELONGINGS WITH YOU AND LEAVE THE LOCKER KEY IN THE DOOR OF THE LOCKER ON YOUR DEPARTURE.
A coronary angioplasty takes approximately ninety minutes depending on the complexity of the anatomy and narrowing.
Length of Stay
You will be admitted to the Clinic where you will stay until the time of your angioplasty after which you will be transferred to the Coronary Care Unit. Generally you will stay overnight and be discharged home the following morning.
Your immediate family or carers can see you briefly in recovery after the procedure. The Coronary Care Unit has set visiting hours and their staff will advise you of the times.
Discharge Information and Care
Your doctor will discuss your discharge care with you and your family / friend prior to your discharge from the hospital. You will also be given information if you
require further treatment.
The Clinic advises patients NOT to drive after their discharge from Hospital for at least 48 hours (longer if you have had a recent heart attack). You will need to organise transport home. Your doctor will advise you when you may drive again.
Please be aware that the airlines may place restrictions on patients flying after certain procedures, such as angioplasty and stent insertion. Sutherland Heart Clinic advises that patients who are having an angiogram that they must not fly home on the day of the procedure. If you are intending to fly home after your procedure you need to speak to the airlines when making your flight arrangements to ensure you comply with their guidelines.
Secure lockers are provided for your belongings, however please do not bring large amounts of cash or valuables with you on the day.
For patients and Visitors the Public Car park costs $4 per day (coins are needed).
Relatives and Friends ..
Are welcome to wait at the Clinic but cannot go in with the patient once they are called for their procedure. Our staff are happy to answer any of your enquiries and will give you an estimated discharge time.
Please note that Sutherland Heart Clinic is part of a tertiary referral centre and at times we are required to undertake emergency procedures as a priority. This may at times lengthen your stay at the clinic.
The Clinic advises patients NOT to drive after their procedure for at least 24 hours or longer for certain procedures. The medical and nursing staff will advise you when you may drive again.
If the doctor who carried out your procedure was not the doctor who referred you then a full report of findings and recommendations will be forwarded a few days after the procedure to your doctor.
Health Insurance Coverage
Sutherland Heart Clinic has contracts with all private health insurance funds. Sutherland Heart Clinic is a NO GAP facility. Please confirm details with us and your fund prior to your procedure. If you have an excess or co-payment on your health insurance cover then you may incur some out of pocket expenses.
Sutherland Heart Clinic, like most specialist centres, undertakes ongoing research projects. Research projects undergo stringent screening from a panel of scientists, doctors and members of the community who verify that
methods used are sound, safe and ethical. You may be asked if you would like to participate in a current research project while you are at the clinic.
Participation is entirely voluntary. If you think you might be interested you will be given a full explanation and information about what is to be tested, if any
alternatives are available and any risks and / or benefits you may experience. Written consent is a participation requirement of the study but is by no means a contractual arrangement as you can withdraw at any time.
What You can Reasonably Expect while in our Care:
You are entitled to be treated with care and dignity. You are entitled to a
clear explanation by your doctor of:
- Your condition, problem or disease.
- Any planned treatment or investigation.
- Any alternative procedures available.
- Possible side effects, the chances of success and any serious risks involved.
By presenting yourself to the Clinic you have implied general consent for treatment. However for specific procedures and for patients who may be having a general anaesthetic you will be required to give written consent after suitable information is given. You may withdraw your consent and refuse further treatment at any time. You have the right to know the identity and professional status of the individuals providing service to you. Staff employed by the Clinic are required to wear identification badges. You have the right to privacy when undergoing any treatment or procedure. Sutherland Heart Clinic respects and upholds patient rights to privacy protection under the National Privacy Principles contained in the Privacy Act 1988. The National Privacy Principles apply to the Clinic from their introduction on December 21st 2001.
- Collects your health information
- What we do with it
- The quality and security of your data
- Your rights to access and correct information
You should expect the clinic environment to be safe and comfortable.
Try to be well informed about your condition and treatment. Please ask questions if you do not understand something. You have the responsibility to provide, to the best of your knowledge, accurate and complete information about your present condition, past illnesses, hospitalisations, medications and any other matters relating to your health.
It is in your interests to comply with the prescribed treatment or care and the pre and post operative instructions. You will be responsible for your own actions if you do not follow the prescribed instructions or refuse medical treatment. You should attend the recommended follow up appointments, or advise those concerned if this is not possible.
It is your responsibility to provide accurate details of your Medicare information and/or private health insurance. Please show consideration for other patients, staff and property of the Clinic. By complying with your responsibilities you are helping us help you.
If a Problem Arises:
Please tell your Doctor or the Nurses if a problem arises, in most cases they
will be able to help you. Should you not receive a satisfactory outcome you should request to see the Director of Nursing for clinical issues or the Office Manager for
administrative issues. They will investigate your complaint and advise you of the outcome or of options if further action is required.
If you wish to take your complaint further you may utilize the following options:
Private Health Insurance Ombudsman
Suite 1201, Level 12, St Martin’s Tower
31 Market Street
SYDNEY NSW 2000
Telephone: (02) 9261 5855 Toll Free: 1800 640 695
NSW Health Care Complaints Commission
Level 13, 323 Castlereagh Street
SYDNEY NSW 2000
Telephone: (02) 9219 7444
Director General NSW Health
73 Miller Street
NORTH SYDNEY NSW 2060
Telephone: (02) 9391 9000
NSW Isolated Patients Travel & Accomodation Assistance Scheme
IPTAAS provides some financial assistance to people, who need to travel more than 200kms one way, to obtain inpatient or outpatient specialist medical treatment.
More information is available in the NSW IPTAAS pamphlet that can be obtained from your doctor, local IPTAAS office or www.health.nsw.gov.au.