The patient has undergone a cardiac catheterization. It has been 2 hours since the catheter and sheath have been removed. Which of the following would be a concern for the nurse recovering the patient after the procedure? (Select all that apply.)
a. Swelling and hardness at the catheter insertion site
b. Complaints of itching and urticaria
c. Urine output less than 30 mL/hour
d. Low back pain radiating to both sides of the body
A, B, C, D
If hematoma or hemorrhage is present at the catheter insertion site, apply pressure over the insertion site, and notify the health care provider or physician if interventions do not stop the bleeding, or if the patient demonstrates symptoms of acute blood loss (hypotension, tachycardia). If the patient has an allergic reaction to contrast medium manifested by symptoms of flushing, itching, and urticaria, continue monitoring the patient and assess for anaphylaxis. Notify the health care provider. Renal toxicity from contrast can be detected by monitoring intake and output. Urine output of less than 30 mL/hour is a sign of renal toxicity. Low back pain radiating to both sides of the body is a hallmark sign of retroperitoneal bleeding.
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