322-0947 CARDIAC CATH POST PROCEDURE rev 10-08

CARDIAC CATHETERIZATIONPOST PROCEDURE PROGRESSRECORDDATE: _____________________ HOLD START TIME: MANUAL _______________ CLAMP _______________ VCD________________SITE: RIGHT LEFTHOLD END TIME: _________________ RADIAL FEMERAL OTHER__________________________________TIME MEDICATIONDOSE ROUTE / SITERESPONSEINITIALSRESPONSES1 - No effect2 - Mild effect3 - Mod. effect4 - EffectiveBASELINE:BP ____________ HR ____________RR ____________ O2 SATS ____________ %DP PULSE ____________ PT PULSE ____________ULNAR PULSE ____________COLOR ____________TimeO2SatIV FLUIDSTime Amt/IV Sol Site RateFLOW CHART POST PROCEDUREBP HR RR Sed Site Pulses Cap Col I+OLevelRight Left Refill or IN OUTDP/PT DP/PTPain0-10Total InNOTESInitialInitialLEVEL OF SEDATION SITE PULSES CAP REFILL COLOR1= Awake, Alert D=Dry PS=Pulse Strong 1+=2 sec PK=Pink3= Asleep, Easily Arousable (touch/voice) H=Hematoma D=Doppler 3+=>3 sec CY=Cyanotic4= Asleep, Not Easily Arousable (deeply sad) B=Bleeding Ø=None M=Mottled5= Asleep, Unarousable (general anesthesia)Initials Signature Initials SignatureFORM 322-0947 10/08DISPOSITION PERMANENT MEDICAL RECORDCARDIAC CATH POST PROC NOTES

CARDIAC CATHETERIZATIONPOST PROCEDURE PROGRESSRECORDFLOW CHART POST PROCEDUREPAGE 2 OF 2Time O2SatBP HR RR Sed Site Pulses Cap ColLevelRight Left Refill orDP/PT DP/PTINI+OOUTPain0-10NOTES Initial Sitting in chair: Ambulatory: Dressed with Assist:DISCHARGE CRITERIA1. Awake, responding appropriately = 2Arousable on stimulation = 1Not responding = 02. P&BP < or > 0-19 of pre-sedation level = 2P&BP < or > 20-50 or pre-sedation level = 1P&BP < or > 50 of pre-sedation level = 03. Respiratory clear unsupported = 2Obstructed, supported = 1Apneic/mechanical ventilation = 04. Pulses = pre-procedure pulses = 2Pulses strength present but diminished = 1Non palpable pulses = 05. Ambulation unchanged from admit = 2Ambulatory w/lightheadedness = 1Profound lightheadedness (symptomatic) = 06. Pink SAO2 = baseline or >95% = 2Pale, dusky, blotchy SAO2 91%-94% = 1Cyanotic SAO2 91% = 0POST PROCEDURE DISCHARGE INSTRUCTIONSInstructions reviewed and copy given to Patient Family N/APain score at discharge __________ .Pain medication prior to discharge Yes No N/ASaline lock discontinued: Time __________ Initials __________Discharge Home Admit OtherTransport Gurney Wheelchair AmbulatoryFamily / significant other with patient Yes NoTime discharged from SSU CVU Other ____________________ a.m. __________ p.m.Initials SignatureScores needed to discharge9-11 Admit ________10-12 Home ________