Nursing Care Plan for Transcatheter Aortic Valve Implantation (TAVI)

1. Overview of TAVI

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure used to replace a diseased aortic valve in patients who are at high or intermediate surgical risk. The procedure is performed via a femoral, subclavian, or transapical approach, allowing valve deployment without the need for a sternotomy or cardiopulmonary bypass.

2. Role of the Nurse in the TAVI Care Continuum

The nurse is central to patient safety and optimal outcomes from preprocedure assessment through discharge and longterm followup. Key responsibilities include:

• Comprehensive assessment and risk stratification.
• Education and informedconsent support.
• Perioperative monitoring and rapid response to complications.
• Postprocedure rehabilitation, wound care and medication management.
• Coordination of multidisciplinary team communication.

3. Nursing Assessment

3.1 Preprocedure

• History & Physical: NYHA class, angina, syncope, comorbidities (COPD, CKD, anemia, frailty).
• Vital Signs & Baseline Labs: ECG, CBC, electrolytes, coagulation profile, renal function.
• Imaging Review: Echocardiography (valve area, gradients), CT angiography (vascular access, annulus sizing).
• Psychosocial: Cognitive status, support system, health literacy.

3.2 Intraoperative (Cath Lab)

• Continuous ECG, invasive arterial pressure, pulse oximetry, capnography.
• Monitor for rapid ventricular pacing, hemodynamic instability, arrhythmias.
• Assess access site (femoral artery) for bleeding, hematoma.

3.3 Postprocedure (ICU/Stepdown)

• Hemodynamics: BP, HR, central venous pressure, cardiac output if available.
• Neurologic status: level of consciousness, stroke signs.
• Bleeding & access site assessment every hour for the first 6h.
• Renal output, urine dipstick, serum creatinine trends.

4. Nursing Diagnoses (Examples)

1. Risk for Bleeding related to anticoagulation and largebore arterial access.
2. Decreased Cardiac Output related to valvular dysfunction and procedural stress.
3. Acute Pain related to femoral or thoracic incision site.
4. Impaired Physical Mobility related to postoperative fatigue and vascular access precautions.
5. Risk for Infection related to invasive lines and prosthetic material.
6. Anxiety related to unfamiliar procedure and hospitalization.

5. Goal Statements

• Patient will maintain hemodynamic stability (SBP 100140mmHg, HR 60100bpm) within 24hours postprocedure.
• Patient will demonstrate no signs of major bleeding or hematoma at the access site.
• Patient will report pain 3/10 on a numeric rating scale within 2hours of analgesic administration.
• Patient will ambulate at least 30meters with assistance by postoperative day2.
• Patient will verbalize understanding of medication regimen and followup schedule before discharge.

6. Nursing Interventions & Rationales

6.1 Manage Bleeding Risk

• Maintain strict aseptic technique during dressing changes; reduces infection and secondary bleeding.
• Apply manual compression and pressure bandage to femoral site for 1520min postdecannulation; promotes hemostasis.
• Monitor hemoglobin/hematocrit q6h for 24h; early detection of occult bleeding.
• Reverse anticoagulation per protocol (e.g., protamine for heparin); prevents excessive hemorrhage.

6.2 Optimize Cardiac Output

• Position patient semirecumbent (3045) to reduce myocardial oxygen demand.
• Administer prescribed vasodilators or inotropes; titrate to target MAP65mmHg.
• Encourage deep breathing and incentive spirometry; prevents hypoxia and improves preload.

6.3 Pain Management

• Assess pain using a 010 scale every hour; guides timely analgesic dosing.
• Provide multimodal analgesia (acetaminophen + lowdose opioid); minimizes opioid side effects.
• Apply cold packs to the access site after the first 24h if no contraindication; reduces inflammation.

6.4 Promote Mobility

• Implement early ambulation protocol once hemostasis confirmed (typically 46h postprocedure).
• Educate on use of compression device for lowerextremity DVT prophylaxis while walking.
• Assist with sittostand transfers; prevents deconditioning.

6.5 Prevent Infection

• Maintain sterile dressing changes every 24h or sooner if soiled.
• Administer periprocedural antibiotics as ordered; continue per protocol (usually 24h).
• Monitor temperature q4h; initiate sepsis bundle if >38C.

6.6 Address Anxiety

• Provide clear explanations of each step and expected outcomes; reduces fear of the unknown.
• Offer relaxation techniques (guided imagery, breathing exercises).
• Involve family in education; enhances support network.

7. Evaluation

Evaluation must be documented at least twice daily until discharge and again at the first outpatient visit.

• Hemodynamics stable and within target range goal met.
• No expansion of hematoma, hemoglobin stable bleeding risk mitigated.
• Pain 3/10 with scheduled analgesics pain control effective.
• Patient ambulated 30m with assistance mobility goal achieved.
• Temperature <38C, wound clean infection prevented.
• Patient demonstrates understanding of medication and followup education successful.

If any goal is not met, revise the plan, identify barriers, and implement additional interventions (e.g., consult pain management, adjust anticoagulation dosage).

8. Discharge Planning & Patient Education

8.1 Medication Review

• Antiplatelet therapy (e.g., aspirin + clopidogrel) emphasize adherence.
• Statin, antihypertensive, and heartfailure meds as indicated.
• Provide written schedule and counseling on sideeffects.

8.2 Activity Recommendations

• Limit heavy lifting (>10lb) for 4weeks.
• Gradual increase in walking distance; aim for 30min daily by week2.
• Continue compression stockings if prescribed for DVT prophylaxis.

8.3 Followup Appointments

• Cardiology visit at 1week for wound check and echo.
• Repeat echocardiogram at 30days to assess valve function.
• Routine primarycare followup within 2weeks.

8.4 Warning Signs to Report

Fever, increasing chest pain, shortness of breath, palpitations, swelling or bruising at the access site, or sudden weakness.

9. References

1. Van Mieghem NM, et al. 2023 ACC/AHA Guideline for the Management of Valvular Heart Disease. J Am Coll Cardiol. 2023.

2. De Backer O, et al. Transcatheter Aortic Valve Implantation: Nursing Practice Guidelines. Journal of Cardiovascular Nursing. 2022.

3. European Society of Cardiology. ESC Guidelines for the Diagnosis and Treatment of Aortic Stenosis. 2023.

4. Lgar A, et al. Patient Education Strategies for TAVI. Heart Lung. 2021.