What are the critical elements of a Cardiac SBAR handoff?

Cardiac SBARs must cover rhythm and telemetry findings (current rhythm, any arrhythmias during the shift, ST changes), hemodynamic status, access site assessment (for post-cath patients), anticoagulation management (drips, INR targets, bridging), cardiac medication timing and response, activity restrictions, and any chest pain recurrence. For post-procedure patients, include what was done in the cath lab, which vessels were stented, and any complications.

How do I document groin site checks in a post-cath SBAR?

Document the closure device used (Angioseal, Mynx, or manual pressure), the current site appearance (hematoma size if present — measure and mark it), presence of bruit, distal pulse comparison to pre-procedure baseline, and any bleeding or oozing. Include the time the sheath was pulled, how long the patient must remain on bed rest, and when they can ambulate. If a hematoma is present, mark the borders with a skin marker and note the time so the incoming nurse can monitor for expansion.

Should I include the cath lab findings in my nursing SBAR?

Include a brief summary — which coronary arteries were involved, what intervention was performed (stent type and location, balloon angioplasty, diagnostic only), and any complications during the procedure. You do not need to recite the full cath report, but the incoming nurse needs to know what vessels are at risk so they can correlate any new symptoms. For example: 'LAD stented with drug-eluting stent, 95% proximal lesion now 0% residual stenosis' is enough context.

Cardiac SBAR Example: Cardiac Unit Shift Report

Cardiac unit nursing requires constant vigilance — rhythm changes can be subtle, access site complications can escalate rapidly, and anticoagulation management has a narrow therapeutic window. A well- structured cardiac SBAR ensures the incoming nurse knows exactly what rhythm to expect on the monitor, what the access site looks like, and what the medication timing demands will be overnight.

The example below covers a post-cardiac catheterization patient — a scenario that every cardiac nurse handles regularly. Notice how the cath lab findings, access site status, and anticoagulation plan are documented in specific, measurable terms.

SBAR Example: Post-Cardiac Catheterization with Stent Placement

Situation

Mr. Kowalski, room 310, 63-year-old male, returned from cath lab at 1300 today after diagnostic cardiac catheterization converted to PCI with drug-eluting stent placement to the LAD. Right femoral access, Angioseal closure device deployed. He is currently 5 hours post- procedure, has been flat on bed rest, groin site stable, no chest pain since the procedure. He is a new admission to this unit — came in through the ED this morning with NSTEMI. Wife Sandra is at bedside, appears calm and well-informed. Reporting end-of-day-shift handoff.

Background

PMH: HTN, hyperlipidemia, Type 2 DM (A1c 7.8), prior smoker (quit 10 years ago, 25-pack-year), obesity (BMI 33), mild CKD (baseline Cr 1.3). No prior cardiac history or interventions. Family hx: brother had CABG at age 58. Home meds: metoprolol succinate 50mg daily, lisinopril 20mg daily, atorvastatin 40mg daily (being increased — see Recommendation), metformin 500mg BID, ASA 81mg daily. Allergies: iodine contrast — pretreated with prednisone 50mg PO x3 doses and diphenhydramine 50mg IV prior to cath (tolerated contrast without reaction today). Access: 18g R AC, saline locked. Right femoral access site — 6Fr sheath, Angioseal deployed at 1245. Flat bed rest x6 hours from sheath pull (can elevate HOB to 1400 at 1845). Full ambulation at 2045.
Cath findings: 95% proximal LAD stenosis — drug- eluting stent placed (3.0 x 18mm Xience), 0% residual stenosis, TIMI 3 flow. Circumflex: 40% mid-vessel (non-intervened, medically managed). RCA: clean. LV gram: EF estimated 50%. Contrast volume: 180mL. No procedural complications reported by interventionalist Dr. Gupta.
Post-cath medications started: Clopidogrel 600mg loading dose given in cath lab, then 75mg daily (DAPT — must take with ASA for minimum 12 months). Atorvastatin increased to 80mg daily. Metoprolol continued. Lisinopril continued. IV heparin bolus given in cath lab — NOT on heparin drip post-procedure.

Assessment

Cardiac: VS: BP 128/76, HR 68 NSR on telemetry (sinus rhythm all shift, no ectopy, no ST changes on monitor). Pain: 0/10 chest pain — no recurrence since cath lab. No dyspnea, no diaphoresis, no nausea. 12-lead EKG post-cath: NSR, rate 72, ST segments normalizing in V3-V5 compared to admission EKG that showed 1.5mm ST depression. Troponin trend: 0.82 on admission (ED), 1.44 at 6 hours (expected post-PCI rise). Next troponin at 2100 (expect it to peak and begin trending down).
Access site (R groin): Angioseal site intact. Small hematoma present — 3cm x 2cm, borders marked with skin marker at 1400 and 1700, NO expansion between marks. No active oozing, no bruit on auscultation. R pedal pulse 2+ palpable (same as pre- procedure baseline documented in cath lab chart). R foot warm, pink, brisk capillary refill, full sensation, can wiggle toes and dorsiflex against resistance. L pedal pulse 2+ for comparison. Patient on flat bed rest, tolerating well, using urinal without difficulty.
Renal: Cr pre-cath 1.3. 180mL contrast used (on the higher side for his CKD). NS bolus 500mL given pre-cath, running NS at 100mL/hr post-cath for hydration (1L given so far post- procedure). UO adequate — 400mL since return from cath lab (using urinal). Will recheck Cr in AM.
General: T 98.4, RR 16, SpO2 98% RA. Ate dinner in bed (full meal). BG checked at 1700: 186 — covered with sliding scale. Metformin held today (contrast), resume tomorrow per nephrology protocol if Cr stable.

Recommendation

Activity: HOB can be elevated at 1845 (6 hours post-sheath pull). Full ambulation at 2045 (8 hours) — assist first time, assess for groin site bleeding or orthostatic hypotension before walking. If any bleeding at groin site when he first stands, return to flat bed rest and apply manual pressure for 15 minutes, then reassess. Notify interventionalist Dr. Gupta if bleeding requires more than 15 minutes of pressure.
Groin site: Check q1h until ambulation, then q4h. Compare hematoma borders to skin marker — if expansion beyond marks, apply manual pressure and call Dr. Gupta. Check R pedal pulse with each groin check. If pulse diminishes or foot becomes cool/pale, stat vascular assessment.
Cardiac: Continue telemetry — call for any ST elevation, new arrhythmia, or runs of VT. Troponin at 2100 — expect it to peak, then trend down. If troponin continues to rise beyond 2100 draw or patient develops new chest pain, call cardiology fellow (on-call pager on unit whiteboard). Post-cath EKG in AM.
Medications: Clopidogrel 75mg with breakfast tomorrow (CRITICAL: do NOT hold — stent thrombosis risk). ASA 81mg with breakfast. Metoprolol 50mg at 2100. Atorvastatin 80mg at HS (new dose). Lisinopril in AM. Hold metformin until AM Cr results — if Cr stable or down from 1.3, can resume. BG check at 2100, sliding scale.
Renal: Continue IV hydration at 100mL/hr overnight, reassess with AM Cr. Encourage PO fluids to flush contrast. Goal UO above 0.5mL/kg/hr.
Discharge: Anticipate discharge tomorrow AM if groin site stable, no chest pain, Cr stable, and able to ambulate independently. Cardiac rehab referral placed. DAPT education started today — wife understood but Mr. Kowalski was drowsy, repeat teaching tomorrow before discharge. Prescriptions for atorvastatin 80mg and clopidogrel 75mg need to be sent to pharmacy before he leaves. Follow-up with Dr. Gupta in 2 weeks, PCP in 1 week.

The Post-Cath Handoff Priorities

This example demonstrates the three highest-priority items in any post-cath handoff: access site stability, stent-related medication compliance, and renal function after contrast. The Angioseal site assessment is documented with measurable hematoma dimensions and skin marker comparisons — not a vague "looks okay." The clopidogrel is explicitly flagged as critical because stent thrombosis from missed DAPT is a life-threatening complication. And the renal monitoring plan accounts for the contrast load in a patient with baseline CKD.

The activity progression timeline is spelled out in exact hours so the night nurse does not have to calculate when bed rest ends. This kind of precision prevents both premature ambulation (bleeding risk) and unnecessary prolonged bed rest (patient discomfort, DVT risk).

Record Your Cardiac Handoff in Seconds

Post-cath handoffs are dense with times, doses, and site checks. ShiftSBAR's voice recorder captures your spoken notes and structures them into a cardiac-specific SBAR — cath findings, site status, medication timing, and activity restrictions all organized for the incoming nurse.