Who belongs in the Cath and IR labs?

So…who belongs in the Cath and IR Lab anyway?


There are a lot of questions out there, from a lot of people, all of whom say they are the most important group in the Cath and IR labs.  The RNs say they are, because of their knowledge of patient care.  The RCIS say they are because of their knowledge of everything, and the RTs say they are because it started as a Radiology department, and they know Radiology.  In my opinion, they are all important to the proper operation of a Cardiac Cath or IR department.

Here’s why:  Each of the three professions address a vital part of the procedure.

The RN has a vast knowledge not only of the medications used in the lab, but of the medications the patient may be taking for other conditions.  An RN is trained in medication interactions, and should be able to treat and recognize symptoms of those interactions.  Further, an RN will be able to go beyond basic emergency medications to administration of IV therapies following a bad crash.  While crashes (thankfully) only happen a small percentage of the time, they do happen, and for that reason we need RNs in the lab!  Of course, in my (humble but most accurate) opinion, any RN coming to the cath/IR lab should at least have critical care experience, if not be certified CCRN.

The RCIS has an amazing depth of knowledge of the heart itself.  Included in the RCIS exam are cardiac diseases, intense work in right heart wave forms and pressure measurements, cath math (all those formulas…), coronary and cardiac anatomy and panning.  As part of their training, they discuss medications and patient care along with the basics of radiation protection and imaging.  However, they do not reach the level of instruction on medications and patient care that the RN reaches; nor do they reach the amount of knowledge that the RT has regarding radiation protection and imaging.  Therefore, the RCIS is and should be a vital part of the team, but needs the expertise of the other two groups to be complete.  My thought is that the RCIS should be accepted into the Interventional Radiology lab carefully as their education is incomplete regarding neuro and mesenteric angiography and intervention, and non-vascular interventions such as nephrostomy and biliary procedures and dialysis access treatment.

The RT has studied and is licensed in radiation biology and protection along with extensive training in anatomy.  The RT has as much training in anatomy as the RN has in physiology.  RTs spend 2 – 4 years earning a license and passes a test that includes complete human anatomy, some patient care and communication and hospital operations.  But the RT’s main area of expertise is the amount of time they spend with and around radiation, learning the importance of protecting themselves, their colleagues and their patients from deleterious effects.  Further, an RT with the CV, CI or VI credential (Cardiovascular, Cardiac Interventional and Vascular Interventional) has passed a test that includes the specific areas of expertise required in the Cardiac Cath and Interventional Radiology labs.  For this reason, the RT is a vital member of the Cardiac Cath and IR lab teams.

So…now that we have cleared up that all three professions:  the RN, RT and RCIS belong in the cath lab, who should be in charge?  There is a school of thought that says that only an RN should be in charge.  I have no issues with an RN being in charge, as long as they have experience (5 years or more) in the cath lab.  No one can manage a procedure area if they haven’t worked there (IMHO).  However, I don’t believe that it must be an RN.  I believe that any of the professions with appropriate experience (5 years or more) is capable of leading the team; the real question is, are they able to lead and manage people?  All the experience and knowledge in the world doesn’t make up for someone who can’t manage people.

So…who belongs in the cath/IR lab?  A balanced team of RNs, RTs and RCIS who are willing to work together to provide the best care possible for their patients.

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