For Floor Nurses: What we wish you knew about the Cath Lab

If you’ve never been to the Cath Lab, you should visit. It’s really a fun place! However, if you’ve never been, there are probably a few things you haven’t learned. Here’s what we wish you knew:

Please give the patient their meds!  It doesn’t do them or us any good at all for them to arrive in the lab with a frighteningly high blood pressure!  Coumadin and Xarelto are the only two exceptions.  A few sips of water to get the meds down is ok, but please…no cup of coffee, no full breakfast, etc.

Please have them remove all clothing, even if we are going to perform a radial (wrist) access.  We will usually prep both groins, because as I tell the patients, we only need to access the groin if it isn’t prepped!  Also, if we are inserting a pacemaker or ICD, we need the legs for the grounding pads.

If you are at a facility who preps for us, or if you have a lot of spare time (right…I know), please shave an area about 7” in diameter.  This is the size of the tape on the fenestration in the drape and if they’re not shaved that large, they will get waxed.  The hair is coming off one way or another, and it’s a lot more pleasant for the patient if it’s clipped!

If the patient is coming for a PICC line, please let us know if it is single, double or triple lumen.  Let us know what it is for, and if there are any contraindications to one arm or the other.  A pacemaker in the left is a contraindication for the left arm.

The consent is also important.  Your facility should have the specific wording for the consent.  It should be signed by the patient or their representative and a witness, according to your facility protocol.  The physician will sign it when they arrive in the department.  There will be several places on the consent the patient will need to initial.  The cath lab will be happy to send a sample to guide you with the consent.  The patient will also need an anesthesia consent for conscious/moderate sedation.  For a routine cath with intervention, the RN manages the anesthesia, so the anesthesiologist will not visit the patient prior to the procedure.  There are exceptions, such as EP procedures and implants.  Again, the cath lab will be happy to guide you.

Following the procedure, simply watch the patient.  The groin site should stay soft and flat (relative to patient’s body prior to the procedure), with no pain.  If the site begins to bleed, or if it swells, the best thing to do is to remember basic first aid:  pressure for bleeding.  Call the physician, then apply pressure proximal to the access site for arterial access and distal to the site for venous.  Just remember which direction the blood is flowing, and stop it before it gets to the hole.

The patient may eat and drink, but should not do anything that resembles a sit-up.  Their head should stay on the pillow, and their leg should remain straight.  The head of the bed may be raised to 30o but no farther (depending on facility protocol).  Following a pacemaker, the patient should not move the affected arm too far:  they may raise the arm enough to feed themselves, but not enough to comb their hair.  A sling should be placed to remind them not to move very much.

Please remember that when we ask for a bed, or try to bring a patient to you, it’s not to ruin your day.  It’s usually because we have another patient to go onto the table and need to keep things moving.  We run from 7 am until we’re done, 8 or 10 or 12 hours later.  It isn’t unusual for us to work 12 hours on an 8-hour shift, and get up and do it again 5 days in a week.  The weekends are even worse.  We are a single team, on a call-back basis for each procedure we perform.  We have usually already worked 40+ hours in the week, and are trying to work as quickly as possible.   All we ask is to get one patient off so the next can get on, especially if a STEMI has just arrived and we are on the clock for a 90-minute door-to-balloon time.

Cath lab is physically demanding work but we do it because we love it, even though it is very wearing on us.

We appreciate all you do, and hopefully this will help you know where we are coming from, so we can be a better team.