| US News and World Report has labeled Cardiovascular Technician/Technologist as one of the most stressful jobs in the country. |
Overview
Welcome to the Cardiac Cath Lab! This is arguably the most fun place in the hospital. It is a high-stress, high-volume procedural area, where an interdisciplinary team saves lives on a daily basis. The high-stress schedule is balanced by the support from each team member. In this course, we will look at the makeup of the team and each member’s strength, the role each colleague plays, the procedures performed, the equipment used, and the diseases we treat in the Lab. This course is intended to prepare you to begin your journey in the Cardiac Cath Lab. The course will begin with a short description of the procedures and roles in the lab. More in-depth descriptions of each will follow. By the end of this course, you will know what each procedure is, and what are the expectations for each staff member.
The Cardiac Cath Lab is the area of the hospital where Catheters and wires are used to place therapeutic equipment to open blocked blood vessels and save hearts and legs. We also work on the electrical side of the heart, to treat arrhythmias and to insert devices to keep a heart beating or to restart it when necessary.
The Cath Team
The Cath team is composed of three distinct professionals: The Registered Nurse (RN), The Registered Radiologic Technologist (RT), and the Registered Cardiovascular Invasive Specialist (RCIS). Each profession brings to the Lab expertise in a different segment of the procedures. Each is an equal member of the team and should be treated as such.
The RN brings expertise in patient care and pharmacology. While the RCIS and RT both receive training in these areas, the RN is the “resident expert”. We depend on the RN to administer conscious sedation, to ensure the patient’s safety while sedated, and to move quickly to treat any adverse reactions the patient may experience. Nurses should remember that the patient is in the Cath Lab for the procedure; patient care is an important component of the procedure, but not the reason the patient is here. If the patient only needed nursing care, he wouldn’t come to the Lab!
| Many labs include EMTs, Respiratory Therapists and other professionals as part of their Cath Lab teams. These colleagues add extra knowledge that is useful during procedures. In short, anyone who is willing to train and learn the Cath Lab, should be welcomed to the team! |
The RCIS is the expert in all things Cardiac. Their in-depth training includes the diseases of the heart, pressures, calculations, and each of the different tools in the cardiologist’s arsenal. Their training includes someradiation safety, radiology, patient care and pharmacology, but their true expertise is in the Cardiac Catheterization itself.The RT is the expert in the x-ray equipment. Radiologic technologists spend two years training with radiation. During that time, they develop a deep respect for radiation as well as an understanding of the angles and projections necessary to provide the physician with the best views of the coronary arteries in which to work. The RTs also understand the equipment and how best to keep it running, whether to reboot or to call in the field service techs. RTs also study vascular anatomy in great detail during training, and can be considered experts in peripheral and carotid studies as well. These subjects are covered as part of Vascular and Interventional Radiology units.
| It is the opinion of this author that the RCIS has received adequate training to safely pan the table during the procedure. However, due to the training mentioned above, I believe that each Cath Lab should be staffed, at a minimum, with one RT for each x-ray system. Further, there should be sufficient RNs in the department to add an extra RN if needed during a procedure. Call teams should be 2 RN, 2 tech (either RT or RCIS). |
Each member of the team is valuable because of what they bring to the team. A functional Cath Lab consists of either all RNs, all RTs or all RCIS. A good Cath Lab team contains RN and either RT or RCIS. A complete and great team consists of all three: RN, RT and RCIS. Most Cath Lab teams have three members; with the changes in regulations, many are going to 4-man teams. The extra person may be a second RN, as one RN will be administering sedation and monitoring the patient without distraction. The extra person may be another tech, as many states require an RT to operate the x-ray equipment. Whomever is added, it is always nice to have an extra pair of hands during an emergency!
Description of Roles
There are three major roles in the Cath Lab: The scrub, the monitor and the circulator.
Scrub
The scrub is responsible for setting up the table and pulling equipment to begin the case. The scrub drapes the patient and assists the physician. In some labs, the scrub preps and cleans the patient; in other labs another team member performs that function. The scrub then assists the physician during the procedure. In the lab, the scrub should be the unofficial team leader, determining when to call the physician to scrub in and begin. The scrub is usually a tech, but can be a nurse.
Monitor
The monitor is the “scribe”, or “writer” for the procedure. They are responsible for recording everything that occurs from the start of the procedure to the end. This team member ensures that all patient information is entered into the record, including identifying numbers, allergies, and lab results, and that the patient information is entered into the x-ray system. The monitor provides the consent, H&P, and other paperwork for the physician to sign. In many facilities, the monitor is responsible for initiating the “Time Out” prior to the procedure. Following the procedure, the monitor enters the radiation dose into the appropriate place, gathers the reports, ensures the physician and circulating nurse sign the medication sheet, and enters charges according to facility protocol. The monitor may be either an RN or a tech. If the monitor is a tech, it is a good idea to check with the RN to ensure all medication has been entered into the record.
Circulator
The circulator is responsible for patient care, safety and comfort during the procedure. They ensure the patient is connected to the proper monitors, and administers the conscious sedation along with any other IV medication ordered by the physician. The circulator communicates with the monitor to ensure all medications are entered into the record. In some facilities, the circulator is responsible for gathering additional diagnostic catheters and wires, as well as interventional equipment. New regulations require that the conscious sedation nurse does nothing except monitor the patient during the procedure, necessitating another team member to pull equipment. The circulator should be an RN, due to the narcotic/medication administration. However, in some states, non-nurses are allowed to administer medications; in that case, the circulator may be either an RN or a tech.
Extra
Some facilities are adding an extra team member because of the state requirements regarding radiation and/or medication administration. The extra member is usually an RT. The RT is typically stationed at the end of the table and pans for the procedure, then moves to pull other equipment as needed for the diagnostic or interventional segment. If the extra member is an RT, they are usually responsible for entering patient information into the x-ray system and recording radiation dose at the close of the procedure.
This is the beginning of a complete Cath Lab 101 course. Stay tuned…