Cardiac Cath Lab... What's it like??

[Kgibson089]

I am a fairly new Grad and looking at my options of where I would like to work. I've thought about the ED, ICU's or even L&D. However there is just something about the Cath Lab that catches my eye. Any insight on what it's like? What exactly is your role as an RN? Any help would be greatly appreciated.

[GinRN777]

I have to agree with the other 2 posters about CCL. We definitely do not stand in one spot. Our cath lab is smaller, with one cardiologist, the xray tech scrubs, RN circulates and other RN monitors. When a diagnostic turns to an intervention, the 2nd RN comes out and helps out with drips, etc. You have to be able to anticipate what the physician will want next, while mixing drugs, getting supplies and keeping your patient sedated and stable (and that is on an easy day). Definitely not for the new nurse.

[RAO RN]

I've been in cath lab for almost two years now. I work in a high volume lab that runs a three person team in several rooms. Our hospital does most of the standard style cath cases such as EP study/Ablation/PVI/Left atrial appendage isolation/LHC with PCI/RHC/PPM/Loop Recorder/AICD/BiV/ASD Closures/PFO/Carotid Stents/IVC filters/Peripheral PTA/Atherectomy and Thrombectomy. All the cool toys Impella/IABP/CSI/Crosser/Laser/Turbohawk/Rotobladder/Angiojet/IVUS/FFR/OCT. As of now we do not do TAVR or any coiling procedures. With that being said, I have 5+ years ICU and Step down experience.

You better have your big boy pants on when you step into the cath lab. Many of our patients are stable, but many of them are deathly ill. Patients go bad quickly, much more so than on a nursing unit. Just learning the types of procedures and what the hell is going on can take a year. Mix in a whole host of new pharmaceuticals to play with and you can lose your mind. There is no pharmacy tech mixing drugs and putting them in a pyxis for you. You mix your own pressors and gtts. Its mind blowing just trying to learn the supplies associated with doing interventional cardiology. Like CCL RN stated, it really gets bad when its 3 am and you are doing the job of 5 people, mixing drugs, titrating drips, setting up equipment, monitoring vitals, assessing your patients vitals and rhythm, running a code, shocking/pacing your patient, pushing meds, getting thrown up on, dropping sterile supplies, and trying to document all this chaos unfolding.

I am sure there are cases of new grads thriving in a pre-op/recovery area for CVI, but it is not healthy for the RN to try to make this leap into the lab without some SOLID background in emergency/critical care/even paramedic training. You need to be 100% independent. I learned so many things in the ICU and even on step down. LVN's with 20 yrs experience have even taught me things I use in my practice today. Bottom line... Its not safe for your career or your patient. You need to know things like what you need to do if you perf a right ventricle during a PPM insertion without the MD asking, he's busy putting in the pericardial drain you dropped to him. What you do with a CHF patient that's BP/HR has tanked with an LVEDP of 35. Its almost like being the MD's ultimate resource. Some of the older nurses I work with know more than some of the Cardiologist doing the cases. My cath lab nurses out there know what Im talking about here.

I hope this reaches new nurses or nurses who want to get into the lab. Its the most rewarding job I've ever had, and I wouldn't trade any of the blood, sweat, or tears I have shed while working there. It has made me a stronger nurse with a huge skillset. Please know that every goal is attainable if you put in the work.

[csu1234]

thanks

[canned_bread]

A lot of people keep saying it's not a great place for a new nurse, and I completely disagree.

I was a new grad direct entry into the cath lab (We do interventional and diagnostic neuro, vascular and cardiac, I/O lines...basically everything a cath lab can do, we do), and I picked it all up and continue to love it so, so much.

It was a very steep learning curve, and I had to do a LOT of study myself or I would not have survived beyond...gosh, even 3 months. But if you are incredibly bright and dedicated, can take instructions and take constructive criticism, are willing to put in the hours (and I mean, LOTS OF hours, as you are cheap initially, and need to learn), and willing to work it, you will be fine. It is INCREDIBLY different to the ward, and it can get incredibly critical very quickly. But it's great.

I went to a BLS course early on, then self funded a cardiac course that I went on, and then an ACLS so I could manage situations, and also was not on-call until they felt I was competent for emergencies in the middle of the night, which occurred 9 months into my employment. Even then, I was never put on-call with an inexperienced nurse. Always with a senior nurse.

I spent a lot of time at home watching television coiling wires without looking until I got it down-pat and it became automatic. I spent hours at home with the manifold using red dye and fluids until I knew that thing inside-out (and to think initially I thought it was the most complex thing in the world! Ha!). And I spent hours and hours quizzing myself, and then getting other people to quiz me on various heart beats and treatments until I could identify torsades (never seen it yet though!), VT, VF, junctional, AF...everything. And the heart I have never, ever, stopped learning about.

I have asked thousands of questions of doctors and nurses so I understood every. single. thing. that was happening.

And I learnt an awful lot very, very quickly. And my hands got very strong, very very quickly from pushing on those groins. And every day I am still asking questions, and still looking up things after cases so I can know why.

That being said, there was a lot of stress, and a lot of tears early on. And I had to learn a lot about the politics of the place, because it's a small tight-knit environment that can be very stressful, and as such requires dealing with other employees to the face all the day! But I truly believe I was beyond blessed to have been placed in an area that is my love, and if you love critical care, and nerd-out with ECG's, it can easily be your place.

Basically, if you are prepared to work it, you can make it work.

As for the comments above, some extra comments I have. In australia here, I have no heard of RN's inserting sheaths or anything - that is most definitely the doctors job. As a scrub, we assist the doctors in performing the procedures, both with our advice and with our skills.

As for "standing in one place for hours", we definitely do not do that. If you are doing that, you are missing out on doing something and probably should be fired. Some procedures take hours (Ie PVI's), but if you are actually doing your job you are moving, or concentrating on things that need to be concentrated on, such as the ECG tracing. I mean, seriously, even if you LITERALLY had nothing to do (which should not be the case), couldn't you be stocking up, or cleaning? That's another thing about the cath lab. It's your environment, and the small team needs to do everything for the place. It's very, very, very much about team work. Even more so than the ward.

Another great thing about the cath-lab is you can get a LOT of money from over-time. If you have a young family, it can be very difficult and you may need to have set hours as worked out with your employer, but if you are young like me, you can start saving for that mortgage.

And ANOTHER great thing, is by wearing your lead, as long as you take care of your core-strength (so you don't get a back injury), you can loose a lot of weight, really quickly. I started my job weighing 96kg, and lost 20 kgs in one year. That's from moving fast, with lead on. No diet changes, no added exercise outside of work.

I think very quickly your employer would be able to ascertain if you can cut it in the cath lab, and if you want a constant active social life, it's not for you (I don't know about other cath labs, but we have cases that come in waves/seasonal. It's 18 hour days and then it's 4 hour days!). It's fast, it's intense, patient's crash, and at other times you see miracles (I love a patient that comes in with no feet pulses and comes out with warm pink toes).

The staff members around me supported me to become the cath lab nurse I am. They were integral in training me so quickly, and so wonderfully. That's another aspect, everyone was my preceptor (although I had one "official" preceptor for a year), and everyone was my educator, and everyone was my encourager. They put a LOT of time into me even though I was a risky gamble because I could have been dumb, or unenthused (although you pick up on them really quickly, and can easily identify those that won't fit into the cath lab), or had no paid attention at uni.

I was hand picked as well. The cath lab said they needed a new grad, probably due to budgets. The new-grad co-ordinator looked through the resumes until she found someone that was slightly older (I started working there at the age of 25), had top grades, and at the interview they subtly ascertained that I was a nerd, slightly quirky, headstrong but could be a follower too. That's what they wanted, that's what they got.

My point is, they gambled on a new grad, were willing to put the work in as long as I was. And now they have a competent nurse. Don't cast us all out.

[OptimusPrime]

Obviously, not all new grads are created equally. So it's not unheard of for a new nurse to be hired in the cath lab, pick it up and do well. However, I do not recommend it o the nurses that rotate through as students. I started out as a paramedic, worked in a CCU for 5 years and an ER for a year before going to cath lab. And let me tell ya, there was a steep learning curve for me. I am glad i started in the CCU, so much is to be learned from spending 12 hours a night with two sick patients that cannot be learned in cath lab by a new nurse. ICU's and Cath Labs are very, very different departments and most ICU nurses I worked with (myself included) knew very little of the cath lab when working on the floor and the nurses that have only worked cath lab know very, very little of floor nursing. It's only natural and it's ok.

We try not to hire new grad RN's to the cath lab where I work. However, the RN that oriented me to cath lab has only worked in cath lab and is an amazing CL RN. But like I said, not all new grads are created equally.

But as a general rule, I think it's a bad idea to start in a CL.

[jennyRN1]

I completely agree with CCL RN. I work on a cardiac telemetry unit and care for patients that come out of the cath lab. I have had close co-workers that have a lot of experience working the floor that have transferred to the cath lab and it is absolutely no place for a new grad. Its a tedious job that challenges even the most experienced RN. I have observed the cath lab and my head was swimming at all the nurses do. I can't imagine a new grad in there.....

[Ruby Vee, BSN]

If you have your heart set on the Cath Lab, try to get some experience in a CCU or CVSICU first. You'll learn about pacers, balloon pumps, VADs, drips, vents and all the other "nursing tasks" you will be responsible for during the cath. Then apply to the cath lab and you'll be a very strong candidate.

[cubby777]

Sounds like you are one who has been there!

[ATLRN2008]

I am laughing so hard at the previous posts about new grads working in the Cath Lab. I was an open heart nurse for 7 years prior to transitioning to the Cath Lab, so I had my share of TAVRs at a few renown teaching facilities during my 2.5 years as a CVOR travel nurse. I wanted to work in the Cath Lab to expand my training and have more than one specialty. I have worked with two new graduate nurses, but they were both BSN prepared and from an excellent nursing program, WAR EAGLE... LOL😜. I was nervous coming from a surgical background, but I passed the CVRN-BC within 5 months, and it was more difficult than taking the NCLEX. I was surprised that my co-workers were not as welcoming during the beginning of my orientation, because I had open heart experience; I scrubbed and circulated in the OR, so I was brought in to do both in the Cath Lab. It was very difficult transitioning, because I was used to seeing blood, guts and glory; however, I had to learn to train my mind to view radiologic images. Overall, I am very happy with my transition and the compensation is equivalent to traveling. I love the adrenaline rush along with the vents, STEMIs, Impellas, IABPs, Rotablators, CSIs, Angiojets and etc... It's definitely a different beast, but one has to remember to function within their scope of practice. I have seen a few nurses get so besides themselves (previous ER nurses) they think they are CRNAs... If that's the case, go back to school (my current status 😉). It's not as intimidating as it is made up to be. If all crashes, I will always be an Open Heart Nurse and can get back into that mode easily😊

[ernurse77]

I'm a col th and sorry lots of standing in my lab! Granted its either feast or famine 0-100. I worked inpt and ED and those were both way busier on a day to day. If the new RN is eager and willing to spend off time learning then they could be a great fit. But if they just want to go in and be done probably not so much. Our call team is 2 RN, 1 rad tech and a recorder that may be a RN or RTech, so we are never alone at 2am. Also I work in a major teaching hospital so we do not scrub. We are managing the pt. Cath labs can differ greatly. It's a very rewarding job and I wouldnt recommend it as a first job but if it keeps popping in your mind try it out. That is what nursing is all about finding your niche and passion. Some people that appear perfect wont be and others who seen questionable will be.

[ICUClint]

Take it easy Lee Harvey

[MaleRn77]

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