New to cath lab- any tips?

  1. After working nights in tele, I finally got my dream job in the cath lab! I am a person who always wants to know as much as possible about any new environment. I bought a text book and have been studying the Wiggers diagram and hemodynamics- things i know they will teach me but want a good base to begin with. What other things should I know going in? what drugs are standard in your lab? What non-obvious topics do you deal with on a daily basis in an interventional lab? Sedation, other drugs, labs, etc. Any tips for me?? We have separate EP/Cath labs, so I don't have to worry about EP (yet). TIA!
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    About enigmaticorange

    Joined: Apr '08; Posts: 33; Likes: 56


  3. by   CCL RN
    Bummer that nobody answered you yet.
    Meds: fentanyl, versed, asa, heparin, plavix, reapro, angiomax, nipride, nitro, integrellin, adenosine. Those are our most common meds.

    Cath lab handbook by Dr Morton Kern.
    Cat lab digest-->free! Subscribe!
    Take an IABP class ASAP.

    Have your lunch packed and ready before you go to bed on call nights. Have scrubs and keys ready on call nights. Sock and shoes:ready. Know your route in. There's nothing like a STEMI...nothing! Be prepared. If you get called in at 3--you're probably staying allll day. Have a toothbrush in your locker.

    Welcome to the cath lab!!
  4. by   m4ttjabz
    i'm not an RN, but an RCIS cath lab tech(registered cardiovascular invasive specialist). in the cath lab i work in, a large university health system, we work interchangeably with nurses. a nurse is required to give a sedation and an RCIS or RTR (CV or CI) must scrub. documenting can be done by either and circulating on anesthesia or non-sedation cases can be done by either.

    essentially, some of the most important things to know about the cath lab are hemodynamics and procedural steps and equipment. in our lab, it typically takes about a year for new employees to become competent in documenting. knowing what each waveform should look like and why we record them will help tremendously. for example, looking at valvular disease and simultaneously recording pressures on each side of the valve (LV and Wedge/ LV and LA for the mitral valve, RV and PA for the pulmonic semilunar valve, AO and LV for the aortic semilunar valve). learning the various angiographic views and being able to discern all of the arteries generally takes a few months as well. some physicians are more tolerant than others and will tell you that "we are intervening on OM1" while others expect to you be able to look at the monitor and know what lesion we are crossing.

    -know where supplies are! fumbling around looking for devices and needed items is never good. stocking your lab will help you learn where things are.

    -for drug dosing, at my lab we have a standardized protocol book where all drip instructions are listed. knowing your patients weight ahead of time and figuring out bolus dose and volume to be administered for each possible drug will save time. depending on the lesion type and physician preference, a variety of different meds may be given for what may seem like similar events.

    -read a RCIS review book to learn about catheter shapes and wires as well as hemodynamics. most things can be picked up by simply doing your job and learning as you go, but books and tutorials will help you put concepts together and get a better understanding of why things are done.

    -ask a lot of questions, don't get frustrated that you don't know everything from the start. like many things, the more you learn, the more you realize how little you know.

    -have fun!

  5. by   enigmaticorange
    Thanks! Ive been in there a few weeks now and the advice given is spot on! I really, really get now why critical care/ER experience is usually required. Ive been in codes before, but what Ive seen and treated now? Whoa. What an amazing job, and I have SO much to learn.
  6. by   CCL RN
    The best part? You learn something new every day. Its no cliche either. Our field is constantly changing; new research, new ways to do things, everything is always changing.

    It's the best field!!
  7. by   red_jeans
    I’ve worked as a Cathlab RN for more than 5 years. Truly, it’s one great nursing specialty, specially if you can experience to assist both on Cardiology and Radiology procedures. You’ll learn in every procedure you assist. Expect the unexpected, and you have to learn to work under stress as patient’s response to procedure is unpredictable.

    I agree with matt and CCL_RN. In our hospital, nurses are either circulating nurses, scrub nurses or Cathlab Tech. We are trained to do all such positions, and are rotated on a weekly basis.

    As a new Cathlab RN, it would be helpful if you have good understanding of the Cardiovascular System – specifically coronary arteries, heart valves, hemodynamics and EKG. With months of experience, you’ll develop that “clinical eye”, wherein you can easily distinguish the arteries, which part is stenosed and what sizes of balloons or stents will be deployed. This is helpful particularly if your doctors are open to suggestions of nurses.

    It’s also important that you know how to protect yourself from large amount of radiation. Some hospitals conduct Radiation Safety Seminar for cathlab associates. Be reminded with TDS principle, Time-Distance-Shielding.

    When it comes to medications and supplies, be familiar with your E-cart. It would be easier for you to respond in emergency cases if you know where the supplies/equipments are. Be involved in your department’s inventory, that can help you. Mostly used drugs are the ff: inotropics (Dopamine, Dobutamine, Levophed), calcium channel blockers, anti-anginal, diuretics, nitrates, magnesium sulfate, calcium gluconate, sodium bicarbonate, and sedatives. Be friends with the different types of catheters, stents, balloons, and wires as well.

    On-call work is also stressful. Despite that, I find it rewarding specially when your team successfully revived a patient after heart attack, giving him a new life … with a new heart.

    High level of maturity is a must for a Cathlab RN. I believe that it’s a great experience wherein you’ll be able to perform mixed nursing specialties – critical care nursing, med-surg nursing, emergency nursing, out-patient nursing (for some benign cases), and a lot more.

    Best of luck on your career as a Cathlab RN!!!
  8. by   yulliweed
    I went for an interview for an NHS trust which turned out to be a mass interview event (up to 200 of us were interviewed over 4 days) I was aiming for a ward post, acute medicine, if possible cardiology and hey presto Ive been offered a job as a Cath Lab RN... of course Ive accepted it.
    Im now thinking OMG as Im a newly qualified nurse, I read on here on another post how its such an advanced area (obviously) to work in and that experience is almost essential......... so Im like 'Why have the offered me the job?!'

    Im already swotting up on advanced cardiology, but I guess its the fear of the unknown.

    P.s I dont have a start date yet, hopefully by Sept.


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