New Cardiac Cath Lab - page 2

by Sadie47

3,726 Views | 20 Comments

Hey everyone need some advise, I'm from a small town that just opened a diagnostic only cardiac cath lab. 3 nurses and 1 radiology tech trained to work there by just shadowing and eventually working at a bigger hospital 1-2... Read More


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    Sadie47....unfortunately when ...ish hits the fan you are expected to do a whole lot than just monitor mostly because your interventional cardiologist will be too busy trying to put in a temporary pacemaker or IABP, or intubating the patient, trust me from a seasoned Cath lab ....these patients go into tamponade, code, perforate get PEs right infront of you. If you work in Cath lab there are certain standards that you have to be proficient in. Just like if you work in CVICU you are responsible of having the knowledge to pace, monitor iabp and titrate vasopressors, monitor ventilators and know the complications....
    Esme12 and umcRN like this.
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    More hospitals are adding cardiac cath labs, because cardiac procedures are high profit. It is good that they let you work at the sister hospital. When we opened up the cath lab and CVICU we had to learn trial by fire.
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    ugh. I don't think ANY cardiac caths are "low risk". I work in a peds CVICU and while their hearts are obviously much smaller, it only takes a fraction of a tenth of a centimeter to perf a ventricle, atria or aorta...and I've seen it happen. Perfed aorta, attempted patch via cath, emergent chest cracking, deploy to ecmo, run to OR, chest exploration, kiddo ultimately herniated and died.
    It might only happen once in a thousand cases but when it does it's going to happen big and bad and then someone will come investigating on why there is a cath lab in a hospital without a stand by CV surgery team...a 15 minute transfer ain't gona cut it, your patient is dead before you can get them on a stretcher.
    echoRNC711 likes this.
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    I hear ya!, I'm just trying to get administration to get it!
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    How are you doing and how long have you been open?
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    Are your critical care trained? There will be instances that you will need to have that...who is your back up? Are you familiar with the Balloon Pump? When I worked cath lab we had a 2 man call team and I had to circulate and retrieve catheters/balloons we did all pre and post care our selves. Will you be doing anything emergent? Even a "standard" angio can go wrong.....very wrong with a tear in the ostium (opening) of the L main coronary artery and the entire circulation to the anterior heart will be compromised. Ventricular arrhythmias are common and it isn't all that unusual to defib someone. Or someone throws a clot and the code or stroke.

    Who/what is your back up.
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    mmm this week I had a PERFECT example of cath gone wrong. 1730 I get report form cath nurse (diagnostic cath mind you), everything looks good, kiddo did great, they were going to bring her back intubated until she woke up and would extubate this evening. Just going to do a TEE before bringing her back. 30 minutes later my charge nurse is yelling to me that they need help in the cath lab, kiddo coding, going on ECMO, surgical & cicu teams en route.

    I did not get out of work on time.

    There is no such thing as a "routine" cath.

    I hope you are able to get your administration to understand this!
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    I was part of the nursing team when CVRU was opened in our hospital. Like you we also trained in a sister hospital.The first few months we were cracking chest galore in the unit until we got passed the learning curve. Certainly this is a close but different field of cardiac but until the kinks are worked out you may see a lot of emergencies.
    Nurses are expected and required to ask for training before taking on anything not in your scope.If you do not you can be held liable. Hopefully the sister hospital can meet those requirements.
    I will say it is incredibly exciting to be be part of any new program and because you are all beginning together you may witness the very best of team work. I have terrific memories of this myself.

    Good luck. Have fun together!
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    Why was the pt incubated?
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    Quote from Sadie47
    Why was the pt incubated?
    If you're talking about my patient, we intubate all pediatric patients prior to cath & use general anesthesia for sedation. It's hard to knock a little one out enough to get them to hold still for the length of the cath (which may be 4+ hours) w/o compromising their respiratory status. Plus most have a tendency to be liable with vitals so its better to start intubated. Most can extubate and recover in our cardiac procedure recovery unit (essentially a cardiac PACU). Their sick hearts have zero reserve. As demonstrated by this kiddo who almost went on ecmo during her "diagnostic" cath.


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