Cardiac Catheter in the ER?

[RN92]

Just wondering. Do any other emergency rooms take pts back from the cath lab? We have to hold pts in the ER until a bed comes available. I realize that usually, cardiac caths cant wait too long. We use to never recover them in the ER. Nurse manager said that it is a decrease level of care (coming from the lab to er). The residents/admit teams argue that they cant recover the pt in cath lab b/c it closes and the nursing staff go home (as if the nurse on call cant stay to recover). These pts cant be monitored well enough when I have 3 other really sick people. Lately, our manager has been giving in. I know the nurses in the cath lab dont want to have to recover them/ they want to go home...but, this feels like another DUMP on the er. What does everyone else do with their cardiac cath pts that dont have a room?

[neneRN, BSN, RN]

They find them rooms somewhere, because I have NEVER seen a pt come back from cath lab to our ER. I guess we're lucky....I'll be anxious to hear if other ERs are having the same problem as you.

[dianah, ASN]

I have worked in the Cath Lab in a few hospitals. If the pt comes from the ER and has no bed waiting, and considering if he REALLY needs that cath (!), we either have the attending cardiologist arrange with the ER doc to have the pt return there, or we cross our fingers and hope the Admissions nurse finds a bed.

In another facility we always sent them to PACU, as the pt had received sedation, and was post arteriotomy (and the floor nurses didn't do the q 15-min vitals for the first hour -- weren't staffed for it). Is PACU an option in your facility?

Other, larger cath labs have their own holding/recovery area, staffed for that exclusive area.

As we only have one set of staff (i.e., we don't have a shift coming in to relieve us after our tour), we can work 12-14 hr days at any time, just doing cases. If one pt needs recovering and has no bed, the room staff works short-handed while one of the staff RNs monitors that pt. It's not ideal, but if the pts need to be cathed, that's what we're there for. The floor staff can't very well step in and relieve us when we need it.

Yours is a tough situation, hope it's just a push-has-come-to-temporary-shove predicament, that will not require administrative brainstorming to solve.

[oicu8bacilli]

If your facility is truly capable of cathing emergent cases, then they have a unit that functions as an Interventional Cardiac Care (ICC) unit. They will clear a stable pt to ICU, PCU, etc so your ED to cath pt will get appropriate s/p cath care.

[veetach]

Absolutely NOT!!! Our patients do not return to the ER from the cath lab ever. The arrangements that our hospital has made to take care of the problem is to allow the CCU/ICU to transfer a patient with the lowest acuity level to the ER as a hold, to enable them to make a bed for the patient coming out of the cath lab.

So far, and with the enormous efforts of some really great charge nurses, we havent had to do this. There is usually someone in CCU/ICU that can be transferred either to the floor or to PCU.... we are keeping our fingers crossed though.

In our ER the patient to nurse ratio is sometimes 7:1. There is no way that I could or would be able to give good nursing care to a fresh post cath patient.