Your Experience with Your Hospitals Cath Lab Personnel?

[Nursing_Mamacita]

So thanks to training, I had to spend 2 days in my hospitals Cath Lab. I had previously noticed that the ED and ICUs were their own "little town", as we call it, but I hadn't imagined that Cath Lab would be the same. Don't get me wrong, they didn't treat me badly, but it was just...awkward. Cliquish, very cliquish. Some of them even sat and bad mouthed nurses audibly in front of me. In our Cath Lab, there is only 1 RN, the rest are RCIS. The docs even loved them...and apparently they all go out occasionally and include the MDs. I mean daaaang, I can't even get docs to put in their orders half the time! haha.

So if you have RCIS in your hospital, what are their general regards toward other hospital personnel? Do you work in a cath lab? What is the general atmosphere of the unit?

[loveu123]

I work at a major level 1 trauma hospital with an in house cath lab. My experience with the cath lab staff has been excellent. We do EKG, draw labs and put IVs in, then give ASA and plavix as fast as we can and try to get the patient to the cath lab as fast as we can. it is usually a team work at our Ed with the doctors, nurses and techs all doing whatever work necessary to transfer the patient to the cath lab ASAP. I have heard a lot of nurses from other departments say similar bad things about us ED nurses even though I know it is not true. A nurse requested I hold a medsurg patient until 6pm to transfer so that the admission goes to the next shift. I was given the report in front of my ICU patient's room and had to interrupt several times to change my drip rates because his vitals were constantly changing. He yelled at me and said I don't know how it is on the floor,when I said I need to send the patient in order to concentrate on my critical patient. I unfortunately yelled back and told him to expect patient in a few minutes and stop by our surgical/trauma/tele floor on his way home to find out if I don't know floor work since I used to work there. I think it would be nice if we nurses could just get a along and try to understand each other's role as important.

[MunoRN, RN]

Not gonna happen. The cath lab is at another facility 12 miles away. Our goal is to get them to the receiving facility no later than 45 minutes of initial presentation in our ED. In the meantime, we have to get them naked, start 2 IVs, give ASA, NTG, and heparin, activate EMS, fill out the EMTALA transfer form, call report to the receiving facility, and get them out the door. Our guidelines for what we need to do came from the Cardiologist at the other facility, who designed the STEMI program that serves a large geographical region. He does not want to include anything not absolutely necessary prior to transfer, as rapid transfer is the goal. The process is streamlined for a reason. Adding another task would further delay transfer. Also, we do not have techs or CNAs in our ED.

At my old facility where we had a cath lab in house, we typically only had time to run a 12 lead, start a PIV if not already done in the field, and give ASA and Plavix by the time the cardiologist arrived, since there was a cardiologist on call in house 24/7, and cath lab personnel were required to be able to be in the cath lab within 30 minutes of being called in (so yeah, you couldn't take call for the cath lab if you lived more than 30 minutes away). I frequently gave the ASA/Plavix en route to the cath lab, since I barely even had time to get it out of the Pyxis and bring it to the room by the time the cardiologist swooped the patient out of there. I can just imagine the look on their face had I said "Oh wait a minute, let me prep the groin!".

If it was up to 30 minutes from the Cath code call to having Cath lab staff on the premises, but you are sending them to the cath lab well before that, why are you sending them to a cath lab with nobody in it?

[MunoRN, RN]

As I work in a hospital with an in-house cath lab, my experience is similar to Stargazer's description above -- IF the patient even stops in the ED. If the team is ready, the patient does straight there, without even a stop in the ED.

No such thing as groin preps. Gown, EKG, IV access, Plavix, ASA ... GO.

If they can go straight there then send them straight there, if they can't, which is often the case both during the day and at night, do what you can in the down time before they can go.

[Anna Flaxis, BSN, RN]

If it was up to 30 minutes from the Cath code call to having Cath lab staff on the premises, but you are sending them to the cath lab well before that, why are you sending them to a cath lab with nobody in it?

Maybe it's different where you work, but cath lab personnel are paged with the initial STEMI Alert activation, which is done on scene by paramedics the moment they have a 12 lead showing a STEMI. They then must transport the patient to the ED, which involves packaging them up plus the actual drive time, which can take anywhere from 10-20 minutes depending upon where the patient is coming from. In the meantime the cath team is on their way in, and by the time the patient arrives in the ED, is registered in the system, has had their EKG, blood draw, been gowned, connected to monitor, VS measured, defib pads placed, been premedicated, seen by the cardiologist who interprets the EKG, explains the diagnosis to the patient and their family members and obtains informed consent, 30 minutes has easily passed between the initial activation call and all of these things being done.

[Esme12, ASN, BSN, RN]

I think we need to remember every one has a different protocol and different levels of staff.

I remember when I moved to New England I was stunned that I still had to lack up patient to send them to a cath lab....and cath labs were only in Boston! They still had certificate of need and the only places approved were the huge academic centers.....I shook my head every time there was bad weather and patients had a 40 to 50 or greater ride into town...the goal was to get them out ASAP!

There are a few outlying hospitals that do intervention now outside of Boston with no open heart teams....when they crash you place a bail out catheter, pop em in a ambulance, and pray they make it to the hospital to have open heart.

Stressful stuff.

[Altra, BSN, RN]

If it was up to 30 minutes from the Cath code call to having Cath lab staff on the premises, but you are sending them to the cath lab well before that, why are you sending them to a cath lab with nobody in it?

The 30 minutes is a MAX acceptable time.

[Altra, BSN, RN]

If they can go straight there then send them straight there, if they can't, which is often the case both during the day and at night, do what you can in the down time before they can go.

Again - our situations are clearly different. 60-ish% of our STEMIs do not stop in the ER. Cath lab staff is in-house 24/7 - they *MAY* require a max of 30 minutes to get ready but that 30 minute clock starts ticking with the STEMI page which may well be even before the patient has arrived at the hospital.

It's been 4-5 years since I even heard any discussion of groin preps -- it's simply a non-issue in the region where I work. The region has a fairly well-developed system with EMS services to identify STEMIs and funnel them to area hospitals with immediately available cath services.

And with the movement away from transfemoral approaches and toward transradial -- it will continue to be a nonissue.

"Down time" on a cath lab patient? That's a failure of systems/technology/personnel.

[Anna Flaxis, BSN, RN]

That is a good point. Transradial approaches went from being a rarity, the trademark of one particular cardiologist we had on staff, to a more common occurrence, maybe about 25-30% of cases, in just the four years I worked at that particular facility. I'll bet it's even more common now, as more of the interventional cardiologists get on board with it. Even if you don't know which approach the cardiologist will use, best to allow them to decide and then do appropriate prep in the cath lab, so as to not waste time getting the patient there.

[MunoRN, RN]

Again - our situations are clearly different. 60-ish% of our STEMIs do not stop in the ER. Cath lab staff is in-house 24/7 - they *MAY* require a max of 30 minutes to get ready but that 30 minute clock starts ticking with the STEMI page which may well be even before the patient has arrived at the hospital.

It's been 4-5 years since I even heard any discussion of groin preps -- it's simply a non-issue in the region where I work. The region has a fairly well-developed system with EMS services to identify STEMIs and funnel them to area hospitals with immediately available cath services.

And with the movement away from transfemoral approaches and toward transradial -- it will continue to be a nonissue.

"Down time" on a cath lab patient? That's a failure of systems/technology/personnel.

It doesn't actually sound like the situations are that different. Just over half of our STEMI's codes are activated in the field, the remaining 40% are activated in the ER, which is where the opportunity to maximize prep prior to the cath lab occurs. As I've said a couple of times now, if the cath lab is ready then send 'em, if not do what you can.

It had sort of trended towards a non-issue where I work as radial approaches became the fad, although it's gone back the other way with radial approaches.