Cath Lab or ICU for new grad

[bdy93]

Interested in both the cath lab and ICU as a new grad which would be more manageable?

[kaylee.]

I dont think you can do cath lab as a new grad. I have looked at postings and most say they require icu experience...

[2210485]

Cath lab if you can. I dont necessarily understand the benefit of working in icu first and i dont entirely understand why its a requirement.

Aside from getting alot of code blue experience.. The skills learned in the icu hardly transfer... Care during the procedure and care after the procedure are 2 entirely different situations. If i had to pick a background that would be most beneficial in the lab it would be OR/ Anesthesia. The cath lab nurses primary job is going to be medication (specifically sedation) administration, patient monitoring and airway management and filling in as needed circulating. In a code yes, comfort with acls medications is a must but i feel like you can get that without necessarily needing experience in the icu.

Working in an area where you get some ultrasound transducer time wouldn't hurt either. You can,never have too many people that know how to work an ultrasound machine in a cath lab.

[dianah, ASN]

Speaking from 21 years experience in Interventional Radiology (and general Radiology Nursing) and most recently 14 years' experience in the Cath Lab (plus Stress Lab and providing contrast injections for Echocardiograms):

We appreciate and require ICU or PACU or ED experience because we want RNs to come into the Cath Lab knowing about

* how to handle a code

* cardiac rhythm recognition

* mixing and administering pressors

* understanding cardiac anatomy and physiology

* arterial lines and arterial access

* administering potent anticoagulants, titrating doses and maintaining therapeutic levels for procedures

* understanding sterile field set-up and maintaining a sterile field (we implant pacemakers and ICDs and loop recorders)

* understanding the medications required and the physiologic changes required for, say, a vasoreactivity study or producing a hyperemic state for a FFR study

Our RNs prepare patients for their exams (talking with them about the exam and prepping and draping the patient),

scrub and set up the sterile table and understand what supplies are needed and why, especially if we do a diagnostic cath and it turns into an intervention (we have to add supplies to put in a stent or two or three, and how to handle the wires and equipment [e.g., thrombectomy, IVUS, FFR]),

set up for electrophysiology mapping/studies and the associated RF ablation cases,

administer moderate sedation and monitor per facility's guidelines,

know how to trouble-shoot any given equipment being used,

perform post-procedure patient instruction.

Oh yes we do use a small sono-site machine to help locate vessels, but that is a very small part of the procedures, and once we have arterial (or venous) access, the case proceeds and we are done with the sono-site.

Always happy to have nurses come observe. :)

[2210485]

I can definately see icu as a great background in terms of how to handle a code, and for being able to rapidly mix and administer meds. You dont necessarily get the same kind of case load when it comes to cardiac arrest in the lab. At the lab where im at there wil maybe be a code every other month, whereas the icu and ed get them throughout the week. So yeah, in that regard absolutely agree icu is helpful.

As for the other aspects:

Anesthesia starts our art lines in the lab like 90% of the time, and the physicians jump in if they aren't available.

I don't necessarily know what they do at other facilities, but at least where ive been ed and icu nurses dont set up fields or anything like that.. If a code requires operative intervention a team from the operating room comes down and handles all that. Edit: by this i mean like..full blown backfields, not like.. Drapes for central lines or foleys or something.

They don't ever administer adenosine for ffr outside of the cath lab, and hemodynamic knowledge is limited to basic swan ganz monitoring (looking at pressures in 1 chamber) as opposed to the parameters involved in a full study/pullback.

Point being; i feel like aside from the aforementioned code blue experience i feel like with a strong training/orientation program new nurses could be introduced to the required concepts in the lab straight out of school.

As for ultrasound:

We utilize sonosite, but the nurses can also be of value imo in adjusting settings such as gains and focus when using ice (the physician is sterile, and the techs are operating stimulators and 3d mapping, so the extra hand there can help).

Also im not sure when the regulations are in terms of scope of practice in different areas, but nurses may be capable of doing tte or helping a physician with tee images in an emergency. This could potentially help in acquiring the required images early without having to wait for a tech to come in, or taking the attention of an extra physician.

I know though it gets tricky in some countries, facilities or states. This board was actually the first time i had ever heard of a nurse being required to go through a formal training program just to use an ultrasound to get access.. I was literally dumbfounded by the bureaucracy and lack of logic involved..

How is allowing a nurse to stick blindly or off tactile input any safer then allowing a nurse to use an ultrasound with on the job instruction?