New Cardiac Cath Lab

Specialties CCU

Published

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 times a week for 4 months. We realized right away that we need way more training but administration isn't listening, we opened without any hitches but we all want some kind of more training and education.....any idea's if there are any online training or something we can do to get more training?? We are suppose to eventually learn each others jobs. I would appreciate any input. Thanks

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.

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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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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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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Specializes in cardiac CVRU/ICU/cardiac rehab/case management.

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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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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**plus she coded during the cath so even if she had not been intubated prior to that point she would have wound up intubated during the code

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