Groin Prep for Cardiac Cath

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ALL: Docs want us the ED to prep the groin on patients going to Cath Lab for emerging MIs, along with the lopressor, heparin, ntg drip, pcxr, lab and two IVs. Goal is 15 minutes. In addition the Docs think us doing the groin prep will save time too. Our goal is get the patient Door to Cath within 60minutes. Any of you all doing this (the groin prep) out there?

Thanks

Thanks, We are working on our processes to get patients to the lab quicker, this is one of the things the Cath Lab RN suggested. I like both of you are willing, but you know if this is written down in a flow chart, it becomes law.

Scott

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Specializes in ER.

I work nightshift in the ER we have been getting our cath patients ready complete with meds on board and groin prep with texas cath for males and foleys for females and groin prep in under 10 mins. Our goal is 3 IV sites of 18 gauge preferable 20 acceptable and blood tubing primed. Heparin and nitro going. Once the EKG is done this is all completed in 10 minutes. Our meds are pulled out in a pre packaged tray and charged accordingly. Most patients since November have been getting to cath lab in under 40 minutes from time of EKG showing Changes.

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Specializes in ER.

Most of our wait tim has been waiting for cath team and cardiologist to arrive to hospital, they do not stay in house 24/7.

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As a cath lab nurse, and a nurse with ED experience, I would like to say a few things in response to many of these comments. First, and foremost, we are a team that the patients depend on. I have been in situations while working in the ED where I haven't been able to complete all of the tasks required. If I, as an ED nurse cannot complete them all, I should prioritize those that I can. Groin prep would be a low priority versus starting ivs (with extension tubing), or any one of my meds. We have ED techs where I work. Put one of them to work, if possible. Ours can start ivs, as well as prep groins. If you absolutely can't do it, and you've done everything you can, then you've done a job well done.

Now.....on the flipside.....from a cath lab nurse's perspective....we do not just stand there while getting report. All three members of the team are preparing the pt. It isn't "just placing the patient on the monitor". There is a lot of prepping to do. The cath lab tech will drape the patient, fill his lines and ready the fluroscopy. The nurse still has to prepare their meds. The RT still has to set up the monitoring system with the correct patient info. Yes, there are three of us. Yes, we do hope that our pt is prepped accordingly. If not, and we know that all was done that could be done, we finish up. No problems. Simple as that. That's part of teamwork. As for calling for the patient 3 times in 2 minutes....that's ridiculous. The cath lab team should know better. Our cath lab team transports the patient while accompanied by the cardiologist, or the ED physician if the cardiologist isn't present, yet.

I would invite your unit directors to plan a "unit swap". That is, have the cath lab staff follow the ED staff for a day, or two just so they can see what happens in the ED. And vice versa, let the ED staff follow a cath lab team for a day, or two. I've worked both units. I know.

Remember, it isn't an us against them..........it's all of us against the clock!!

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Specializes in ED.

I've been asked to prep the groin exactly once in 21 years and fortunately I had the time to do it because the cath lab team was running late and I was caught up with all the i's and t's done. I think it depends on who has the most time to do the prep. I'd say 9 of 10 times, I don't have the time to do it, but I'd have no problem with doing it when I have the time-if asked.

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Specializes in ER-Med-Surg-Travel/Contract Nurse.

we are considering this since we are trying to get our times cut in half. I am really frustrated that it seems the ER nurse always gets more dumped on them to accommodate other departments. Why are we always the flexible ones and the other departments usual response is "it can't be done"

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Specializes in Critical Care, Cardiac Cath Lab.

It is disheartening to read some of these comments, because aren't we ALL supposed to be caring for the acute MI patient here? The "us against them" mentality is really unfortunate and has the potential to adversely affect the outcome of the patient. WE need to get this patient's coronary opened and stop their MI, and this takes everyone, from the ED tech to the interventional cardiologist, to accomplish this feat.

At my facility, the cath lab team reports to the ED and transports to the patient to the lab. For STEMIs, we are routinely paged based on EMS reports of ST-elevation in the field, so I am often in the ED as the patient rolls in, or at least within a few minutes of their arrival. The outstanding ED RNs at my facility generally have two IVs and meds given (ASA, NTG, metoprolol, etc.) before I get there (if I'm not there before the patient rolls in), so often the first thing I do is mark the pedal pulses and prep the groin. I will also assist the RNs with medications and IV access if needed. Like I said, we are all one team. I don't consider certain jobs to be "ED" and others "Cath Lab".

While I agree that IV access is a huge priority, the MI cannot be stopped - i.e. the coronary ballooned and stented - without a groin prep! So in my book, prepping the groin/wrist (if a radial approach will be used) is pretty darn important! Care and interventions should always be prioritized, but clipping the groin should be somewhere on the list. We're not prepping the groin simply to prepare the patient for bikini season here!

And regarding the comments that the Cath Lab just sits around until the patient arrives, let me tell you what I need to do before I can receive a patient in my lab (assuming it's an after-hours case).

1. Perform QCs on the ABG machine, glucometer, Hemochron (ACT machine), AVOX (for right heart caths - O2 sat measurements), the code cart/defibrillator. (5 minutes)

2. Turn on three different computers, each requiring two separate logins. (2 minutes)

3. Log into a different program on each machine. Cerner on the mobile workstation, the angiography viewing portal on the 2nd computer, and the hemodynamic monitoring program on the cath lab terminal. (3 minutes)

4. Turn on the x-ray to let it warm up (takes about 2 minutes of standing there in order to accomplish this part).

5. Set up the ACIST, which is the iodinated contrast delivery system for shooting coronaries, LVs, etc. (3 minutes)

6. Ensure that the exam has been ordered on the Cerner computer, then look patient up on hemodynamic system and open the case. (hopefully

7. Ensure that the exam has transferred to the x-ray system and open the case there. (hopefully

8. Pull supplies for procedure (sterile table setup, catheters, sheath(s), IABP setup, transvenous pacing catheter/equipment, table fluids - heparinized saline and lidocaine, etc.) so they will be ready for my scrub RN or RTR to open. (2 minutes)

9. Manually add patient to Pyxis (first, last name, DOB, 11-digit ID number) in order to pull meds (starting with the heparin and lidocaine). (30 seconds)

10. Grab linens from supply room for cath lab table (1 minute)

There are more things that need to be done before the patient can be received, but the terrific RTRs in my lab accomplish these tasks as they are specific to their scope of practice. (In my state, RNs cannot fluoro, so I don't touch the x-ray past letting it warm up.)

I only list these things as a reminder that ALL OF US are busy and are scrambling to meet that door-to-balloon time. Based on what I'm reading here, I can see that I'm really lucky at my hospital because Cath Lab and ED get along really well. I have a great deal of respect for the ED RNs and they always treat us with respect, as well.

Tolerance and undestanding. These two things go a long way!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
2. Turn on three different computers, each requiring two separate logins. (2 minutes)

3. Log into a different program on each machine. Cerner on the mobile workstation, the angiography viewing portal on the 2nd computer, and the hemodynamic monitoring program on the cath lab terminal. (3 minutes)

Just as an aside, it might be a fabulous process improvement project for someone to work with your IT department to make this particular piece a lot shorter. Five minutes spent turning on and logging in? Good grief.

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Specializes in general surgery/ER/PACU.

I'm an ED RN. At my facility, when there is an EKG with ST elevation and symptomatic patient, we overhead page a "CODE AMI" which alerts the ER MD, charge RN, lab, xray, and sends a page to the cath lab and on call cardiologist so that we can rally the help we need to get the patient to cath lab within 60 minutes. We "swarm" the patient and work very well as a TEAM. Techs in my facility prep the groin while I'm starting IV's and giving meds and charting ect. I'm not saying that my hospital is perfect, because there is always tension between some of the cath lab staff and some of the ER staff, but those certain people will always find something to complain about, if you know what I mean. Kudos to everyone because time is muscle:)

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

This has never come up in our ED, and isn't mentioned in our STEMI protocol. Hmmmm. Might make a nice change project for someone! Because we're a freestanding ED, our STEMIs go by ground transport STAT, or by helicopter. (Usually ground these days, since our local hospital started doing interventional caths this past year.) We have a defined protocol for the number of RNs and a tech at the bedside during a STEMI, and I'm thinking one of them could wield a razor if need be. We only have one tech on shift at a time (if we have one at all), but they're definitely pulled to the bedside during a STEMI. I'll have to look into it and see if it's ever come up. Our cath lab people are great, though -- I've only spoken to them by phone, but they've never asked about groin prep. I wonder if it's embedded in the cath lab protocol anyway.

Interesting discussion!

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Specializes in Critical Care, Cardiac Cath Lab.
Just as an aside, it might be a fabulous process improvement project for someone to work with your IT department to make this particular piece a lot shorter. Five minutes spent turning on and logging in? Good grief.

You have NO IDEA how long I've been beating my head against the wall over this issue. My "life" before nursing was in the IT realm, so the way technology-related items are handled in my facility drives me CRAZY! Believe me, if there was ANY WAY to get around this issue, I would do it...but there's not at this point in time. The answer is always that "we don't have the money to upgrade these systems". We still print out our cath lab reports because the hemodynamic monitoring system doesn't interface with Cerner. :uhoh3:

I am half-way through my MSN program specializing in nursing informatics, so my colleagues are used to me (half-jokingly) saying that I'll fix this issue someday. Wish me luck! :p

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
I am half-way through my MSN program specializing in nursing informatics, so my colleagues are used to me (half-jokingly) saying that I'll fix this issue someday. Wish me luck! :p

If anyone can do it, it sounds like you! :D I also came to nursing from an IT-related career, and I understand the frustration. We have our own issues in our ED with programs that don't communicate and single sign-on "solutions" that are more trouble than they're worth.

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