ccheartRN

Hi there! I am a long time lurker, first time poster. I realize that this post is a few months old, but the topic really resonated with me as I had the same questions (and a similar preceptor!) when I oriented to the Cath Lab. Hopefully I can be of some help. A quick note: our circulator was responsible for conscious sedation, any other medications, patient needs, and grabbing items for the scrub and MD. All labs seem to operate a little differently! It goes without saying that the patient's status goes first: think of your ABCs and pain control. If there is no live patient or a squirming patient in pain, there is no case! Generally, the case is initially set up for a diagnostic heart Cath. Our lab uses a 5fr system and a mutipack of catheters with a jwire, all of which is set up in advance. As a new Cath lab nurse, my struggle began as soon as the case turned to intervention because so many things happened so quickly! Look at your patient and their history. Have they had stents before? Are they having active chest pain? Positive troponins? Is the diagnostic portion looking lumpy and bumpy? If you suspect that some angioplasty is in your future, there are some items you can pull together to make the transition easier. I would grab a 6fr sheath (your mileage may vary, not all docs upsize), an indeflator and some conray. These are items you know will be needed. When the doc turns to you to tell you what interventional catheter, wire and stent/balloon they want, you can be opening these three things while you listen. The first thing they will need is a bigger sheath (if they are upsizing, which most often they are). Good, you've thrown that. While the doc is trading out sheaths, the scrub person can prep their indeflator while you look all over for strangely-named wires and catheters! Throw your interventional catheter next. Once the MD has the new sheath in place, this is the next thing they will need. Once the catheter has been advsnced, an interventional wire is needed. I used my wire as a "red flag": I did not hand the wire over until I had given (or was immediately prepared to give) heparin/aggrastat/angiomax or check an ACT if we were radial and heparin had already been given. Too many times I saw the circulator become very task focused and forget to ask about/administer a "thinner" (yes I know these are not all thinners, just generalizing here) until later in the game, when stents were hazy and appeared to be clotting. **This method may not work for you, but be sure you find a way to remember to give the "thinner" of choice. It is a soul crushing mistake to see a routine 75% lesion turn into a 100% occlusion because someone forgot to start the aggrastat! ** Finally, you'll need your stent or balloon. Around this time, it is a good idea to also be sure your scrub has enough contrast and double check your patients pain and sedation level. A patient who easily tolerated a diagnostic Cath may have some chest pain with the inflation of a stent, so a little reassurance and/or fentanyl can go a long way! Since this is such a long post, I will make a quick summary for you: It's time to stent! 1) bigger sheath, indeflator and conray 2) interventional catheter of choice 3) wire**ask about "thinner" 4) stent/balloon I hope this helps you! I am now PRN in our Cath lab as I've transferred full time to critical care, but I would be happy to answer any questions you may have. Best of luck! The Cath lab is a fun place to work and gives you a really unique skill set. Happy cathing! :)