CCL

Congratulations Nurse Kyles! The cath lab is a great place to be. In the beginning, you will be absorbed with keeping up with the pace of the case and your responsibilities, but with enough exposure and education, you can become a resource in that room. For example, if the cardiologist has a hard time crossing the aortic valve with a J-wire, you would know to have a straight-wire handy. You will also know that if the first picture of the left coronary system shows a lot of collateral circulation, then you may very well expect to see a chronic lesion in the right coronary. And you will know that it's good practice to be standing near the defibrillator when the right coronary artery is being cannulated because this is a time when you might be more likely to have some VFib. You will become well-respected if you have a deeper understanding about how the procedure relates to this patient's disease. What is the cath going to tell you? Understand how that information relates to the diagnoses and treatment because cath lab is much more than just visualizing coronary plaque or thromboses. Understand cardiomyopathies, valvular diseases, right heart and left heart pressures. Know your coronary anatomy and which projections of the c-arm will show which vessels best. Know the difference between left dominant and right dominant. Know the right time in the procedure to approach your patient and remember not to approach the c-arm when pictures are being taken unless patient safety is at risk; otherwise you will be blasted with radiation. Anticipate the needs of everyone in the room, especially the scrub. Always remember to take care of your scrub and make sure they aren't waiting on you to drop something to them unless it is absolutely necessary. Make sure they have what they need when they need it. If your lab does interventions, remember to have blood thinners on board before the wire goes into the coronary. Not having your patient thinned out before introducing a wire can lead to serious thrombus. My fail safe is to not give the interventional wire to my scrub until after I have had a chance to give the heparin or angiomax. If a patient receives a stent, make sure they get their plavix, effient, or brilinta ASAP. If using the medrad for a ventriculogram, make absolutely you and the scrub and the doc watch the tubing to make sure there is zero air in that line or you will have an air embolism. I would start with the basics of coronary anatomy and hemodynamics. Help yourself visualize coronary angiography in different projections here https://www.cardiologysite.com/html/cath_menu.html Reviewing the cardiac cycle will help you understand hemodynamics and will especially come in handy when doing right heart caths and measuring valvular gradients https://www.cvphysiology.com/Heart%20Disease/HD002 Your strengths will lie beyond getting the patient positioned property, on the monitor, and sedated safely. Stay positive, speak up, and be patient with the learning process. Congratulations again!