BJNurse

I've been in the cath lab for 4 years now and I've never considered it boring or low stress, but to each his own. I personally love it and will stay in the cath lab setting as long as I can. Some things to consider are: wearing 10-15lbs of lead all day, call - being called in at 2am to do an acute then having to work all day, cath lab schedules are fluid ie: last case may go late and run to 8-9pm there isn't a next shift to relieve you and cardiac patients (even routine ones) can go bad quickly , when the #$%# hit's the fan its just your cath lab team and the cardiologist so you need to really know your stuff. Those are the cons in my opinion but to those of us who really love the cath lab it is a small price to pay. I thought that going from CVICU to cath lab I might be "bored" but I was wrong, in fact I had to work hard to bring my knowledge and practice up to the next level. Cath Lab nurses , at least where I have worked, are expected to practice at a very high level. It sounds like you are doing all the right things to make sure this is the job for you. I would just say if you are looking for a challenge and adventure then the cath lab would be a great move. If you are looking to relieve stress and lower adrenaline then maybe the ADON might be a better route. Good luck in whatever you choose.

Cystic Fibrosis is a recessive gene so if the father is not a carrier the child will not have cystic fibrosis but will have a 50% chance of being a carrier themselves (anyone correct me if I'm wrong since it's been a long time since biology 101) . If the father is also a carrier then the child has a 25% chance of having CF and a 50% chance of being a carrier of the gene. It is definatley something that the father will want to get tested for. If he is not a carrier the child should still be aware that he/she might be a carrier which will be important when it comes time for that child to have children (I hope by then they will have found a cure!) I lost my first husband to cystic fibrosis at 25yrs old, it is a awful disease! Good luck.

Fem-stops are a disposable/one time use item and should not be re-used on another patient. These devices come in direct contact with blood and I don't think that "washing" them would be adequate! I have a hard time believing that the fem-stop cost is really stretching your hospitals budget to the point of needing to re-use a device. Fem-stops cost my lab approx. $70.00/pc. If you are seriously considering this you should run it by your legal department and realize that JACHO would have a feild day with you re-using a device marked one time use. The real question is: If you ever have an arterial puncture would you like to have a USED femstop put on you? Granted the last patient it was used on may have had Hep. C but I washed it really, really good!!! I would encourage you to look at other cost saving measures, maybe manual pulls with a hemostasis patch.

Where I work there isn't a difference in pay based on what area you work in. Pay is based on the number of years you've beeen a nurse. However, I do think that there should be a pay ladder based on your qualifications, certifications and speciality. I think that paying based only on years worked is very "backwards" and think nurses should be compensated at different rates based on the level of their practice. I would like to hear if any hospitals are starting to recognize that not all nurses are equal and paying their critical care nurses a premium.

You've got to love July! One of my favorite new intern stories was when I worked midnights in CCU. I had a patient that was made a DNR and passed away during the night so I had to call the resident on call to pronounce. I had a really hard time getting him to come and when he did he insisted that I go in the room with him, my guess is he had seen too many horror movies where the dead guy reaches up and grabs you. After all this I looked at his note and he had wrote...patient appears dead. Nothing else just the time, patient appears dead, and his signature! LOL. I've also had some fun trying to explain to newer doc's that yes those are pacer spikes but there is no rhythm, yes you can pronounce a patient with a permanent pacemaker and no I can't turn it off! I also have some good stories from my days on the code team. I went to a code one day to see the code captian was fresh out of ACLS and looked like he was going to pee his pants. As myself and the rest of the code team were working he would add his pearls of wisdom, such as... can we add some oxygen to the ambu bag (great idea why hadn't I thought of that:)...shock! shock! (he wanted to shock everything, including the sinus rhythm we had finally achieved)....and my favorite was make sure to check that rhythm in two leads (great thought if it was asystole but Vfib will look the same no matter what lead you pull up). Oh those were the good ol' days. Now that I'm in the cath lab I don't have to deal with the new interns but I do have those lovely cardiologists which is a whole new ball of wax.

i don't know of any books off the top of my head but I would encourage you to visit a few good websites I know of, if you haven,t already found them: Cathlab.com and try to ggogle SICP and Wess Todd last I looked they both had some good info on their websites. Good Luck in the cath lab, I left SICU for it and I,ve never regretted my decision!

Since I work in the cath lab we have pressure bags all over the place but I would definatley expect that there would be at least a couple on every crash cart. There are times that you need to provide a rapid fluid bolus and that is the quickest, easiest way to do it.(Unless you have a rapid infuser availabe which isn't pratical in most settings). The disposable pressure bags are only a few dollars so it shouldn't be to much problem to stock the facility with them. As far as fluid overload, at the point your breaking out the crash cart that of little concern!

Our policy is to get an accucheck on admission for all our same day admissions. If the patient is coming to us from the floor they generally have an accucheck prior to us picking them up, if not we do one prior to the case. We don't have a policy for in case accuchecks but rather just use our common sense. If the pt is showing of s/s of hypoglycemia I will check or if it is a long biventricular pacemaker or extensive plasty I might recheck. I must admit I rarely recheck because most of my patients are in and out in 1-2 hours. Hope that helps.

Same fight different day. I don't usually even look at ADN vs BSN threads anymore because I just can't stand to see nurses bickering back and forth about who's better, more qualified, etc. I was however intrigued by the state actually mandating a BSN. Personally, I think whoever is proposing this in the middle of a huge nursing shortage either has huge kahunas or is a few cards short of deck, or maybe both. I personally am an ADN grad. I have been in nursing for 7 years and my career has taken me from med/surg to SICU to the cardiac cath lab. I feel that I am a highly skilled nurse and I am no better or worse than a BSN prepared nurse with the same resume. I have considered going back for my BSN but right now unless someone "shows me the money" I am happy with my degree. I am not prepared to pay for the BSN degree to go back to my same position for the same pay. If I worked in NY, I would go back if they made me but I would definatley make sure the powers that be know how displeased I was. But more importantly why do we as nurses allow things like this to divide us? United we are a huge lobbying group who could affect great changes in our political system, improve our public image and increase our status in the workplace. I have always believed in picking your battles, I sincerely hope the ADN vs BSN battle isn't the one we choose.

I work in the Chicago area. It is common for the cath labs in this area to run with a mix of RN's, techs and RT's. It is not uncommon to be the only RN in a case especially during a call in. I have found that this doesn't cause too much trouble so long as the staff your with is well trained, in fact I think that I have learned more from the veteran CVTs and Rts than many of the nurses I have worked with. That having been said when my pateints crashing on the table having another nurse there is ideal. Often the techs are great at the technical stuff like prepping for intervention but aren't great at the assessment and tx of a pt going down the tubes. I have heard rumors of some labs running without any RN's but most nurse practice acts specify that a RN has to be the one giving the conscious sedation and that keeps us in the lab. It all boils down to cost and because of that high number RN labs are becoming a thing of the past. There is another forum called Cathlab.com that frequently has posts about this but I should warn you that it can be a little hostile towards RN's (my opinion) but it's a good place for cath lab info. Good luck with the changes and try to hang in there.

If your looking for a non invasive "pad" type device the D-Stat dry has my vote. It is similar to the closur pad but doesn't stick to your fingers and tear apart. I also think that I get better more reliable hemostasis with it. It requires a 10 minute hold and I have had success pulling even while Integrillin or Reopro are infusing so long as your ACT and BP are okay. Vasomedical makes this device, the same people that make Duett.

We use the Witt system in our cath lab also. Sometimes we have a RN recording and sometimes a tech records. We have an area for the doctor, nurse and recorder to sign on the Witt documentation. Ultimatly I feel responsible for what is recorded so I take a quick read thru the report before I sign it and if there are errors I have the recorder fix these and print out a new report. Sometimes these don't get caught right away esp. in an emergency but you can print a corrected report after the fact. Besides not wanting my signature on an incorrect or incomplete document, I also worry about a possible lawsuit in the future. I want to make sure if 2 or 3yrs down the road I have to give a deposition about a case I could look at the report and know what was done in the room. Our techs are usually very good about recording but if all else fails you could always make a quick note by hand. Trust me, I know how crazy it can get and I am sure I have signed Witt reports that weren't up to par hopefully none will come back to haunt me. On a different subject it is nice to see another cath lab nurse on this forum. If you haven't found it already there is also a forum for cath lab personel at cathlab.com.

These stories are great. Nothing is more entertaining than a room full of nurses talking about their most disgusting moments. Here are a few of my own, hope you enjoy... First one was told to me by a friend who is a resp. therapist ( I'm very glad I didn't experience this first hand) He was caring for a long term trach patient. This patient was non- compliant with trach care and had come in for a smelly fungal infection at the trach site. The therapist set out trach care supplies and started to review proper trach care when the patient told him that took to long instead she took the inner cannula out of her trach and sucked it clean!! Yes I said sucked it clean. The RT couldn't tell the story without gagging. The next two stories aren't that disgusting but humorous. I once cared for a parapalegic patient who used a texas cath. Well, I guess he had trouble keeping the cath in place so he decided to duct tape the cath to his member. Needless to say he had one nasty tape burn. The next story was from my nursing school days. I had clinicals with a very hyper , Type A nursing student. She had bathed her 80yr old patient and when I went in to she if she needed any help I noticed that her patient had a prolapsed uterus and the student had washed and powdered the entire thing!