I manage a small cath lab where the staff is integrated in job responsibilty (with the exception of medication administration). When a sheath is needing to be exchanged, we wait for the physician to arrive, perform our "time out", re-anesthetize the groin and proceed with sheath exchange. If initial access was an issue, then we practice better judgement and wait for the M.D. to do the exchange. Hope this helps.:redpinkhe