Southern_RN

"Mash out" the hematoma. If the pt developes a hematoma... hopefully someone is holding manual pressure at the same time of mashing it out. A hematoma itself is not enough pressure to stop an active bleed. The standard hold time is 5min for every French size used. For example: 6fr sheath= 30min; 8fr Sheath= 40min. Only 10-15min of this time will be total occlusive pressure. A mere 5min of holding will not stop an active arterial bleed. The rebound alone will cause another. CathLab RN

In a-fib it is "ventricular stand still"-- just sounds more fun :chuckle

Keep fighting for your three 12's. Upon starting my last job, I was promised first chance on a day shift position once one opens. My NM was VERY passive aggressive. I was bounced from days to nights, even though my job description did not indicate I was "rotation". 2 months before leaving, a day shift position opened; no other night shifter wanted it. After expressing complete interest, I was told I'd "be night shift indefinately". My last schedule consisted of working 4 out of 5 shift types (7a-7p, 7p-7a, 11p-7a and 3p-11p) AND weekends. So, the moral of this story.... Dont take "No" for an answer, you will get walked on, LOL! In addition, talk to your co-workers. Maybe someone is willing to switch a couple shifts with you??

For unit experience, it depends who you talk to. My fiance (cath lab RN) worked CSCU recovering hearts, while some of his co-workers worked MICU. On the other hand, I worked step down and had no problems entering a cath lab position. Typical call to respond is 30min to meet door to balloon time. I have heard of some hospitals hiring staff who reside >30min away, but excluding them from the call team. This may be an option if amount of staff isn't an issue. Remember to sell yourself! High energy with a positive attitude and motivation to learn goes FAR! Best of luck to you!!!!

Just some rationale behind holding/giving the meds listed. ASA: give. They will be on ASA for a time after procedure, risks associated with bleeding are less than the benefits. Metroprolol: give (as long as HR >60, or per protocol). Beta Blockers help control heart rate, which in turn helps to decrease oxygen consumption of the heart. Pretty helpful in controlling chest pain while ballooning (blood flow is temporarily cut off distally) Metformin: hold. If possible hold 24-48hr pre-procedure. This is to help prevent nephropathy. Bumex: hold. 3 reasons... no one wants to put a pt on a bed pan/get them a urinal mid-cath (if the pt has no foley that is, lol) Bumex and other diuretics increase the chance of Contrast Induced Nephropathy post cath. In addition, a full bladder can cause oozing through the puncture site. If your pt is on a IIb-IIIa, you want to limit your ooz as much as possible.

Just clarify if it is a "Strict NPO" or "NPO except meds". Every MD is different, and contradictary to the previous answer posted, we request our procedure pts to recieve their usual meds (with the exception of glycemics and diuretics) with no more than 8oz of water. Just another perspective

I worked on a PCU before leaving for a Cath Lab position 5 months ago. I have decided to start preparing for the CCRN exam, even though I plan on taking the exam next year. In reading the AACN's elegibility requirements it states: "Critical care practice as a registered nurse is required for 1,750 hours in direct bedside care of (adult, neonatal or pediatric) acutely or critically ill patients during the 2-year period preceding date of application, with 875 of those hours accrued in the most recent year preceding application." I know that PCU is more for the PCCN exam, and Cath Lab for the CCRN exam. Would I fit the CCRN requirements in 7 months???