cathlabrn

I am not sure what your duties are but these departments do require sedation. We are required to have ACLS to give sedation. I have been a cath lab nurse for 8 years and I came from a strong cardiac background. In our cath lab, you need to be a strong, independant nurse. Many times we manage urgent/emergent situations. I can't imagine doing this job without cardiac background. Even minor procedures or patients in recovery can go bad. I'm sure you're a great nurse. Good Luck!

You always hope that grafts will last a long time. However, over time they could occlude. A patient could either need bypass surgery again if he is symptomatic. Many times if it is many years later, when you do the angio you may find the graft down but the patient has built collaterals and therefore would not require another surgery. If needed, often times you can do plasty on grafts. There are many different scenerios. I have seen patients come with 20+ years on their grafts and they are all patent. Hopefully he will work on keeping a healthy lifestyle and take his medication. That is so important!! If he hasn't converted his rhythm with meds, then cardoversion is worth a try. Sometimes you just can't convert them and they have to be managed with meds. You might convert him and then he'll flip back again later. Cardioversion can be done more that once. However if that rhythm is stubborn, many people live with fib and get managed on meds. All of this stuff is scary for patients and their families. Over time they adjust and get more comfortable with their conditions/treatments. Good Luck!

I'm not sure if you mean SL or a Nitro gtt. With a pressure in the 90s, and chest pain, I would try the Nitro, especially knowing he's got severe disease. It's really necessary to dialate those arteries, and the nitro can do just that. If the pain continues and the BP gets lower, there's always Dopamine and a trip back to ICU. Just stay with him and watch him close (as I'm sure you were). It's always good to wait and do bypass after they cool down from a big MI, whenever possible. Their chance of a good outcome is better, hopefully less complications. Sometimes they just can't wait as was the case with your patient. You did a good job!! Sometimes you just have to hound those docs!! Hope your patient did well.

Try this job for awhile. Set a time frame, if you don't change your mind in 6 months, then move on. For now accept the challenge and give those patients great care. A step down unit is a great place to learn. You will care for so many different types of patients. We changed a med/surg unit to a tele unit about 10 years ago and the staff didn't like it, but many of those nurses stayed and are still working on that unit. You are a great nurse and those patients will be glad you are their nurse!!

We have done quite a few radials but I have never heard of a TR band. How does it work? We just use a syvek with a radial pressure band. You just tighten manually around the wrist. We can usually close a diagnostic within 20 minutes. We used to do alot more radials but the docs didn't love them. Sometimes we ended up accessing the groin also because we couldn't get to the artery well enough to do PTCA. We angioseal groins most of the time. We haven't really had much trouble with it. In fact we love it.

I definitely remember the Bad ole days, dutchgirl. When we first started angioplasty, you could count on v-fib showing up more than once in a case. Complications were part of everyday life. Stents are wonderful, but it took a while to get them perfected, that't for sure. And then, it took forever to stop groin bleeding. You could barely chart when you got done because your hands were so stiff. Things are better for everyone, staff and patients. Life is good! Now, we concentrate on door to balloon time. How's everyone doing with that? Our average, off hours is 67 minutes. Keep up the good work everyone! Cath lab nurses are awesome!

:redbeathe I have been a cath lab nurse for 8 years. It's been a great job. So much has changed for the better in this time.

They can be rolled onto their side with pillow support behind them. They are still able to keep their leg straight and also to get off of their back. Also, have them bend up the unaffected leg. This takes pressure off of their back. A rolled blanket or a semi-flat pillow under both knees often helps. We have become very creative over the years.

I have pulled alot of sheaths. I think the two finger method works best. Make sure you find that pulse and get on it. Hopefully, you are using some type of closure patch to help you out. The c clamp is great and saves your hands for charting afterwards. We use the 10 minute, no-peek rule also. Make sure the bed is at a good level for you. Your wrists are probably fine, just have to get your technique down. Good Luck.

Try checking his pulse when this happens. He may end up needing a pacemaker, or his meds changed. I would definitely call the cardiologist.

I started on a very busy IMCU right out of nursing school and got plenty of med/surg experience. It was a very hard place to work but I learned alot. I am glad that I started there.

We are having alot of issues with blanket orders such as, "continue previous orders", "continue home meds", etc. Even after a procedure such as a normal angiogram, insertion of perma-cath, uneventful angioplasty they want us to rewrite the orders including all previous meds. For many patients this is alot of rewriting which many of us feel is increasing our risk for errors. I am just wondering what other facilities may do to continue things as they were after a procedure is done off the unit/floor.

I've been a cardiac cath nurse a long time and I think every case is different. Whatever it takes as long as the patient is responding to your efforts in some way. Sometimes multiple shocks and drugs can get you through until you can finish a much needed intervention. I also think it is very important to know your patient's wishes whenever possible, although that is tough with the ED patients.

We try to use angioseal whenever we can. It has been great. We used syvek for years, but then changed to Chito and really haven't experienced any problems. What problems have you been having? What is your ACT required before pulling? We have used the new syvek NT and are not super impressed for routine sticks. It seems to be an advantage for large sheath sizes, which we use rarely.

I have worked as a cath lab rn for 6 years. We have only one rn cross trained and that was his choice. Our call teams consist of 1 rn and 2 techs. Our techs are awesome. With the exception of a couple, our techs are great in an emergency. If we need an extra set of nurse hands, the icu has always been there when we need them. I think working as nurse only makes it easier to be the patient advocate we need to be, and pay close attention to the patient's needs. We don't get involved with which wire might work better, what guide has a better fit, or stuff like that. Good Luck!