rad-angio nursing 1970-2006

Kristej · Jan 18, 2006

I've done cath lab since 1999. I don't know all the answers, but am willing to try to help you. Just let me know what you need and if I don't know the answer, I'll find more info for you. I've worked with some great cath lab nurses that are more than willing to share!

Editorial Team / Admin · Jan 18, 2006

am ruminating on this, putting thoughts together . . . have been in the cath lab total of 26 yr (interspersed with ICU and PACU), out of a 30-yr career. I'll be back later once I sort things out. :)

sharshar · Jan 18, 2006

thanks for the quick responses. i sense, for example, that the biggest changes in cath lab nursing are an evolution from functional (sterilizing and setting up trays of instruments), and assisting the radiologist, to nursing assessment, interpretation of ekg, and knowledge of sophisticated equipment and materials. i remember in angiography (peripheral not cardio) we didn't even have an ekg. this was in a large and progressive los angeles inner city hospital. we had a maximum of 3 catheters that we used for about everything! we were limited to diagnostic angiographic procedures. when did it all change? was there a turning point? because i have been away from the cath lab so long, it seems to me that the change was explosive. even now, we have a hard time to keep up with the pace of change in a large university hospital! if you can fill me in on what you remember of the years i have missed, i would be grateful. sharshar

Editorial Team / Admin · Jan 19, 2006

OK, I'll try to touch all the bases (at least, the ones I remember on the playing field that kept changing, lol!):

When I first started Cath Lab, in 1978, our duties were to set up the table, monitor the pt's VS, LOC and EKG, medicate (whatever was needed. We learned the table controls (it was a cradle) and how to run the "E for M" (Electronics for Medicine) machine to record the pressures. We developed the paper (mixed the chemicals, even ). I think we had a sedation sheet for charting. Occasionally we scrubbed in (that was the exception); the nurse and the tech and the cath assistant all circulated, opening catheters and positioning the table. We also "zeroed" the pressure transducers (attached to the side of the table, and needed sterile dome with sterile NS in them) once a week, with a manometer.

Fast forward to 1980 (yeah, I know, only two years later!), another facility, in their combination Cath Lab/Angio suite. One room: tech started all the IVs, I set up the table, administered the meds, monitored the pt (I think the second tech recorded all the pressures, meds, etc). The Cardiologists pulled the sheath as they were heading out the door, pt on the gurney, and held pressure during transport. Angioplasty was the "NEW" thing we didn't do any PTAs, let alone any PTCAs. I worked with a Dr. Simmons, who developed radiology catheters (with the Cook Co. --- ever heard of the "Simmons Catheter" for selective cerebral imaging? that's him!:)); we used many shapes of caths, but mostly his and H-1s, pigtails . . Cardiology caths were the same: JL4, JR4, then the other sizes as the pt anatomy dictated. We did monitor NIBP, RR, HR (I recall a pheochromocytoma pt and we had just gained arterial access, and his pressure shot up to 330/210!! AMAZING!!) and EKGs, of course. As the only nurse, I guess I was kinda responsible for making sure the (reuseable) packs were sent down to get cleaned and sterilized every evening.

The Radiologist scrubbed in with the Cardiologist (those were the days!).

In 1982 I was at a different facility, working both Radiology and Cath Lab (we staffed the Cath Lab). We transported all the ICU pts down and monitored them for procedures, CT scans, IVPs, and other radiological exams. We cathed the adult and peds pts for voiding cystourethrograms. We started all the outpt IVs for CTs and IVPs, administered the contrast and monitored the pts for reactions.

Angios and Caths: we mainly set up and broke down; most of the time we scrubbed in with the Radiologist for the angios (I learned how to deploy coils) and with the Cardiologist for the caths. I was at the facility 21 yr, and in that time we went from reuseable pack to all disposable angio pack for cases. Changed from side-of-the-table transducers with the dome, to in-line disposable transducers (some physicians in some labs still prefer the ones at the side of the table).

We have always monitored the EKG, NIBP and RR. I'd say in the mid-to-late 80's the Pulse Oximeter became part of the standard for monitoring (I recall being at a meeting of the minds re: sedation, and hearing a GI doc argue he didn't need the oximetry monitoring, he's done fine all these years without it, and never had a problem, thankyouverymuch! He was overrulled, BTW, as anesthesia was present ).

Until the late 80's I don't think we had a sedation sheet (I may be a little off re: which year we didn't use them): we wrote a beginning and an ending BP, HR and RR on the technologist's run sheet.

I think in the early 90's and beyond is when Radiology really took off with procedures: Nephro tube placements (we prepared the pt and sedated and monitored); Sedations for MRI (that's when "conscious sedation" and limits for sedation and all that got developed at our hospital); renal transplant biopsies; administering and monitoring Dipyridamole for chemical stress tests in Nuclear Medicine; IJ-approach liver biopsies; TIPPS procedures; hepatic chemoembolizations; preop hemangioma embolizations; CT- and US-guided drainage catheter placements (another area where R&D has paid off, IMO: securing devices for drainage tubes); CT- and US-guided biopsies . . . just can't think of any more right now, although I'm sure we did more, lol!

Standards for monitoring - who may monitor and how to monitor - were developed. The MDs were actively discouraged from using Valium IV after one of them administered 40mg, I believe, for a cardioversion. The pt wasn't himself for a few days after that = very sleepy. VERSED became the drug of choice, actively promoted by the anesthesia crew); better ways of doing biopsies and drains, mainly coming from BETTER PRODUCTS (that's where the cost for R&D kicks in) for doing those. Better contrast agents came around, too. At first the cost was very prohibitive, although the merits of using the nonionic agents were clearly evident. A lot of hospitals developed guidelines for choosing contrast based on certain comorbidities or past contrast reaction.

In the end, our dept admin decided to go exclusively with the nonionics, based on their safety. He reasoned, he would like it given to him or one of his family, if they needed it; he calculated we could get a reduced price by buying "in bulk," and just went ahead and did it. At a county facility, no less! I have always applauded him for putting the patient first, in that instance.

Let's see, where was I? Oh yes. With the explosion of procedures (r/t development of new and improved tools and meds - such as streptokinase), we could no longer schedule ourselves around the ICU patients, and with a little kicking from the nurses (and a lot of support from our dept admin), we gave that task over to them, so we could concentrate on the dept.

We ordered stock and maintained supplies. We coordinated the various procedures. With the changes in "conscious sedation" requirements, no longer could we simply give a bolus of Versed and MS IV just before we started an angio or procedure, and then scrub in. We had to delegate one of us to primarily sedate and monitor. The techs learned to scrub in, or the MDs simply learned to do certain procedures (not usually angios) without a nurse scrubbed in.

We were still monitoring (never stopped, really) but now we were better at documenting. Oh, and along came the terms DRG and ICD-9 codes. We developed billing sheets for supplies used for procedures, as we had to enter all the supplies used, into the computer for billing! Add that to your "turnaround time!" :eek:

Closure devices!! What a good thing for the pts, not having to lie flat for 8 hr, but only 2 (or so)! As with anything, they have their pitfalls (and I know some MDs just don't use them, don't trust them or whatever). . .

PTAs, tPA infusions, urokinase (and it's disappearance and resurgence), --- our IR taught us how to make gelfoam "bullets" for use with coil deployment for, say, pelvic artery bleeder. OH, and uterine artery embolizations!

I guess I'm winding down here . . I feel I've wandered far astray from your original question (what was that question??? ). If you need something clarified, or specific details, let me know.

All I can say is, WOW, what a ride. :D

sharshar · Jan 24, 2006

thanks dianah!!!!! whew! i have read and reread your response. what a great anthology of cath lab nursing. i have to say some of your abbreviations have perplexed me a little. you can imagine, having lived outside of the country for 26 years, and working exclusively in french, my abbreviations are different....and usually opposite of yours (english). for example a cva in english is an avc in french...and so on. even after all these years, i am stumped while reading pt. histories. but you have outdone yourself with your answer to my question. as i was initiated to the cath lab in 1974, i can identify with much of what you described as you tasks early on. i did my own cleaning, setting up trays and sterilizing instruments, etc. i have never used conscious sedation. even now, in europe, many labs don't. but thanks for all the useful info. if i have more questions, i'll ask. if you have any more thots, just add them. i check the site every 2-3 days...sharshar

Editorial Team / Admin · Jan 24, 2006

Ahhhhhhhhhhh, vous-vous parlez Francais? Moi, j'ai oublier beaucoup! Apres quatre ans des classes de francais en ecole secondaire --- mais plus de 35 ans ago!! Sans doute, ma tete n'est pas la meme!

Yeah, well, I certainly out-did myself there, showing my ignorance, lol! Glad you found a few useful tidbits out of my previous post. I'm here pretty frequently, you're welcome to PM me. Good luck!

(BTW, in which French-speaking country did you recently practice? Tell of your experiences! Cross-cultural nursing!! :))

sharshar · Jan 25, 2006

i have been living (26yrs) and working (16yrs) in french-speaking switzerland. you do real well in french! your tête is just fine! i didn't have any problem getting my licence to work here, as i have always kept a current licence in the states. i had worked in psycho-geriatrics for 13 years while my 3 children got old enough to go to school. then i took a refresher course, and 2 yrs later started in the cath lab . voilà! my working language is french, but i use english and german regularly. as switzerland has 4 national languages, and we have an unusual number of foreigners with international organizations and european and international headquarters, etc..i can easily use 3 languages several times a day!! the interdisciplinary team i work with is multinational, and i love it! it is difficult for me to compare working here to working in the states..as i worked in the operating room last time i worked there and that was in 1979. my guess is that it is more expensive there, and is complicated by the medical-legal issues that we are not yet too exposed to.. but you are lightyears more organized in the cath lab. my dad was stented twice in the last 4 years, and i saw the neat way things are done there...and could only wish...... so there is an abridged version of my experience working here. sharshar

Editorial Team / Admin · Jan 26, 2006

What a great experience for you!! I've used a little French in my years of nursing; have used much more Spanish (which I learned on the job!).

If I ever got the chance to travel, I'd love to see Switzerland (and maybe bug you at work, lol!). I did go to Paris twice :).

Do you do Radiology Nursing as well, or are you exclusively Cath Lab?

I see you just recently joined allnurses; a belated Welcome! I'll be interested to see more posts (join us in the Break Room for some fun, too!), and to hear more about what you do. It's always good to network! --- D :)