Switching Specialties, EP or Cath Lab?

Editorial Team / Admin · Jan 18, 2020

Our Cath Lab nurses also function as EP nurses. During a cath they are cross-trained to function in any capacity: 1. At the computer, documenting the patient condition and catheters used, meds given, etc during the procedure; 2. Moderate Sedation nurse, administering sedation and other medications, monitoring the patient for changes, implementing measures for patient support during the procedure; 3. Either an RN or a tech scrubs at tableside, to assist the Cardiologist and/or Cardiology Fellow , hands-on, during the procedure.

The EP nurses are specially trained as well. For an ablation, at least two will set up the patient (this is quite involved) with electrodes positioned in proper areas on the patient's chest, to receive information from the various catheters. One nurse will scrub and prep the patient, but will often break scrub once the Electrophysiologist and the Fellow enter the room and scrub. They will gain access (usually four groin sites in the femoral vein). That nurse then becomes the circulator, performing q 15 min ACTs (if there is an arterial access as well, e.g., for an afib ablation). Another nurse administers Moderate Sedation, unless the procedure is done with General Anesthesia. A third nurse monitors the display of the many electrical signals received from the catheters, and initiates pacing from a specified spot, at the direction of the Electrophysiologist. At the end of the procedure the nurses will remove the groin sheaths, and hold pressure at the sites and provide patient instruction.

As we are a combination lab, Mondays are scheduled for device placements (dual or Bi-ventricular pacemakers, dual or bi-ventricular ICDs) or upgrades. Tuesdays are for out-patient cardiac catheterizations. Wednesdays are scheduled ablations. Thurs and Fridays are caths. Any day, the MDs may add in-patient needed catheterizations or device implants. We run two rooms, and switch off, and hopefully have enough nurses and techs to staff so we can bounce from room to room: when the MD is done in one room, another is set up and ready so he/she can keep up the flow!

Ask questions of staff at your facility, and perhaps go in to observe (maybe more than once, as days vary in their schedule and craziness). Let us know what you decide!

hcurry1 · Jan 20, 2020

Thanks for the response! What are your on call requirements like?

Editorial Team / Admin · Jan 20, 2020

Usually every third weekend, and we nurses split the weeknights, or (as I recall), we would do a week at a time, just to get it out of the way. We were allowed to work it out amongst ourselves. It was a small department, but busy, and a regional trauma center.

I am not on call in my present position.

guest769224 · Jan 21, 2020

On 1/18/2020 at 10:35 AM, dianah said:
3. Either an RN or a tech scrubs at tableside, to assist the Cardiologist and/or Cardiology Fellow , hands-on, during the procedure.

Dianah, at your facility you have an actual RN scrub in next to the physician? That's fascinating to me, because at my facility only a tech ever scrubs in, and the nurses always circulate doing meds, charting, supply retrieval, etc. Very interesting. I wonder if most labs have their RN's scrub in as well, and mine may be an outlier.

Also your description of the ablation process is fascinating. My facility doesn't do ablations so I haven't got to see any, but it sounds very involved with 3 RN's. I asked why we don't perform them and was told that ablations don't particularly bring in a lot of $ to the hospital.

You mentioned no call with your position? What do you guys do for 2 am STEMI's then? Or is it just you specifically that doesn't have to take call. If so, lucky ?

OP, when you mentioned living in a big city with bustle and hustle, that definitely may hinder your ability to respond to call time. Be prepared with a response during your interview on addressing how you would meet call times. Most Cath Labs are 30 minutes maximum from the time you get called in. During my interview, the staff and manager informed me that they were concerned and almost didn't call me because I lived 23 minutes from the facility. They we were worried I wouldn't be able to meet call times. I told them I would recreate for this position to a closer area, and I did. Is this an option for you? STEMI's have door to balloon times of 90 minutes maximum, so it's very important to be there as quick as possible when called.

By the way... I did ICU for 5 years and switched over to Cath Lab recently. Love it and haven't looked back. It's been the best career decision I've made so far.

Editorial Team / Admin · Jan 22, 2020

ICUMan, we are training a tech right now, to help scrub the cases and help with maintaining stock. She has OR experience so isn't a complete neophyte. ?

Perhaps the benefit of doing ablations reduces the number of admissions for afib w/RVR, and required cardioversions, and eventually maybe the pt can go off anticoagulants, with their inherent risks? Dunno, have never done a study. ?

We are 1/2 mile from a large sister hospital, who already maintains on-call staff. The Cardiology Fellows rotate between the two hospitals as well, and their Interventional Cardiologists come over occasionally to help staff for caths. Apparently it has not been shown to be cost-effective for us to be on call, for the small amount of cases that would occur. Our after-hour STEMIs are sent to the sister institution.

I am so glad you are excited with your area change! There is so much to learn, and it is cerebral as well as hands-on, as I'm sure you are finding! ?