What do Cardiac cath lab nurses do?

[RN34TX]

I was wondering what are the duties and typical day of nurses who work in the cardiac cath lab. I've taken post-cath patients and understand the procedure itself, but what do nurses do who work in the cath lab?

Do they work mostly day shifts? 8 or 12 hours? Do they take call for weekends/nights in case of emergencies? Are families allowed in the cath lab during the procedures?

What skills are most important in this area?

[suzanne4, RN]

Assisting with the procedure, as a circulator would do in the OR.

Shifts can vary on facility, can be either 8, 10, or 12 hour shifts.

There is usually alot of call involved, if it is a busy unit.

Families are never permitted in during the procedure. It is done under fluoroscopy and the staff is wearing lead aprons.

Knowing cardiac rhythms on a monitor would be of the most important and what to do in an emergency. Codes can happen in the cath lab and do. A patient can have a reaction to the dye. Remember that the patient is not asleep for the procedure, is usually just given some mild sedation. They need to be awake to be able to turn as needed, as well as tell the Dr. if they are experiencing any type of chest pain during the procedure.

Hope that this helps.............. :balloons:

[dianah, ASN]

Yes, we do most of what Suzanne has posted. In some labs the nurses don't scrub and assist, they only sedate and monitor the patient. Other labs they may rotate tasks. But these days, the RN is the one who sedates the pt and monitors him/her during the case, which includes watching the monitor like a hawk for any changes (know your rhythms), and be ready to defibrillate or hang drips or whatever is needed, as the pt's condition warrants.

Suzanne is right, codes can (and do!) happen in the lab. Difference is, you usually have a Cardiologist right there in the room, and hopefully s/he is good during a code!

We are all ACLS-certified, and have come to the cath lab from ER/ED, ICU or PACU backgrounds.

Our lab shifts are 8hr, others are 10s or 12s, as Suzanne has posted. Most labs require staff to take call.

The patients are minimally sedated, as they are asked to take a deep breath for most of the coronary injections. A deep, slow breath moves the diaphragm down, which provides a better image of the vessels. And one ALWAYS wears a lead apron during fluoro! All persons in the room also wear a radiation monitoring badge, whose innards are sent in to a center every month, so each person's radiation exposure is monitored monthly.

Most labs have C-arms now, which the Cardiologist or assistant rotates around the patients, to obtain different views of each coronary artery. Some (very) old labs may still have a table that is tipped (by the Cardiologist or assistant) from side to side, under a stationary Image Intensifier (fluroscopy tube). The C-arms make it VERY easy to obtain specialty images (cranial and caudad, as well as RAO and LAO -- say, a 55 degree LAO with a 30 degree cranial tilt) that open up the different vessel areas.

The RNs check on pre-cath labs (is the K+ elevated or low, what is the BUN and creatinine, the platelets -- oh, why is the white count elevated??? No, we don't cath a pt with a 8.0 hgb, please work the pt up to find out why the hgb is so low . . .), as well as allergies (especially to iodine contrast), and any other condition that may increase the risk-to-benefit ratio for this exam. For example, can the pt lie flat for about an hour or an hour and a half? Some pts in failure MUST sit up in order to breathe, so they would be unable to tolerate lying down for the procedure.

We also implant permanent pacemakers and, at another lab I worked, ICDs as well. I have scrubbed and assisted on both.

I guess I don't need to say, I think it's a VERY interesting area! (by the way, we also help sedate for TEEs and help in the stress lab, starting dobutamine drips for the "chemical" stress tests).

Suzanne is right; I have never heard of a lab allowing family members to watch. If we did, and a watcher gets ill or unruly or doesn't understand what's going on (which is 99% of the time), our job is to take care of the pt, not to add another pt (the fainted or unruly family member) or to spend time explaining what's happening/what we're doing. Our aim is to be as gentle, efficient and expedient as possible, as increased "catheter time" (time the catheter is in the pt) increases risk of complications.

Arggggghhhhhhhhh, I see I've written another book! Sorry to go on so; PM me if you have any specific questions.

Thanks for the springboard, Suzanne! :)