Your Experience with Your Hospitals Cath Lab Personnel?

[Nursing_Mamacita]

So thanks to training, I had to spend 2 days in my hospitals Cath Lab. I had previously noticed that the ED and ICUs were their own "little town", as we call it, but I hadn't imagined that Cath Lab would be the same. Don't get me wrong, they didn't treat me badly, but it was just...awkward. Cliquish, very cliquish. Some of them even sat and bad mouthed nurses audibly in front of me. In our Cath Lab, there is only 1 RN, the rest are RCIS. The docs even loved them...and apparently they all go out occasionally and include the MDs. I mean daaaang, I can't even get docs to put in their orders half the time! haha.

So if you have RCIS in your hospital, what are their general regards toward other hospital personnel? Do you work in a cath lab? What is the general atmosphere of the unit?

[Anna Flaxis, BSN, RN]

I have to say that I'm sorry....just because a MI is unstable is no excuse for not bathing them. I have bathed an unstable vented bilateral ventricular assist device with an open chest, balloon pump and 14 pumps with a linen change....It can be done. Its hard work...but it can be done.

Stable or not...patients need to be clean...to feel cared for.....even if it is a face, mouth, pit and private...it's still counts....and washing crud off their feet doesn't include turning. If I recieved a patient that smelled...unless they were directly from the street.... I'd be pretty unhappy myself. I have worked both sides of the stretcher and I see both sides.

Surely you are talking about scheduled procedures here. You cannot possibly be advocating increasing door to balloon time in order to bathe the patient?

In my previous ED, the IV site requirements were specific. It had to be 18g or larger in the RAC. That was because of the layout of the table and for patient rescue. I can completely understand how frustrating it would be for cath lab personnel if they were consistently receiving patients without appropriate access. But rather than bashing the nurses, interdepartmental communication and education would be the appropriate avenue for remedying the situation.

My last place of employment was a very large facility, and there were a lot of sour pusses around. My new place is small and intimate. We have agreements between departments about how we will communicate with one another, and in general people treat each other with respect; it's more the rule than the exception.

I wonder if that's sort of the nature of the beast, that the larger the organization, the more impersonal and the easier it is for people to get away with treating each other badly?

[cardiacfreak, ADN]

I don't believe Esme was talking about ER to CCL, nobody in their right mind would take time to fully bathe a pt and delay intervention, however, that being said, if you have to wait for the team to arrive to the hospital in the middle of the night there is time to do a quick wash up. It doesn't take very long to use chlorahexadine wipes to wash someone.

I don't have a problem with the cath lab nurses where I work, some are just more likable than others. But then again I'm not at work to make friends, I am there to save lives and fight infection.

Esme12, I want to be just like you when I grow up.

[Anna Flaxis, BSN, RN]

Mmm, not really. If there is any delay in cath lab personnel arrival, we are starting Angiomax and Nitro gtts, placing a 2nd IV, etc.

[Esme12, ASN, BSN, RN]

Mmm, not really. If there is any delay in cath lab personnel arrival, we are starting Angiomax and Nitro gtts, placing a 2nd IV, etc.

Clearly..... if I was referring to a post open heart, open chest, bilateral assist device....I was referring to an inpatient. Although, I have been known to be liberal in my groin preps if someone was particularly odoriferous.... I mean you have to undress them anyhow....why not a little extra along the way.

I have to say that I'm sorry....just because a MI is unstable is no excuse for not bathing them. I have bathed an unstable vented bilateral ventricular assist device with an open chest, balloon pump and 14 pumps with a linen change....It can be done. Its hard work...but it can be done.

Stable or not...patients need to be clean...to feel cared for.....even if it is a face, mouth, pit and private...it's still counts....and washing crud off their feet doesn't include turning. If I received a patient that smelled...unless they were directly from the street.... I'd be pretty unhappy myself. I have worked both sides of the stretcher and I see both sides.

Surely you are talking about scheduled procedures here. You cannot possibly be advocating increasing door to balloon time in order to bathe the patient?

In my previous ED, the IV site requirements were specific. It had to be 18g or larger in the RAC. That was because of the layout of the table and for patient rescue. I can completely understand how frustrating it would be for cath lab personnel if they were consistently receiving patients without appropriate access. But rather than bashing the nurses, interdepartmental communication and education would be the appropriate avenue for remedying the situation.

My last place of employment was a very large facility, and there were a lot of sour pusses around. My new place is small and intimate. We have agreements between departments about how we will communicate with one another, and in general people treat each other with respect; it's more the rule than the exception.

I wonder if that's sort of the nature of the beast, that the larger the organization, the more impersonal and the easier it is for people to get away with treating each other badly?

Surely, I am not inferring the delay of an emergent procedure in order to give a bath.....

and don't call me Shirley...........(I couldn't resist....).

I think there are cultures within every facility...some foster this ridiculous animosity between departments....and encourage this deplorable behavior...which is completely unnecessary as far as I am concerned. I will always play the devils advocate and try to get folks to peek behind the curtain....take a brief walk in someone elses shoes. I encourage people to take a moment....a deep breath....and ask yourself....are you perceiving what is actually being said or are you just reacting to what you thought you heard. Did "your"(not you you the collective you) behavior play apart in this situation? How can I better this situation in the future? Middle child peacekeeper here.

I don't advocate bashing.....but some cultures are hard to break. AND I think some larger tertiary facilities can be more aggressive. I actually think it has to do with the dog eat dog mentality of the residents.....rubbing off on everyone else.

Trauma flight crews can also be conceived as being arrogant and demeaning. As a former flight nurse I was always glad to hear "Thank god it's you...so and so is such a ____!" However.... there were times that even I (and I have the patience of Job) was less than therapeutic in my communication when I was exhausted and the patient was critical and the local staff would become fixated on some minor detail that has absolutely no bearing on the patient nor the patients condition...I was, at times, less than patient in my response.

There are also times that or responses sound curt and dismissive.....but in reality we are taking everything in that is said....but have a thousand patient scenarios running through out heads to best plan what we need for flight and to get our behinds off the ground.

I don't advocate rude behavior....but I do advocate seeing the best solution and how to effect change.

[HikingEDRN, BSN, RN]

My experience with cath lab personnel has mainly been good but most/all of our transfers from ED to cath lab are emergent (no bathing ). Sometimes they are short, quick and to the point, but then again, sometimes, so am I. Considering I have had walk-in patients in the ED for no longer than 18 minutes, I think we work pretty well together.

[MunoRN, RN]

I've never come across a Cath Lab RN who expected a full bath, but everywhere that I've worked cleaning of the 'boxer shorts' zone has been mandatory, cath code or not.

[FineAgain]

Our Cath Lab staff has been known to be cliquish...I have had nothing but good experiences with them myself. And having been on the other side -- my husband had a STEMI and coded in the Cath Lab -- the entire staff bent over backwards to not only save his life but to make sure I was kept informed, and took the time to make sure I was okay. So if I ever run into an attitude from any of them, they have a "gimme" from me.

[Anna Flaxis, BSN, RN]

I've never come across a Cath Lab RN who expected a full bath, but everywhere that I've worked cleaning of the 'boxer shorts' zone has been mandatory, cath code or not.

We just have to make sure they're naked underneath their gown, but we're not expected to prep the groin. I did groin prep when I worked an inpatient interventional cardiology unit, but it has never been an expectation in the ED. Now granted, if someone has a code brown, I'm cleaning it up as efficiently as I can, but I'm not doing the groin prep.

[MunoRN, RN]

We just have to make sure they're naked underneath their gown, but we're not expected to prep the groin. I did groin prep when I worked an inpatient interventional cardiology unit, but it has never been an expectation in the ED. Now granted, if someone has a code brown, I'm cleaning it up as efficiently as I can, but I'm not doing the groin prep.

You might consider changing that to be an expectation in the ED, the more that can be done prior to the arrival of the Cath lab team the better, otherwise it's more likely to delay the cath. In three different ER's I've worked in it's been the responsibility of the techs to shave and clean the groins, I can't really imagine leaving that to the cath lab unless they are ready to take the patient before there is time to do it.

[Anna Flaxis, BSN, RN]

You might consider changing that to be an expectation in the ED, the more that can be done prior to the arrival of the Cath lab team the better, otherwise it's more likely to delay the cath. In three different ER's I've worked in it's been the responsibility of the techs to shave and clean the groins, I can't really imagine leaving that to the cath lab unless they are ready to take the patient before there is time to do it.

Not gonna happen. The cath lab is at another facility 12 miles away. Our goal is to get them to the receiving facility no later than 45 minutes of initial presentation in our ED. In the meantime, we have to get them naked, start 2 IVs, give ASA, NTG, and heparin, activate EMS, fill out the EMTALA transfer form, call report to the receiving facility, and get them out the door. Our guidelines for what we need to do came from the Cardiologist at the other facility, who designed the STEMI program that serves a large geographical region. He does not want to include anything not absolutely necessary prior to transfer, as rapid transfer is the goal. The process is streamlined for a reason. Adding another task would further delay transfer. Also, we do not have techs or CNAs in our ED.

At my old facility where we had a cath lab in house, we typically only had time to run a 12 lead, start a PIV if not already done in the field, and give ASA and Plavix by the time the cardiologist arrived, since there was a cardiologist on call in house 24/7, and cath lab personnel were required to be able to be in the cath lab within 30 minutes of being called in (so yeah, you couldn't take call for the cath lab if you lived more than 30 minutes away). I frequently gave the ASA/Plavix en route to the cath lab, since I barely even had time to get it out of the Pyxis and bring it to the room by the time the cardiologist swooped the patient out of there. I can just imagine the look on their face had I said "Oh wait a minute, let me prep the groin!".

[Altra, BSN, RN]

As I work in a hospital with an in-house cath lab, my experience is similar to Stargazer's description above -- IF the patient even stops in the ED. If the team is ready, the patient does straight there, without even a stop in the ED.

No such thing as groin preps. Gown, EKG, IV access, Plavix, ASA ... GO.

[emtb2rn, BSN, RN, EMT-B]

Same as altra & stargazer. Our goal is door to lab in 20 minutes.