Ask the SICP!

This month's first question comes to us anonymously, and is answered by Kenneth A. Gorski RN, RCIS, FSICP, Assistant Manager for the Cleveland Clinic Cardiac Catheterization Laboratories, and Standards Committee Chair for the SICP. Question 1: Are any formal job delineations for the RCIS licensure that can help to establish role responsibilities in the cardiac cath lab, which have recently been curtailed at my facility? The RCIS Scope of Practice (as defined by the Society of Invasive Cardiovascular Professionals) in the cardiac catheterization laboratory covers all roles/functions. Here is an excerpt from the Scope; I have underlined a couple important points for emphasis: The Society of Invasive Cardiovascular Professionals (SICP) maintains that all invasive cardiovascular professionals, with or without formal cardiovascular academic training, should demonstrate knowledge and competence through education and certification in advanced cardiac life support (ACLS/ECC) and the achievement of invasive cardiovascular credentials RCIS (Registered Cardiovascular Invasive Specialist). The credential RCIS offered by Cardiovascular Credentialing International (CCI), has been recognized as the cardiac cath lab credential of choice by the American College of Cardiology (ACC) and by the Society of Cardiac Angiographers and Interventionalists (SCA&I), an organization founded by the pioneers of cardiac catheterization, Mason Sones and Melvin Judkins, to ensure proper training and the maintenance of high standards in invasive cardiac laboratories. For these reasons the Society of Invasive Cardiovascular Professionals has chosen to develop a unified scope of practice for the Invasive Cardiovascular Specialist, this scope of practice encompasses the responsibilities and functions, which may be normally reserved specifically for registered nurses and radiologic technologists in departments other than the cardiac catheterization laboratory. It is mandatory that all personnel be given additional education and training when assuming responsibilities for which they have not received formal education. Personnel should not assume responsibilities for which they are not adequately prepared. It is the obligation of the employing institution to validate an employee's credentials, preparation and knowledge base for which he/she is hired to assume. Ultimately, the responsibility of the cardiac catheterization procedure itself remains the responsibility of the physician of record. Source: https://www.sicp.com/images/ Scope_%20of_%20practice.pdf The Scope of Practice may delineate specific roles and responsibilities, but it cannot supersede local laws or department of health codes. For example, in my state (Ohio), the administrative code specifically states that an RCIS or cath lab RN is allowed to position the patient, pan the table, and develop film (i.e., process quantitative analysis, post process DSA), but we cannot step on the fluoro pedal or adjust radiographic technique. Then there is the issue with administering medications. The RCIS board does test cardiovascular pharmacology and dosing, more so than my state nursing licensure exam did. This includes critical thinking questions, and covers moderate/ conscious sedation pharmacology. My institution does not allow non-RNs to administer intravenous medications while circulating. According to my friend and colleague Patrick Hoier (who is also on the SICP Professional Standards Committee), every state is required to have a statute outlining the ability of a non-certified/non-licensed person that would be responsible for medication administration. This statute is what allows nursing aides and med techs the ability to administer/give medications. According to these statutes, it is possible to train individuals to give medications (and may include IV medications) as long as the statute's rules are followed. These statutes often require a minimum educational requirement and testing, annual competency reviews, and supervision by a licensed individual (in the case of the cath lab, most often the cardiologist). Each state may have a different wording in the statutes, and some are more restrictive than others. Some states may also specify that inserting arterial lines (which would include sheaths) may only be performed by a licensed physician. One thing to remember is that the RCIS is not a licensure; it is a professional practice credential. The credential has been around since the early 1970s. It originated with 2 levels, as CCPT and RCPT (Certified Cardiopulmonary Technologists/ Registered CPT). It evolved into the CCVT and RCVT (Certified/ Registered Cardiovascular Technologists). Eventually, through mergers of credentialing organizations, the certification levels exams were dropped, leaving just the RCVT. The RCVT was renamed RCIS (Registered Cardiovascular Invasive Specialist) in the early 1990s, to make the credential more appealing to RNs working in the cath lab. Use the Scope of Practice and seek the support of your cath lab medical director, some of the other cardiologists, and lab manager. Hopefully, your lab has in place training documentation and annual competencies to support the job responsibilities they have recently limited. The following question is answered by Todd Chitwood, RCIS, SICP Representative to the CARE Alliance: Question 2: I would like to get some clarifications on the CARE Bill for a cath lab/EP lab. 1) Does the bill state that anyone who inputs data, moves the table, or position the x-ray tube has to be RCIS-certified? Our techs input data into the x-ray machine and brings the tube in at the start of the case but the physicians are the ones who pan and x-ray. 2) Does the bill also state anything about a tech who scrubs but does not do anything with the x-ray, or is this bill strictly for those involved directly with using the x-ray? The CARE Bill, as it pertains to the RCIS, is just what was printed in Cath Lab Digest in the November 2006 CARE Bill article (available online at https://cathlabdigest.com/article/6449). RTs, etc., would not have to become RCIS-credentialed to continue to operate imaging equipment. Rather, the Bill would include the RCIS as operators. As written, and if passed, the CARE Bill would permit the RCIS to operate imaging equipment in the invasive cardiovascular lab, which would include the duties outlined in the RCIS scope of practice (see below). The verbiage in the Bill originally contained the scope of practice for the RCIS, which stated: Cardiovascular invasive specialist means an individual other than a licensed practitioner who performs a comprehensive scope of invasive cardiovascular and peripheral vascular diagnostic, therapeutic and interventional procedures under the supervision of a licensed practitioner through the use of fluoroscopy or utilizing equipment, which emits ionizing radiation, and who has met and continues to meet the standard. However, at the Alliance meeting in August 2006, it was decided that the RCIS scope of practice would be removed from the Bill. You should also know that all other professions removed their scope of practices as well, as it was considered a redundancy to include them in the Bill. The scopes of practice are well-defined by each of the professional societies. As far as inputting information into the x-ray system by non-licensed (RT) personnel, I would suggest checking with your state radiation board. In my state (Oregon), we are not allowed to power up the system nor shut it off. I hope this helps. Thanks for the question!

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