What Do You Think?

Manual Pressure
I work in the cath lab. My main job is to hold manual pressure on all post cath patients. I am trying to find out how many cath labs use manual pressure compared to closure devices. Do any other cath labs have one person that is responsible for holding pressure? Thank you!

Tim Boylan
Email: hematomas69@verizon.net
Cc: cathlabdigest@aol.com

Cross Training with Recovery Unit
Due to some staffing issues in our cath lab and recovery units, our director of nursing wants cross-training between the areas. We are a 2-room cath lab that also does electrophysiology studies as well as pacer and ICD implants. In the lab, we have 3 full-time (FT) RNs, 1 part-time (PT) RN, 3 FT RTs and 1 PT RT. The 12-bed recovery area has 5 FT RNs and 3 PT RNs. Does anyone cross-train with their recovery area?
Our cath lab RNs do cover recovery for lunches and breaks. I am concerned about the constant changes within the lab and keeping the recovery staff up to date. Thank you!

Sue Irwin, RN, Cardiac Interventional Educator
St. Lukes Hospital, Maumee, OH
Email: susan.irwin@stlukeshospital.com
Cc: cathlabdigest@aol.com

Staffing with Case Fluctuation
I am doing some research into how to handle staffing when the census/# of cases fluctuates in the cath lab. Any suggestions about how to keep employees’ schedules relatively stable when the case load bounces around so much?

Lois Roorda, RN
Human Resources Business Partner
Banner Heart Hospital
Email: Lois.Roorda@bannerhealth.com
Cc: cathlabdigest@aol.com

Advanced-Level Physician Specialists
1. Are readers interested in attending an educational symposium presenting high-quality advanced board review programs for advanced level physician specialists who work within radiology-based or cardiology-based medical imaging departments?
The advanced level physician specialists would include nurse practitioners, physician assistants, radiology practitioner assistants, radiologist assistants, radiologic technologists who work in cardiovascular settings and have a desire to take the advanced ARRT examinations for Vascular Interventional studies (VI) and Cardiac Interventional studies (CI), cardiovascular technologists who are Registered Cardiovascular Invasive Specialists (RCISs) and other board-certified allied health professionals, who work in invasive and interventional cardiology settings, hold the CCI RCIS credential and /or have a desire to take the CCI RCIS exam or the new CCI EP Examination. The program would also be open to students and graduates who have to take board examinations that deal with medical imaging, patient assessment, pathophysiology, medical and surgical disease processes, etc.

2. How many readers who meet the descriptions listed above would be interested in helping develop a societal organization that would be in alliance with international certification credentialing organizations and would offer certification processes for an Advanced Level Cardiology Physician Specialist or an Advanced Level Radiology Physician Specialist?

We have the opportunity to develop the largest board review course that has ever been offered for those who have professional desires to function at advanced levels, especially in cardiac cath labs as well as radiology settings. Our goal is to offer a program which will not only satisfy the needs of advanced level physician specialists, but will establish unity amongst our valuable peers, the nurse practitioners and physician assistants. Those who have an interest, please contact the persons listed below as soon as possible. We need to have as much information from our readers no later then February 29, 2008 at midnight.

Jeff Davis, RCIS, RRT,
Director, Cardiovascular Technology Program,
Edison College, Ft. Myers, FL
Email: jdavis@edison.edu

Chuck Williams, BS, RPA-RA, RT(CV)(CI), RCIS, FSICP
Email: codywms@msn.com

International Society of Advanced Level Medical Imaging Physician Specialists Board of Directors to Begin
Would current physician extenders (nurse practitioners, physician assistants, RPAs, RRAs) who work in cardiology and radiology cardiovascular settings and have an interest in serving as an officer on the International Society of Advanced Level Medical Imaging Physician Specialists Board of Directors, please send their name and contact information to cathlabdigest@aol.com. Plans are to have this organization that will focus on continuing education needs for advanced level allied health professionals functioning on May 1, 2008.

Normal Caths & Standard Ambulation Times
How does your institution handle the following items?
1) Do you track normal cardiac cath numbers? If so, how? If yes, what is the criteria in place that defines a normal cardiac cath (i.e., no blockages greater than 15% in any major artery greater than 2mm diameter)?
2) What are the standard ambulation times after a diagnostic cath using 5 or 6 Fr sheaths, when the patient has not received heparin. How long do you keep patients on bedrest after hemostasis is achieved? (Manual holds only, no devices used for closure.) For those responding to this question, do you know of any studies or articles/research that supports this ambulation time?
Thank you!
Annie Ruppert
Email: Annie.Ruppert@sharp.com
Cc: cathlabdigest@aol.com

Data on Pre/Post Beds per CCL
I am looking for data or research that supports the number of pre/post beds per cath lab. Are there any guidelines on recommendations ratios? Thanks for your help.

Kind regards,
Melissa A. Muller
Cardiovascular Service Line Administrator
Bronson Methodist Hospital Kalamazoo, MI
Email: mullerm@bronsonhg.org
Cc: cathlabdigest@aol.com

Ambulation, T&S Questions
1. Does anyone ambulate patients to the lab (elective outpatients only)? Do they have criteria to assist with the decision to wheel or walk?
2. Do other labs require a type and screen on all patients pre-procedure? Is there a specific subset of criteria to meet for T&S requirements?
Thank you!

Terry Leonard, Unit Educator, Invasive Cardiology,
Stony Brook Univer. Medical Center
Email: tleonard@notes.cc.sunysb.edu
Cc: cathlabdigest@aol.com

Medication Errors
I was wondering if anyone knows of any studies on medication errors in the cath lab and statistics involving the errors (i.e., nurses vs. techs, intervention vs. diagnostic). I was wondering who commits the most errors and during what situations the errors are committed. I feel this would help the lab where I work with calling attention to some areas where we may not always look (not that we have many errors at all). We have a lot of relatively young staff and we may be looking at cross-training techs to give medications down the road. If you have heard of any studies or know of where I may be able to find this information, I would greatly appreciate it.
Thank you,
Mark Baker, MICP, RCIS
Email: cathtech99@yahoo.com
Cc:cathlabdigest@aol.com

ACT Check Prior to Sheath Pull
Our cath lab is currently reviewing and writing policies and procedures. We are currently reviewing standards for pulling arterial sheaths when heparin has been given as a bolus prior to a diagnostic procedure or during a peripheral intervention. Currently, there is no practice in place to check an ACT unless the physician orders it. Our Policy and Procedure Committee wants to implement a policy for checking an ACT prior to pulling the sheath.
What is your department’s policy/ practice, and what level of the ACT is deemed safe for patients?
Thank you!
Mike LeGal, RN, BSN, CCRN
Cardiovascular Lab Kaiser
Sunnyside Hospital and Medical Center Clackamas, OR
Email: Michael.R.Legal@kp.org
Cc: cathlabdigest@aol.com

Screening Criteria
We are a small rural hospital with one diagnostic cath lab and two cardiologists. We have been unable to locate any up-to-date screening criteria (the most recent American College of Cardiology guidelines are dated 2001). What criteria would you recommend that we follow to screen our patients (inpatients and outpatients)? We do not offer bypass or interventional procedures. The closest facility is 30 minutes away.
Thank you for your help.
Cheryl J. Harrell, RN and Lori A. McMahon, RN
Provena United Samaritans Medical Center
Email: Cheryl.Harrell@provena.org
Cc: cathlabdigest@aol.com

RCIS Mandatory?
We are thinking of making it mandatory for our staff to be RCIS-certified. Are there labs that have done this? What has been your process to implement this change?
Anonymous Email: cathlabdigest@aol.com