Chapter 7: Roles and Responsibilities in the Cath Lab

What certifications should ICVL support staff have?

• BLS — Basic Life Support

• ACLS — Advanced Cardiac Life Support

• PALS — Pediatric Advanced Life Support, if pediatric studies are performed

Why must team members understand each other's roles?

All team members should understand the responsibilities of other support staff, especially during emergencies

What information does the monitor/recorder document?

• Patient demographic information

  • Name, age, date of birth, MR number, case number, etc. 

• Hemodynamic data

• Blood pressure, O2 sats, heart pressures 

• Medications administered

• Sedation, intracoronary, emergency

• Catheters and other equipment used

• Anything that enters and removed from the body 

• Angiographic views

• Coronary, DSA, frames/sec

• Complications

• Dissection of vessel, acute closure of vessel, etc. 

• IV infusion volume

• How much IV fluid was given

• Contrast medium dose administered

• Total of contrast

• Fluoroscopy time

• How many minutes of fluoro used

What is the main responsibility of the monitor/recorder?

Accurately enter and document procedural information throughout the case

Where does the scrub assistant work?

Directly assists the attending physician at the procedure table

What PPE does the scrub assistant wear?

• lead apron

• surgical gown

• sterile gloves

What does the scrub assistant prepare?

• Access site(s)

• Patient draping

• Contrast medium and saline delivery lines

• Sterile instrumentation table

• Sheaths, catheters, guide wires, and other invasive equipment

What does the scrub assistant do during the procedure?

Assists the physician with:

• Catheter and wire exchanges

• Placement of interventional devices

What are important medication safety practices?

Properly identify all drugs on the table with sterile labels

How should catheters be handled?

• Pre-flush catheters

• Store them lengthwise on the table

• Flush catheters between each contrast injection

What should never be done with a needle and guide wire?

Never thread a needle over a guide wire

How are manifolds/injector tubing handled?

Prep the manifold or power injector tubing and ensure all connections are secure and check for leaks before use

Why must air be prevented from entering the system?

Preventing air is important to avoid embolism and ensure accurate fluid delivery

Why is equipment check important?

To ensure each device is compatible with the sheath and procedure

What should the scrub assistant anticipate?

The physician's and patient's needs

What technique must always be maintained?

Aseptic technique.

Before the procedure begins, what should be done with imaging/recording systems?

Switch them on and allow them to warm up

What should be checked regarding supplies?

Review stock levels

What should be reviewed before the procedure?

Review the patient and procedure schedule

What areas need cleaning/preparation?

• Procedure table

• Tray used for sterile procedural equipment

Before the procedure, what should be done with contrast injectors?

Turn on and load mechanical/power contrast injectors

What should be done with the defibrillator?

Test it and leave it on all day

What should be done with emergency supplies?

Ensure they are stocked and readily available

When must consent be signed?

Before any sedation is given

What patient information should be checked?

Check lab results and confirm allergic reactions

What positioning/preparation is required?

Position the patient on the table and check that the cannula is positioned correctly

What should be checked regarding IV access?

Make sure the IV line is working

What should be checked in diabetic patients?

Measure blood glucose levels

What monitoring equipment should be attached?

• Pulse oximetry

• Noninvasive blood pressure monitoring

• ECG electrodes

What should be done to maintain patient comfort?

Keep the patient warm

Where should the patient's hands remain?

On their side

How much should the patient move?

Move as little as possible during filming

What should the patient do during an angiography run?

Breathe in deeply and hold their breath while the angiography run is filmed

When can they breathe normally?

Resume normal breathing when the angiography run is finished

What symptoms should the patient report?

Tell staff if they feel unwell or are in pain

How large should the prep area be?

At least a 5-cm radius from the intended insertion point

What is most commonly used for disinfection?

Chlorhexidine prep

How should chlorhexidine be applied?

Begin at the intended puncture site and move outward

How many preps are required with Betadine?

Three preps

What must happen before sterile draping?

Skin must be completely dry

How is the lead shield prepared?

cover it with sterile plastic covers