I have been working in the United kingdom as a qualified nurse for nearly 5 years. I initially worked for a year in an infection treatment ward followed by a 2 year post in the Accidents and Emergency Department. At present, I am in my second year of working in the Cardiac Catheterisation Laboratory (CCL) and I have been enjoying learning new things in this area. To give back, I want to share this experience to my fellow nurses who are interested to work in this field of nursing. In the process of building a network, I want to learn from experienced colleagues.
Cardiac Catheterisation Laboratory or what we usually call the “Cath Lab” is a special department in the hospital where minimally invasive cardiac procedures are performed such as angiogram, angioplasty, ablation, pacemaker insertion and many more. The main goal of CCL is to diagnose, evaluate the heart function and treat cardiovascular diseases.
In a cardiac catheterisation procedure, various wires, sheaths and catheters along with an imaging equipment or x-ray are all utilised to view and access the heart of a patient. Medications and other medical supplies and equipment will be used depending on the type of procedure.
The team I work with is composed of interventional cardiologists, physiologists, fellow nurses and radiographers. The operating cardiologist is usually supervised by a consultant and assisted by a scrub nurse and a circulating nurse. The physiologists are responsible for monitoring changes in the heart function and rhythm and radiologists, on the other hand, manoeuver the x-ray machine at different angles.
When performing a coronary angiogram, a catheter is inserted through a plastic introducer sheath (a short, hollow tube that is inserted into a blood vessel in either the leg or arm). The coronary catheters is guided through the left and right coronary arteries with the aid of an x-ray machine. Contrast solution is injected through the catheter to view the vessels of the heart.
When a block or narrowing in a coronary vessel is identified, an interventional procedure is conducted. This consists of an angioplasty, stent placement, rotablation or the use of a various balloons. Basically, the purpose of this is to revascularize the heart by opening the narrowed artery.
Other cath lab procedures
In the CCL, procedures like ICD and pacemaker insertion, electrophysiology studies, ablation procedures, mitral valve repair, TAVI and many more are also conducted.
Pre-Procedure Nursing Care Routine
When I started working in the cath lab department, I was initially placed in the cardiac day ward. I instantly felt comfortable because I have been exposed in the medical and surgical wards both here in the UK and back home in the Philippines.
The best thing about working in the cardiac day ward is that I would only handle day cases; meaning we release patients after their procedure or relocate them in an in-patient ward if they need to stay overnight. Also, I was surprised to learn that the nurse patient ratio is 1:5. (Pausing for a moment) I am not kidding. Having 5 patients or less in a day, though sometimes challenging, is something a nurse wont complain about if he/she experienced looking after 12 or more (using holistic approach).
When a patient arrives in the cath lab, they are received by the receptionist to confirm their appointment. Then, the patient is admitted in the in cardiac day ward to a bed or chair depending on the type of procedure he/she will have.
In the cardiac day ward, my usual routine starts by making the patient comfortable and of course establishing rapport. I’d take the vital signs and ECG. We have to accomplish a form/ checklist, which helps us identify and record the profile, medical history and list of medication. I’d also put an IV cannula and collect blood specimen particularly a full blood count, renal profile, coagulation, group and save lab request. For infection control reasons, I’d also swab the patients to check for their covid and mrsa status. I’d put the patient in a hospital gown and ensure that they emptied their bladder before they’d go inside the lab.
Ensuring that they signed a informed consent is also an important aspect that we need to check before procedure. As a patient advocate, I make it habit to check if the patient understood the procedure he/she is having. Since radiation is used, a woman in a child-bearing age should have a pregnancy test. Any sensitivities or allergic reactions must be clarified. In addition, I must check if the patient needs to be loaded with medication like aspirin or clopidogrel prior a procedure. If the pre procedure form and all the checklists are ticked, then the patient is ready for the procedure.
Nursing Care During the procedure
The team, lead by the cardiologist, will gather for safety checks in the lab. We each introduce ourselves to the patient prior to the procedure. We re-identify the patient, validate the consent, check for allergies and so on. In the lab, I can be either a circulating nurse or scrub nurse. Basically, the nursing responsibilities are focused in monitoring the patients and ensure that they are comfortable. Ensuring the sterility of the lab and completing the medical equipment and supplies needed for the procedure are paramount nursing responsibilities. Emergency medications and other necessary drugs must be available within the lab.
Post Procedure Nursing Care Routine
The nursing care of a patient after a case will depend on the type of procedure he/she had. Generally, the main goal is to help patients recover from the procedure. What I tend to check first is to identify the closing device a patient has whether it is a TR band or an Angioseal. For devices, I would assess if the patient has sutures and check the type of dressing they have. Of course, I’d monitor observations by connecting patients to a cardiac monitor including their neurovascular condition. These are necessary interventions, which includes looking for any signs of complications such as bleeding, haematoma, extreme pain or inflammation especially for a patient who had a percutaneous coronary intervention, ablation or any implanted devices.
A post procedure ECG should also be done and see if the patient needs to have medications taken or a special procedure like a chest xray or a v-scan. Since the patient was fasting prior, I’d offer them food to eat or something to drink. Encouraging fluids is also a must to help the patient excrete the contrast introduced in his/ her body. I also make it habit to check for the cath lab report done by the doctor and relay it to the patient.
Based on the outcome, the patient may either be discharged or admitted. For patients who needs to be discharge, I have to make sure that the patient has fully recovered. I have to note if a responsible individual will collect the patient, if transport is available and if the To Take Away (TTA) medications were ordered. Copies of the report or discharge letter must be printed must be given to the patient. And lastly, ensure that the patient has no contraptions attached or remind them to bring any device that they need to plug at home. On the other hand, a patient who needs to stay in the hospital needs to be fully admitted.
Cardiology and Nursing
So far, my exposure in cardiology is fun and enjoyable because I am learning new and exciting aspects in nursing. It feels like I am regaining a part of me who was once thirsty for new knowledge.
Looking forward to write more about my experiences at this point of my nursing career. It’s exciting because it feels like it will give me opportunities, which I never fully enjoyed before. *cheeky wink*