|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 96-97
Nurses in cardiac catheterization laboratory: An important pillar of “heart team”
Surender Deora1, Nipin Kalal2, Kuldeep Singh1
1 Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Submission||21-Dec-2021|
|Date of Acceptance||30-Mar-2022|
|Date of Web Publication||16-May-2022|
Mr. Nipin Kalal
College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Deora S, Kalal N, Singh K. Nurses in cardiac catheterization laboratory: An important pillar of “heart team”. Heart Mind 2022;6:96-7
The practice of interventional cardiology and the role of nurses in the management of cardiac patients is widening and changing with time. With the rise of sophisticated coronary and structural heart interventions, the necessity for a Heart Team approach has grown. The concept of “Heart Team” has come into existence after the publication of SYNTAX trial and has been endorsed as Class I recommendation by the European and American Society of Cardiology. It is not “I” but “us,” that's the concept of “Heart Team.” From the planning of the cardiac intervention until the patient is being discharged, the team members are involved in decision-making and management. But still, the “Heart Team” approach has not been implemented because of various reasons such as lack of knowledge, proven benefits, and logistical issues.
Although nurses are involved during various cardiac interventions in the catheterization laboratory (Cath lab) and act as the first responders, still, a gap is felt in understanding with unmet expectations from either side. Now, the field of interventional cardiology has widened its scope by introducing various structural heart interventions such as transcatheter aortic valve replacement (TAVR) or transcatheter mitral valve repair (TMVR), and it is time that the nurses should be aware of these new procedures and their associated hemodynamics. “From acting as the first responders” to being an important pillar of “Heart Team,” the nurses are expected to understand their role and update themselves regularly. The case should be discussed in detail with a cardiologist before the procedure is performed. Both cardiologists and nurses should value the importance of divergent perspectives. The following are key components of interventional procedures that nurses should be familiar with so that they may assist in treating patients in and out of the Cath lab.
| Cardiac Catheterization Laboratory|| |
The nurses must be familiar with the Cath lab because of its unique and different environment as compared to operation theaters. The temperature is lower in the Cath lab as compared to operation theaters and nurses must be aware of its effect on the hemodynamics of the patient as most of the procedures are performed in a conscious state. If the patient is uncomfortable and feeling cold, this may cause tachycardia and can change the measured hemodynamic values. Furthermore, the Cath lab is relatively a more crowded area with lots of equipment for cardiac procedures such as a Rotablator machine, intravascular ultrasound or optical coherence tomography console, etc. The anesthesia workstation is relatively away from the patient because of the movement of the C-arm, and therefore, all equipment for mechanical ventilation should be kept ready before the procedure. There are also various monitors in the Cath lab showing fluoroscopic live images, still, images, hemodynamic tracings, and nurses should be aware of it and keep a close eye on hemodynamics for any deviation.
| Radiation Exposure|| |
The Cath lab is a radiation-prone environment, and nurses, like the rest of the workforce, are in danger of radiation exposure. Particularly during cardiac emergencies, they may be at risk while gaining intravenous access, during oxygenation, or during endotracheal intubation because of proximity to the C-arm of fluoroscopy machine. The annual limit of occupational radiation exposure is 20 milli Sievert (mS) averaged out over 5 years with a maximum limit of 50 mS/year. The lifetime limit of radiation exposure is 10 mS times the age in years. Therefore, all protective measures should be taken such as wearing lead aprons, thyroid collars, and eye protection spectacles along with radiation dosimeters.
| Contrast Dyes|| |
Most of the procedures in the cardiac Cath lab are performed using either iodixanol (VISIPAQUE) or iohexol (OMNIPAQUE). There is always a chance of allergic reactions with these contrast agents and attending nurses must be aware of the type and total amount of contrast used. There is always a risk of contrast-induced nephropathy, especially if the baseline renal function is impaired or if high doses of contrast agents are used. Therefore, adequate hydration of the patient must be ensured during the procedure, keeping in mind to avoid fluid overload.
| Preprocedure Evaluation|| |
Specific cardiovascular evaluation should be done along with routine evaluation. These patients may have impaired left ventricular ejection fraction, high pulmonary artery pressure, or congenital heart disease that may affect the hemodynamics when any anesthetic agent is given. Obese short neck patients who are difficult for endotracheal intubation needs close monitoring. Caution should be exercised while giving sedation during the procedure because it may cause respiratory depression and hypoxia, making the primary operator confused regarding the cause of hypoxia and abnormal hemodynamics.
| Percutaneous Valvular Interventions|| |
In the past decade, much progress has been made in percutaneous interventions for valvular heart diseases such as TAVR and TMVR. The TAVR is done in patients with severe aortic stenosis with moderate-to-severe surgical risk. Usually, the approach is transfemoral, but if aortic vessels are inadequate to accommodate large sheath size, a transapical approach through mini-thoracotomy may be required. The role of nurses in a “Heart Team” starts from preoperative evaluation of the patient to local analgesia treatment during the procedure and until discharge from the hospital. In the present crisis of COVID-19 and in countries like India, the role of Cath lab nurses has increased.
| Catheterization Laboratory Nurse Educator|| |
Nurses play a significant role in the endowment of evidence-based care and the development of rehabilitation policies and protocols. It helps in hospital cost reduction, increases patient safety, comfort, and shortens the hospital stay. During discharge, the Cath lab nurses have to educate the patient and family members about immediate reporting if any symptoms develop. It helps in improving the quality of life and may reduce mortality.
In conclusion, the Cath lab nurses must be well versed in the hemodynamics of cardiac diseases and procedural details. They should update themselves regularly with continuing medical education and contribute their expertise to make the “Heart Team” approach successful.
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Conflicts of interest
There are no conflicts of interest.
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