What Do You Think?

Questions Answered

Sterile Medication Distribution

Who can/cannot hand off medication to the CVT or physician on the sterile field? If the circulator is a CVT, are they still able to handle these medications and put them on sterile field? In our practice, medications are drawn up (at beginning of the day) and labeled by a RN; however, the concern now is that only an RN can take that labeled medication and give to the CVT and /or physician in the case. Thank you!

CLD posted this question on our Facebook page at www.facebook.com/cathlabdigest, and we received the following responses:

Barbara B.: I would think they would have to be handed off by the RN, if they are the only ones that can draw them up.

Ricky S.: As an RN, I was taught do NOT give meds drawn up by anyone other than yourself outside of your personal view. Meds drawn up at the beginning of the day by another nurse? I’m not going to give them.

You may also find a scope of practice issue. In some states, only a pharmacist can prepare medications to be given by another person. An RN drawing up meds to be used by the entire lab may be outside scope of practice as established by state nursing and pharmacy regulations.

The Florida RCIS

Does the registered cardiovascular invasive specialist (RCIS) have any restrictions in Florida with regards to creating fluoroscopic images? Does an RCIS have the legal right to press the pedal?

I have been asking the same questions for years. I have not found a decisive answer to date. I am hoping that someday we will find better clarification. I am assuming that the RCIS in question does not posses any radiologic credentials (ARRT, CRT, etc.) or radiological state license to practice; otherwise, this would be a mute point. The answers to these questions are difficult to find. Over the years, I have made several inquiries and calls to the Division of Medical Quality Assurance (MQA) at the Florida Department of Health. I have never received a conclusive answer to these questions. From a legal standpoint, it has been explained to me by various state personnel that the subject is discretionary at best when under review. The State of Florida will not comment when it comes to legal matters on this subject. Although I personally have yet to hear that an RCIS has been disciplined as a result of assisting in cath/vascular lab fluoroscopic procedures.

The law/Statute 468 is designed to protect people from harmful effects of excessive and improper exposure to ionizing radiation. Therefore, it has become necessary that proper training be applied and demonstrated through credentialing for those who operate radiation-emitting equipment. To locate specific information regarding this subject, you can review State of Florida Statute 468, Part IV — Radiological Personnel Certification. Under this statute, there is no specific mention of an RCIS. The closest associative description is a radiologist assistant (s.468.301 Definitions). The radiologist assistant must meet requirements as set forth in s.468.304 — Certification. This statute is difficult to explain in short detail, but it contains a wealth of information relating to certification; unfortunately, none of which includes the word “RCIS.”

Now comes the confusion: the exceptions. As you read through the complete Statute, you arrive at s.468.302. When you review Statute 468.302, “Use of radiation; identification of certified persons; limitations,” there are some exceptions to practicing as a radiologist assistant. One of them is in Part 7, which states that “A person who is trained and skilled in cardiopulmonary technology and who provides cardiopulmonary technology services at the direction, and under the direct supervision, of a licensed practitioner.” This is where the State of Florida will not specify in legal counsel if you are “protected.” They simply state that it is up to the legal system to define on a case-by-case basis. Best wishes if you have to wait until that time arrives, as you are already by now defending yourself in a tort case.

Unfortunately, to my knowledge, there have been no specific answers to these questions at this present time. We all would like to have clarification on this subject. In all fairness to the patient, the law/Statute is in place to protect persons from harm. No one wants to be placed into harm’s way. It would be prudent to ensure that the operator of radiation emitting-equipment (as well as positioning a patient) be trained and credentialed as described by Chapter 468 of the Florida Statutes.

Steve Paganella, RRT, RCPT, RPFT, CCT
Email: paygeturner@gmail.com

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New Questions!

Turnaround Time Definitions

As part of a Process Improvement Initiative, my facility is compiling internal data on procedure turn around times. The idea is to increase efficiency/productivity by safely streamlining efforts to “move patient A out and bring patient B in.” I know many of you have gone through (or are going through) a similar process.

What is the definition of turnaround time? (Please choose the answer closest to your own, and please identify your hospital/location with your response).

a.    Last catheter out to needlestick next patient
b.    Last catheter out to prep completed next patient
c.    Sheath out/device deployed to needlestick next patient
d.    Sheath out/device deployed to prep completed next patient
e.    Physician "gloves off" to "gloves on" for next patient
f.    Patient roll out to patient roll in

Thank you!

Note: the author wished to remain anonymous, so please email us at cathlabdigest@aol.com with your response. We will forward it on to the author.

Manual Sheath Removal Post Procedure

I am collecting data for a number of quality initiatives, one of which involves manual sheath removal. (Please choose the answer closest to your own, and please identify your hospital/location with your response). 

1) For manual sheath removal post procedure, where do you pull?
A.    In the cath lab
B.    In Cath Prep/Recovery area
C.    In a designated Post Procedure Unit

2) Who pulls post procedure sheaths at your facility?
A.    Cath Lab RN/Tech
B.    Cath Lab RN/Tech will pull in Prep/Recovery or Post Procedure Unit
C.    Cath Prep/Recovery Unity RN / Tech
D.    RN in designated Post Procedure Unit
E.    Physician or PA pulls all manual sheaths 

Thank you!

Note: the author wished to remain anonymous, so please email us at cathlabdigest@aol.com with your response. We will forward it to the author.

Mask Wear?

We are trying to collect data from cath labs about requirements for the circulator and whether cath labs require the circulator to wear a mask during regular angiographic/interventional procedures, including pacemaker implants. Any help would be greatly appreciated.

Thank you!
Roger Sadberry
Director Cath Lab/Day Patient/GI Lab, Bakersfield Heart Hospital, Bakersfield, CA
Email: Roger.Sadberry@BakersfieldHeartHospital.com
Cc: Cathlabdigest@aol.com