Ok to hire surgical/scrub techs?
I am opening a new cath lab in Wisconsin and am wondering if there are any legal guidelines we need to follow in hiring Surgical/Scrub techs (STs) in the cath lab. Where I came from, we had a couple STs that were not certified because they had been in the field before the ST programs were around. I wanted all RTRs and RNs, but we are having trouble finding those people. Can we hire staff that does not have the ST certification (EMTs, GI Techs, LPNs etc) to fill a surgical tech role if our job description is clear on what they can and can not do? And what roles should these people be limited to in your opinion, can they cover the CV role if they get on-the-job training? Thank you!
Shelly Gluege, RT(R)
Supervisor of Cardiac Cath/
Interventional Vascular Labs
Diagnostic and Treatment Center
Schofield, WI
Email: gluegema@dxandtx.com
Cc: cathlabdigest@hotmail.com

Reader response:
We used to hire operating room technicians (certified or not), and we used to hire monitor technicians from the coronary care units. We used to hire people with no background at all and just train them from the ground up. Having the knowledge of sterile technique was very helpful. We looked for evidence of the appropriate work habits and commitment, and we taught them the rest.

Now that we have experienced budget cuts, layoffs and stricter productivity standards, we have streamlined our efforts. We look for RNs, RT(R)s and RCISs. We replace the cardiovascular technicians with nurses and radiologic technologists and RCIS if at all possible. We cross-train to the degree possible. According to our Nurse Practice Act and hospital policy, only RNs can manage moderate sedation and all other medication administration, and they are responsible for patient assessment. RNs are expected to learn to scrub and monitor. RT(R)s are expected to learn to scrub and monitor. RNs can learn the RT role, but a radiologic technologist must be in the immediate area.

We encourage and support all staff working toward RCIS status. We have specific job descriptions for the CVTs that are cath lab-specific, different from ORT job descriptions from surgery. We have a career ladder for CVTs, as well. Level one is someone in training. Level two is someone who has mastered either scrubbing or monitoring and is training in the other. Level three is a CVT who has mastered both and eligible for RCIS exam. RCIS is another job description similar to CVT III, with mentoring and teaching responsibilites added. The pay scale goes up with each step. RNs and RT(R)s maintain their same job description but receive 3% salary increases.
Yes, it is hard to find the right people when you need them.
Patty Freier, RN, BSN, RCIS
Nurse Specialist
Cardiac Research & Education
Covenant Medical Center
Lubbock, TX
Email: pfreier@covhs.org
Cc: cathlabdigest@hotmail.com

Can you help your fellow professionals with the following questions?

Bispectral index (BIS) monitoring during pacer insertion
What credentials if any, are necessary to use this during a pacemaker procedure? I am nurse new to the cath lab and am concerned that this is getting into the "anesthesia arena" that I may not be licensed for.
Anonymous by request
Email: cathlabdigest@hotmail.com

Left upper arm discomfort after a PCI
Have any of you noticed swelling of the upper extremities on patients who have had prolonged cuff blood pressure monitoring during and after PCIs. One of our cardiologists had a patient who complained of left upper arm discomfort after a PCI. Swelling of the upper extremity was noticed. I was asked and mentioned that I have noticed bruising on the medial areas of the distal humeral areas on patients who had come to the cath lab after being on heparin drips and/or IIb/IIIa™s over night. Some literature has mentioned patients having swelling and petechia from prolonged cuff bloood pressure monitoring that is done frequently.
Chuck Williams RPA, RT, RCIS, Atlanta, GA
Email: rpainga@yahoo.com
cc: cathlabdigest@hotmail.com

Ergonomics and moving patients
I have been a RN in the cath lab for the last three years.  My past experience has been 20 years in the operating room where I am CNOR certified. I have a concern with patient safety and employee injury from the practice we do concerning tranfering patients to and from the carrier to the cath table. The method we use is pulling the patient over by using the carrier sheet (possibly causing skin friction and shearing injury to the patient). Anywhere from 3 to 4 people pull patients without using a roller (a transferring device I have seen used the the operating room). A device we do have is a long board (which is more difficult to use because of its size); I have seen it used twice during the last three years. It is awkward to use and I had no idea of its use until I had been in the cath lab for a year. I am trying to get information for our department from employee health as to back injuries as a result of transferring patients from carriers to the cath table using this method.
Barbara Forest
Email: Bforest2003@wmconnect.com  
Cc: cathlabdigest@hotmail.com