Professional Standards and Scope of Practice for the Cardiovascular Invasive Specialist

Kenneth A. Gorski, RN, RCIS, FSICP
Assistant Manager, Sones Cardiac Catheterization Laboratories; The Cleveland Clinic, Cleveland, Ohio; Chairman, Professional Standards Committee, The Society of Invasive Cardiovascular Professionals

In 1959, coronary angiography became a reality at the Cleveland Clinic, pioneered by Dr. F. Mason Sones, and changing the way we looked at cardiovascular disease. Vae Lucile Van Derwyst, RN, began working for Dr. Sones at the Cleveland Clinic in 1952, and was initially his only assistant. Like Dr. Sones, Lucille was a pioneer, training and supervising the over 40 nurses that eventually made up her staff, as well as nurses from all over the country (who in turn went back to their hospitals to train and educate other nurses). Under the leadership of Dr. Sones and Lucille Van Derwyst, catheterization laboratory nurses learned to circulate, monitor, perform brachial artery cutdowns, act as scrub assistants, and complete skin closures post procedure. Together, they developed this completely new area of practice.

Since then, the cardiac catheterization laboratory has evolved from performing just diagnostic coronary imaging to complex, life-saving endovascular interventions, which began with percutaneous transluminal coronary angioplasty (PTCA) in the early 1980s. In the late 1980s and into the 1990s, various devices such as lasers came and went, and stents became the treatment of choice for coronary artery disease. Today, stents have advanced beyond simple, stainless steel implants to sophisticated, drug-eluting platforms to inhibit atherosclerosis. Atherosclerotic disease is globular, and not limited to the heart. Today, many patients with atherosclerotic carotid disease are treated percutaneously, with a carotid artery stent (CAS). Patients having acute thrombotic strokes may come to the cath lab for a catheter-based intervention to snare and retrieve clots, stent cerebral vessels, or undergo direct pharmacologic therapy.

Catheter-based treatments for structural heart disease are developing rapidly in interventional cardiology. Adult patients with congenital heart abnormalities such as atrial septal defects (ASDs) and patent foramen ovales (PFOs) may be treated with catheter-deployed closure devices. Mitral valve regurgitation may be treated in the cath lab by a procedure which mimics the surgical Alfieri clip. Implantation of prosthetic aortic valves (mounted on balloon-expandable stents) has become a reality in clinical trials. The competent invasive cardiovascular professional must remain informed about current modifications and advances in procedures, as well as in the industry itself.

In 2001, the Society of Invasive Cardiovascular Professionals (SICP) Board of Directors formed a Practice Standards Committee to evaluate and revise the professional standards and scope of practice for the Invasive Cardiovascular Professional. The committee took care to examine current practices nationwide in the cardiac catheterization and EP laboratory. At the same time, we recognized that in cardiac cath and EP labs across the nation, the cardiologist works with a multi-disciplinary team. The team may be comprised of RNs, licensed practical nurses (LPNs), radiologic technologists (RT(R)s), Registered Cardiovascular Invasive Specialists (RCISs), Physician Assistants (PAs), emergency medical technicians (EMTs or paramedics), respiratory therapists (RTs), and others. Our patients benefit because of this diversity. What was developed was meant to reflect the mission of the Society of Invasive Cardiovascular Professionals, and supports the model of the cross-trained laboratory.

The Society of Invasive Cardiovascular Professionals, a not-for-profit organization, formed in 1993 to provide allied health professionals within catheterization and electrophysiology laboratories a professional organization directed at the educational needs of their specialty. Cardiovascular Credentialing International (CCI) serves as the organization testing essentials and guidelines within the invasive cardiology practice. The Registered Cardiovascular Invasive Specialist (RCIS) exam, offered by CCI, is endorsed and recognized as a valid indication of ability to practice in the cardiac catheterization lab by the SICP, the American College of Cardiology, the American College of Cardiovascular Nurses (ACCN), and the Alliance of Cardiovascular Professionals (ACVP), and the American Society of Radiologic Technologists (ASRT).

In June 2006, the American Society of Radiologic Technologists (ASRT) adopted Resolution 06-3.06 Qualifications for Performing Cardiovascular-interventional Radiography and revised to read: The American Society of Radiologic Technologists (ASRT) recommends that only radiologic technologists credentialed in cardiovascular-interventional (CI), vascular-interventional (VI), or cardiovascular-interventional (CV) radiography by the American Registry of Radiologic Technologists (ARRT) or radiologic technologists credentialed as registered cardiovascular invasive specialists (RCIS) by Cardiovascular Credentialing International (CCI) should perform all cardiovascular-interventional procedures.

The SICP is the professional organization for the invasive cardiovascular specialist, whether this person is a registered nurse, RCIS, RT, or other allied health professional. We are responsible for defining and establishing the scope of non-physician, invasive cardiovascular practice. The SICP recognizes the role of other organizations, such as the ACCN and ASRT, who have developed a scope of practice within their respected professions.

Which brings me to the point of this article: the current professional standards and scope of practice documents are in the process of being updated. As Chairman of the Professional Standards Committee, I am seeking input from you, members and Fellows of the SICP, to review, revise, and update these documents and others. We need you.

If you are willing to assist in this endeavor, please contact me via e-mail at gorskik@ccf.org.

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The SICP at EuroPCR 2006

Kenneth A. Gorski, RN, RCIS, FSICP
Assistant Manager, Sones Cardiac Catheterization Laboratories; The Cleveland Clinic, Cleveland, Ohio; Chairman, Professional Standards Committee, The Society of Invasive Cardiovascular Professionals

EuroPCR is an international conference focusing on catheter-based cardiovascular interventions. EuroPCR began modestly in 1983 as the first European course featuring live case demonstrations, and was held under a tent near the Eiffel Tower. In 2000, the program was renamed the Paris Course on Revascularization (PCR). In 2001, it merged with another cardiology symposium, EuroCVS, and is now the largest conference of its kind in the world.

EuroPCR 2006 was held May 16th-19th at the Palais des Congres in Paris, France with 11,000 registrants from 95 countries this year. In all, EuroPCR 06 had nearly 600 invited faculty members, representing every continent except Antarctica. The majority of the lectures were presented in English, with headphones made available with real-time translation in a number of different languages.

The EuroPCR Nurse and Technician Sessions have grown tremendously, becoming a fundamental part of the overall program. The Nurse and Technicians Sessions were presented over three days, with a focus topic for each day: cardiac, congenital/valve/peripheral, and miscellaneous (which included EP and CT/MRI).

Kenneth Gorski, RN, RCIS, FSICP, Assistant Manager of the Cleveland Clinic Cardiac Catheterization Laboratories, Chairman of the Standards Committee for the Society of Invasive Cardiovascular Professionals (SICP), and consulting editor for Cath Lab Digest, served as session moderator for the cardiac day. Ken also presented the lecture New devices for the treatment of chronic total occlusions of the peripheral arteries, and served as a panelist throughout the program.

Marsha Holton, RN, BS, CCRN, RCIS, FSICP, co-founder of Cardiovascular Orientation Programs, SICP Education Council member, and consulting editor for Cath Lab Digest, also served as a session moderator and presented Management of the critically ill patients in the cath lab.

The focus of the third day was cath lab orientation standards and competency checklists for European nurses and technologists. Panel discussion (and a subsequent private faculty meeting) revolved on education and training differences for cath lab nurses and technicians across the globe, and the challenges of creating standards within the European Union. Ken Gorski and Marsha Holton discussed the Registered Cardiovascular Invasive Specialist (RCIS) credential as a standardized knowledge assessment tool, and the role of professional societies in developing education, training, and orientation standards. Planning for EuroPCR 2007 (to be held in Barcelona, Spain) included dedicating a day to cath lab educational basics, using the RCIS review course materials developed by members of SICP. Ken and Marsha have been asked by Sandy Watson, RN, BN, NFESC and consulting editor for Cath Lab Digest, to act as American consultants as European cath lab nurse/tech standards are developed.

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Chapter News

The Illinois Chapter held its latest educational SICP meeting on June 14. Lovenox sponsored the meeting and Dr. George Christy was the speaker. A group from Rockford, Illinois attended, making this the chapter’s largest meeting yet, with 58 participants. Lynne Jones, SICP president, also attended in support of the group.

The Keystone Chapter’s next meeting is being planned for September 2006.

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SICP Meetings and Events

September 21-23
SICP’s SoCal Symposium 2006
Kona Kai Resort, San Diego, CA
More information is available at www.sicp.com

October 8-11
ACE2006
Grand Hyatt Hotel, New York City, NY
www.ny-ace.com

October 11
SICP RCIS Review Course at ACE 2006
More information is available at www.sicp.com

November 1-4
7th Annual New Cardiovascular Horizons and Management of the Diabetic Foot & Wound Healing
New Orleans, LA
www.newcvhorizons.com