New Questions

Advanced-Level Cardiology Physician Extender Program
Would readers of Cath Lab Digest have an interest in the development of an advanced-level cardiology physician extender program? This is a program that would train men and women who have a minimum of an associate's degree. Participants would be required to have the CCI RCIS credential and a minimum of five years in noninvasive, invasive and interventional cardiology settings.

The thoughts are to develop guidelines for those who have AS degrees to complete BS degrees, and focus on noninvasive and invasive cardiology procedures. Those with a bachelor's degree would focus all aspects of cardiology and complete a master's degree. The platform of the guidelines would parallel the requirements for nurse practitioners, except the student would be dedicated to the care of cardiology patients and cardiology procedures.

A suggested title for the AS => BS track would be Certified Cardiology Physician Extender.

For the BS => MS track, the title would be Advanced Level Cardiology Physician Extender.

Thank you,
Anonymous by request
Email: cathlabdigest@aol.com

I am extremely interested in the idea of an Advanced Level Cardiology program.
Any way that I can both further my knowledge of cardiology as a whole as well as the cath lab interests me. However, there are several concerns that I have.
First, the scope of practice would have to be very clearly defined. How would this effect our ability to function in the cath lab? Would this change our responsibilities? My second concern is that RCIS has had significant problems in being recognized in all states. Since I was trained on the job, there are still states where I am not allowed to work. Now I understand that the CARE Bill is to help with this discrepancy, but if an new position is developed, how long will we have to wait before this new position is accepted? All I can do is wait and hope that this program does develop and that I can advance my career as well as my knowledge of cardiology.
Thanks,
Greg Monroe, RCIS

Dear Greg,
Thanks for your response. I encourage you to read the following Cath Lab Digest article for some important information about the CARE Bill:

Letter to the Editor from the Hawaii Society of Radiologic Technologists (Jan 2007, page 30, available at: www.cathlabdigest.com/article/6616)

About the advanced practice issue, the question was asked to determine if persons with AS degrees, BS degrees and beyond who hold the CCI RCIS credential would have an interest in such a program. The concept has been discussed with three CVT program directors who have expressed a strong interest in having such a program.
If there is a true interest in this type of program for RCIS-credentialed persons, most likely its development into a full program would parallel the structure of nurse practitioner curricula criteria. The advanced cardiology physician extender ideally could participate in pre-studies such as EKGs, stress studies, echocardiography, etc.; assess the patient for the invasive study similar to a cardiology fellow; work beside the invasive or interventional cardiologist during the procedure; handle the post care of the patient from departure from the cath lab; and handle the discharge of the patient.

This is termed continuity of patient care. The CCPE or AL-RCPE would be trained to follow the patient from the functional test through the procedure and then participate in the patient's aftercare.
Anonymous by request
(original questioner)

I like the idea of a Cardiology Physician Extender program. There are lots of changes happening right now in cardiology and cardiac catheterizations labs. For me, this would be one that I would whole-heartedly embrace. I have been working in cardiac cath labs for about five years. I have often wondered if the CVT profession would evolve with the potential to obtain advanced credentials, more responsibility, trust and autonomy as other allied health professions have. I would be curious to see how receptive cardiologists and existing mid-level practitioners would be to this new position/credential.
Horace R. Gillins, BS, CVT

Groin Site Care
I am a nurse in the cath lab and we had a question regarding groin site care. We want to know what is most common now for dressing the groin site after sheath pull or closure devices. Do most people use Bacitracin/Neosporin ointment anymore as a standard when putting a dressing on the groin? We are looking for research or data stating what the best practice would be. If you could e-mail me info/literature on this subject that would be great.
Thanks for your time,
Emily, RN
Email: Emily.Mueller (at) lmh.org
Cc: cathlabdigest@aol.com

Emily,
My preferred technique is to dress the site by first cleaning area of blood, wipe with topical iodine (unless patient has a topical iodine allergy, then use chlorhexidine), apply betadine or bacitracin gel over the skin puncture, and cover with a 2 x 2 gauze and transparent dressing (or the bandage provided with the topical hemostasis pad, if using one).

It is not advisable to mummify with a pressure bandage, because it will hide a growing hematoma until it is fairly significant. Let's face it, most staff (unfortunately) will only assess the distal pulse, and never look at the site. If the site is buried under a bulky wad of gauze and elastic bandage, it isn't looked at unless the bandage becomes saturated. If oozing persists, my choice is to use a SafeGuard Pressure Bandage. This allows you to still view the puncture through the transparent window of the bandage.

Kenneth A. Gorski, RN, RCIS, FSICP
Chairman, Professional Standards Committee, SICP
Assistant Manager, Sones Cardiac Catheterization Laboratories
Cleveland Clinic, Cleveland, Ohio
gorskik (at) ccf.org

Dear Emily,
Our facility has switched to chloraprep as the initial groin prep prior to the start of the cath. This provides up to 48 hours of continual protection. Post-cath, the site is cleaned with soap and water, and a sterile dressing is applied. There is no need to use the triple antibiotic on the site. It just adds to the chances of a super bug developing and those infections are nasty. If you go to the Centers for Disease Control (CDC) website, they have recommendations on site care for all types of situations.
Tom, Cath Lab
Tom.hewston (at) crozer.org