Ask the Clinical Instructor

admin — Wed, 30 Jun 2010 12:23:06 -0400

I just transferred from interventional radiology to the cath lab. We used the intra-aortic balloon pump (IABP) last week, and I just don’t understand how a balloon inflation in the aorta can have any value.
– Cath lab staff member, rural Alabama, via Facebook

The use of the intra-aortic balloon pump (IABP) can certainly be counterintuitive. Understanding the differences in coronary artery physiology and the concepts of IABP usage can help. Granted, a full IABP lesson could take many hours, or several articles, to properly address. You should take advantage of your IABP clinical representative to get a full tutorial. I will only address the information specific to your question in this article.

The New, Single-Part RCIS Exam

admin — Wed, 09 Jun 2010 11:22:16 -0400

Cardiovascular Credentialing International (CCI) announced that starting July 1, 2010, the registered cardiovascular invasive specialist (RCIS) credentialing processes will move to a single examination format (the previous 2-part format included both a cardiovascular science exam, and the Invasive Registry level exam).
Todd Ginapp, author of CLD’s “Ask the Clinical Instructor” column, and CCI President Chris Nelson explore reasons for the change.

Todd: As I participate in RCIS review courses, the RCIS review class I facilitate online, Facebook, and so on, I hear many questions about the changes to the RCIS exam. Chris, I appreciate your taking the time to discuss the new exam. I hope we can alleviate some of the fears people may have.
Let’s first take a step back and look at where the RCIS exam originates. What is important for us to know about Cardiovascular Credentialing International (CCI)?

A Q&A column for those new to the cath lab

admin — Fri, 30 Apr 2010 10:11:54 -0400

I don’t work in the cath lab, but I do read the articles in CLD. I work in an EKG department at a small hospital. When performing stress tests, the cardiologist often tells me to listen closely for the “thumps” when I am taking a blood pressure. Is he talking about what I am listening to?
– Via www.facebook.com/RCISREVIEW, from a hospital staff member in rural Montana

What he is probably talking about are the “Korotkoff” sounds you hear when you are taking the blood pressure of your patient. One important note about taking blood pressures: make sure the brachial artery is at the level of the heart. The same principles apply to this procedure as for the use of a transducer during invasive pressure monitoring in the cath lab. The equipment being used to measure the pressure must be placed at the level where the heart is (phlebostatic axis…a topic for another article).

Ask the Clinical Instructor

admin — Wed, 14 Apr 2010 13:49:39 -0400

Todd is the Cardiology Manager for Memorial Hermann Southeast in Houston, Texas. He also teaches an online RCIS Review course for Spokane Community College, in Spokane, Washington, and regularly presents with RCIS Review Courses.

While in a case with a physician, he mentioned that there was a “sign” on the monitor that confirmed the suspicion of the patient having hypertrophic cardiomyopathy (HOCM). I missed it. What could he have been talking about?
– Via email, a Cath Lab Employee from New Hampshire

Without seeing any hemodynamics data or screen shots, I can only guess that he may have been talking about the Brockenbrough response, which is typically indicative of hypertrophic cardiomyopathy (HOCM).

Ask the Clinical Instructor: The Frank-Starling Principle

admin — Thu, 04 Mar 2010 15:29:15 -0500

“I am new to the cath lab and have been sitting in on some vendor in-services. I’ve heard ‘Frank Starling’ a few times already, and I think it has something to do with heart failure. Can you explain what that is?”
– Received at http://www.facebook.com/RCISReview

We’ve used that term a few times in previous articles, and you will likely see it in future articles as well.

‘Frank Starling’ comes from 1914 when Otto Frank and Ernest Starling theorized that the length of the sarcomere [cardiac cell] is the driving force behind effective systole.1 Over the years, this

Heart Blocks: Understanding Which is Which

admin — Fri, 12 Feb 2010 10:26:21 -0500

“HELP! I am new to the cath lab. When I took the ECG class that my hospital required, I was very confused about heart blocks and understanding which one is which. I have 5 people giving me their opinions about the best way to learn and memorize these. Any suggestions?”
– Cath lab employee, Mississippi

I can certainly appreciate your situation. As I was undertaking my paramedic training 29 years ago, I had the same difficulty. Nothing really sunk in and I had a hard time getting it. I obtained my training at Mary Greeley Medical Center in Ames, IA. One of my preceptors

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

admin — Mon, 11 Jan 2010 16:17:29 -0500

In a first-degree heart block, why is there such a long delay in the PR interval? What is the pathology of this occurrence?

– Beverly Eskdale, Winter Haven, FL

A first-degree heart block can sometimes be dramatic and gathers a lot of attention when it is pronounced. It can also be a source of focus for individuals reviewing a rhythm strip to the point that it is distracting from other issues. While it is nice to know what this abnormality is, we should also realize that this particular rhythm is relatively benign and not needing treatment in the cath lab.

A first-degree AV

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

admin — Wed, 09 Dec 2009 14:14:45 -0500

We recently saw something weird on a heart cath, where the left ventricle was filling up with contrast during a coronary injection. The doctor said that it was a ‘cameral fistula’. What is that? How does it affect the patient?

– CV Tech, Virginia

From what you describe, it does appear that it could have been a cameral fistula, also known as a cor

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

admin — Thu, 05 Nov 2009 09:44:46 -0500

“When you have an arterial and a venous sheath in the same site, which one do you pull first and why? At what point do you pull the ‘other’ line?”

– Mike Kashin, Provena Hospital, Illinois

Removal of co-existing arterial and venous sheaths can be a simple process, but, at times, it does require some critical thinking skills. As with many skil

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

admin — Mon, 12 Oct 2009 12:10:13 -0400

“I am manager of a cardiac recovery unit. We are getting feedback that our shaving of patients may not be appropriate. My staff and I have been trying to find additional information from other facilities. We want to do the right thing for our patients, not just based upon someone’s opinions.”

— RN, Lansing, Michigan

If you are looking

Ask the Clinical Instructor

Ask the Clinical Instructor

I just transferred from interventional radiology to the cath lab. We used the intra-aortic balloon pump (IABP) last week, and I just don’t understand how a balloon inflation in the aorta can have any value. – Cath lab staff member, rural Alabama, via Facebook

The New, Single-Part RCIS Exam

A Q&A column for those new to the cath lab

Ask the Clinical Instructor

Ask the Clinical Instructor: The Frank-Starling Principle

Heart Blocks: Understanding Which is Which

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

In a first-degree heart block, why is there such a long delay in the PR interval? What is the pathology of this occurrence?

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

I just transferred from interventional radiology to the cath lab. We used the intra-aortic balloon pump (IABP) last week, and I just don’t understand how a balloon inflation in the aorta can have any value.
– Cath lab staff member, rural Alabama, via Facebook