SICP

The Society of Invasive Cardiovascular Professionals New 2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory

Endorsed by the Society for Cardiovascular Angiography and Interventions (SCAI).

Introduction written by Jeff Davis, RRT, RCIS, FSICP, Educational Guidelines Committee Chair, Florida SouthWestern State College, Fort Myers, Florida.

Endorsed by the Society for Cardiovascular Angiography and Interventions (SCAI).

Introduction written by Jeff Davis, RRT, RCIS, FSICP, Educational Guidelines Committee Chair, Florida SouthWestern State College, Fort Myers, Florida.

Since the advent of cardiovascular catheterization laboratories, the need for highly trained physicians and credentialed health care practitioners, including cardiovascular technologists, has been well established. To support the ongoing training of cardiovascular technologists and provide an educational framework for invasive cardiovascular training programs, the Society of Invasive Cardiovascular Professionals (SICP) has published, with the endorsement of the Society for CardiovascularAngiography and Interventions (SCAI), the 2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory (Appendix A). To create these guidelines, the SICP and SCAI assembled a multidisciplinary team of interventional cardiologists, registered cardiovascular invasive specialists (RCISs), invasive cardiovascular technologists, cardiovascular technology educators, registered nurses, radiologic technologists, and  cardiovascular cath lab managers. The SICP anticipates that programs will require at least one year to demonstrate, based on their advisory board’s recommendations, their intent to include relevant content for the profession of invasive cardiovascular technology.

Evolution of standards

In December 1981, cardiovascular technology (CVT) was officially recognized as an allied health profession by the American Medical Association Council on Medical Education.1 In September 1983, Essentials and Guidelines of an Accredited Educational Program in Cardiovascular Technology was published to address the need for standards and guidelines for post-secondary cardiovascular technology educational programs.1 The Essentials and Guidelines were, and continue to be, influenced by the triad of invasive cardiovascular technology professional organizations: 

  • The Society of Invasive Cardiovascular Professionals (SICP), the professional society;   
  • Cardiovascular Credentialing International (CCI), the credentialing organization; and  
  • The Commission on Accreditation of Allied Health Education Programs/Joint Review Committee on Education in Cardiovascular Technology (CAAHEP/JRC-CVT), the accrediting organization.

In 1993, the SCAI, a professional society now comprised of more than 4,000 adult and congenital interventional cardiologists and their cath lab teams, whose mission is to provide the highest standards of cardiovascular care2, encouraged the formation of the SICP3. The SICP is both the invasive cardiovascular technology professional organization and sponsoring organization for CAAHEP/JRC-CVT. The majority of SICP members work in cardiovascular catheterization laboratories; therefore, SICP has an active role to make recommendations and influence the specific invasive cardiovascular technology content for invasive CVT educational curricula. In 1999, SICP and SCAI formed a task force that resulted in publication of the 1999 Guidelines for Educational Preparation and Staffing of Non-Physician Personnel in the Cardiac Catheterization Laboratory.4 

Cardiovascular Credentialing International (CCI) is the credentialing organization for the invasive CVT profession. Since 1968, CCI has developed and administered cardiovascular technology credentialing examinations for the various sub-specialties in the cardiovascular technology professions.5 Upon meeting the eligibility requirements, applicants, including graduates of accredited invasive cardiovascular technology programs, are eligible to take CCI’s Registered Cardiovascular Invasive Specialist (RCIS) Exam. The content of the RCIS exam is influenced by a job task analysis (JTA) specific to the invasive cardiovascular technology profession. CCI conducts the JTA to quantify the importance and frequency of the tasks performed by cardiovascular invasive specialists during elective and emergent cardiovascular catheterization procedures. This information provides CCI with an additional focus in the development of certification examinations. 

The cardiovascular catheterization laboratory is a melting pot of healthcare professionals. The credentials of these professionals may include RCIS, registered nurse (RN), registered radiologic technologist (RT[R]) and registered respiratory therapist (RRT), among others. The RCIS credential is recognized by the SICP as a unifying credential developed for cardiovascular technologists specific to the practice of invasive cardiovascular technology. The American College of Cardiology (ACC) also recognizes and endorses the RCIS credential.6 

Upon meeting eligibility requirements, individuals holding the credential of a RN, RT(R), RRT, etc., are eligible to sit for the RCIS exam. The SICP recommends that at least one RCIS with basic and advanced cardiac life support experience, knowledge of the care of cardiovascular patients and cardiovascular medications, and experience with invasive cardiovascular procedures should be assigned to each cardiovascular catheterization laboratory at all times. In pediatric cardiac catheterization laboratories, the RCIS shall also have experience in the care of pediatric cardiac patients.4 

The Commission on Accreditation of Allied Health Education Programs (CAAHEP) is the programmatic accrediting organization for invasive cardiovascular technology post-secondary educational programs. CAAHEP provides accreditation services for over 20 health professions in the health sciences field, including diagnostic medical sonography, emergency medical technician-paramedic, exercise physiology, perfusion and cardiovascular technology.7 CAAHEP makes its accreditation decisions based on the recommendations of its Committees of Accreditation. The Committee on Accreditation for the Invasive Cardiovascular Technology Profession is the Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT). The JRC-CVT was established in 1985.1 CAAHEP and the JRC-CVT collaborate on the development of the accreditation standards and guidelines for post-secondary educational programs in invasive cardiovascular technology. Graduates of CAAHEP-accredited invasive cardiovascular programs are eligible to sit for the RCIS exam. 

The CAAHEP/JRC-CVT accreditation standards describe the educational content that should be incorporated in the curricula of CAAHEP-accredited invasive cardiovascular technology programs. Members of the CAAHEP/JRC-CVT defer to the expertise of the professional societies to develop this educational curricula. In the case of invasive cardiovascular technology programs, the CAAHEP Standards defer to the content developed by the SICP. 

Purpose of the national invasive cardiovascular curriculum 

The SICP and SCAI assembled a multidisciplinary team of interventional cardiologists, RCISs, cardiovascular cath lab technologists, cardiovascular technology educators, registered nurses, radiologic technologists, and cardiovascular cath lab managers to update and publish the 2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory standards (Appendix A).

The 2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory standards provide invasive CVT education programs with guidance as they update and develop their curricula. The CAAHEP/JRC-CVT will notify all accredited invasive cardiovascular technology programs and those programs pursuing accreditation with information about the 2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory standards. Programs will have at least one year to demonstrate, based on their program advisory board’s recommendations, their intent to include the relevant content for the profession of invasive cardiovascular technology. 

It is recognized that there will be significant regional differences relative to the mix and scope of invasive cardiovascular catheterization procedures around the United States. Therefore, it is not expected that every accredited cardiovascular technology program will include all of the elements described in the 2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory standards. However, it is expected that programs will include specific content areas determined by their profession to be mandatory. These content areas include, but are not limited to, aseptic technique, blood-borne pathogens, radiation production and safety, cardiovascular anatomy, physiology, pathophysiology, procedures and protocols for diagnostic left and right heart and vascular catheterization, interventional cardiovascular catheterization procedures, hemodynamic monitoring, cardiovascular patient assessment, cardiovascular pharmacology, and cardiovascular cath lab complications.

The 2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory standards are intended to provide a framework for invasive cardiovascular programs as they develop or refine their curricula. The CVT profession continues to evolve at a rapid pace, requiring current curriculum to be updated on a regular basis. Educational programs will also need to respond to advances and changes in the profession. Working together, the SCAI, SICP, credentialing organizations, accrediting organizations, and educational programs will continue to advance the profession and the practice of invasive cardiovascular technology in order to benefit the patients they serve. 

References

  1. Joint Review Committee on Education in Cardiovascular Technology. Cardiovascular Technology History. Available online at  http://www.jrccvt.org/about_us/htm. Accessed April 16, 2015.
  2. The Society for Cardiovascular Angiography and Interventions. SCAI History. Available online at http://www.scai.org/About/History.aspx. Accessed April 16, 2015.
  3. Society of Invasive Cardiovascular Professionals. About SICP. Available online at  http://www.sicp.com/content/about-sicp. Accessed April 16, 2015.
  4. The Society of Cardiovascular Professionals and the Society for Cardiovascular Angiography and Interventions. Guidelines for educational preparation and staffing of non-physician personnel in the cardiac catheterization laboratory. Cath Lab Digest. 1999 Aug; 7(8): 1-10. 
  5. Cardiovascular Credentialing International. About CCI. Available online at http://www.cci-online.org/content/about-cci-0. Accessed April 16, 2015.
  6. Otto CM. ACC recognizes cardiovascular sonographer and technologist credentials. Cardiology. 1995; 24(7): 19. 
  7. Commission on Accreditation of Allied Health Education Programs. About CAAHEP. Available online at http://www.caahep.org/Content/aspx?ID=63. Accessed April 16, 2015.

Appendix A

2015 Educational Guidelines for Invasive Cardiovascular Technology Personnel in the Cardiovascular Catheterization Laboratory Invasive Cardiovascular History and Procedure Descriptions

A.    Pioneers and Historical Overview of the Profession

B.    Cardiovascular Terminology

C.    Right Heart Catheterization

  1. Indications & Contraindications
  2. Risks & Complications

D.    Left Heart Catheterization

  1. Indications & Contraindications
  2. Risks & Complications

E.    The Evolving Role of Registered Cardiovascular Invasive Specialists (RCIS)

I.  Patient Ethics 

A.    Patients’ Rights and Safety

  1. Informed Consent
  2. Patient Identification
  3. Confidentiality/HIPAA
  4. Patient Bill of Rights
  5. Patient Safety Methods

B.    Professionalism

C.    Communication & Hand-offs

II.  Anatomy and Physiology

A.    Normal Cardiovascular Anatomy and Physiology

B.    Flow Dynamics – Cardiac Cycle

C.    Wigger’s Diagram

D.    Coronary Artery Physiology

  1. Coronary Perfusion Pressure
  2. Determinates of Coronary Flow
  3. Microcirculation and Autoregulation

E.    Sympathetic/Parasympathetic Nervous System

F.    Coronary Artery Anatomy and Physiology

  1. Left Coronary Artery System
  2. Right Coronary Artery System

G.    Cardiac Action Potential

H.    Kidney Regulation of Blood Pressure

III.  Patient Care

A.    Patient Prep/Pre-Cardiovascular Catheterization Lab Teaching/Assessment/Time-Out

  1. Patient Medical Record
  2. Physician Orders

B.    Procedure Preparation and Premedication

C.    Basic Assessment Techniques

  1. History & Physical Examination
  2. Vital Signs
  3. Central Nervous System Assessment
  4. Respiratory System Assessment

a.    Whole Blood Oximetry Sampling

b.    PaO2, SaO2, SvO2, CaO2, CvO2

c.    Interpretation of Arterial Blood Gases

    5. Cardiovascular Assessment

a.    Auscultation, Murmurs, Pulses, Arrhythmias, 12-Lead Analysis, etc.

b.    Pain Assessment

    6.  EKG

a.    EKG Monitoring

b.    EKG Paper/Caliper Measurements Heart Rate Calculations

c.    Rhythm Interpretation

d.    Electrical Dynamics

e.    12-Lead Interpretation/Hypertrophy, Axis, Bundle Branch, and Infarct Patterns

f.    Pacemakers Temporary

g.    Defibrillation and Cardioversion

     7.  Peripheral Vascular Assessment

a.    Pulses

b.    Use of Doppler

c.    Allen’s Test (Radial Cases)

d.    Skin Mottling

e.    Barbeau testing

D.    Interpretation of Laboratory Studies

  1. Chemistries, Cardiac Enzymes, Troponin
  2. Electrolytes
  3. Hematology & Coagulation Studies
  4. Lipid Panel/Profile

E.    IV Therapy

  1. IV Insertion
  2. IV Assessment and Maintenance
  3. Troubleshooting

F.    Foley Insertion

G.    Patient Transport and Transfer

H.    Post-Cardiovascular Cath Patient Care, Hemostasis and Teaching

I.    High-Risk Patient Management

J.    Patient Management During Procedure

  1.  Point of Care Testing (POCT)

a.    ACT

b.    Whole Blood Oximetry

c.    PT/INR

d.    hCG

e.    Rapid Platelet Function Assays

K.    Complication & Emergencies

  1. Acute MI (STEMI, UA/NSTEMI)
  2. Chest Pain
  3. Shortness of Breath
  4. Shock – All Types
  5. Dysrhythmias
  6. Tamponade
  7. Dissections – Coronary/Aortic/Iliac/Femoral/Radial…
  8. Cerebrovascular Accident – CVA/TIA
  9. Pulmonary Edema
  10. Pulmonary Embolism
  11. Acute Pulmonary Hemorrhage
  12. Hypertension/Hypotension
  13. Anaphylaxis and Allergic Reactions
  14. Bronchospasm
  15. Air Embolism
  16. Airway Management/Oxygen Delivery Devices

L.    ACLS and BCLS Protocols

IV. X-Ray Generation and Radiation Physics/Safety

A.    X-Ray Tube Components and Imaging Chain

  1. Radiation Production, Radiation Units, Characteristics and Physics
  2. Imaging System (X-Ray Tube and Image Intensifier/Intensifying Screen)
  3. Principles, Positioning and Operation of the Fluoroscopic X-ray Machine
  4. Digital Imaging Systems and Flat Panels

B.    Radiation Biology & Protection

  1. Cellular Biology Overview
  2. Biological Effects of Radiation
  3. Radiation Safety/Radiation Protection (Patients and Personnel)
  4. Digital Imaging Systems and Flat Panels
  5. Radiation Exposure Monitoring
  6. Limits for Exposure to Ionizing Radiation
  7. ALARA

b.  Sentinel Event

     8.  Quality Assurance

     9. Image Analysis and Digital Imaging

 

V.  Diagnostic and Intervention Procedures

A.    Hospital/ Cardiovascular Catheterization Lab Environment and Safety

  1. Regulatory Compliance
  2. Procedure Room Preparation
  3. Body Mechanics

a.    Safely Moving Patients

b.    Safety Strategies for Staff

     4.  Electronics

a.    Biomedical Instrumentation

b.    Ohms Law, Resistance 

B.    Aseptic Technique

  1. Pathogens

a.    Blood-borne, Air-borne, Bacteria, HIV, TB, Hepatitis, MRSA, C-Diff

      2.   OSHA Regulations

      3.    Universal Precautions

      4.    Hand Washing

      5.    PPE (Personal Protective Equipment)

a.    Accident Exposure

  1. Engineering Controls
  2. Workplace Controls

 6.    Gowning and Gloving

a.    Open & Closed Techniques

7.    Sterile Field/Tray Setup

8.    Maintaining the Sterile Field

9.    Methods of Sterilization and Disinfection

10.    Tear Down – Biohazard Handling and Disposal

11.    Latex Allergy

12.    Isolation

a.    Contact

b.    Airborne

c.    Droplet

C.    Prepare Patient and Sterile Table Setup

  1. Patient Positioning, Instruction/Education, and Setup
  2. Sterile Table Setup
  3. Percutaneous Access

a.    Femoral

b.    Radial

D.    Equipment

  1. Disposable and Non-Disposable Equipment

a.    Needles, Sheaths, Guide Wires, Catheters, Stents, Manifolds, Transducers, Automatic Power Injector, Imaging Equipment, Defibrillator, etc. 

E.    Diagnostic Procedure Protocols/Steps

  1. Left Heart Catheterization
  2. Right Heart Catheterization
  3. Combined Heart Catheterization

F.    Manipulation and Positioning of the Patient and X-Ray Equipment

G.    Contrast Media

  1. Ionic, Non-Ionic
  2. Osmolarity
  3. Contrast Reactions – Risk Factors, Side Effects, Precautions, Premedication
  4. Contrast-Induced Nephropathy (CIN)
  5. CIN Scores

H.    Angiography – Standard Techniques and Projections

  1. Native Coronaries
  2. Grafts, RIMAs and LIMAs
  3. Coronary Vasospasm
  4. Collateral Circulation
  5. TIMI Flow

I.    Injection Techniques

  1. Damped and Ventriculized Waveforms
  2. Hand Injection
  3. Automatic Pressure Injectors

J.    Left Ventriculography

K.    Aortography

L.    Peripheral Arteriography

M.    Pulmonary Angiography

N.    Venography

O.    QCA – Vessel Measurement

P.    Arterial, Venous, Pulmonary Artery Lines/Catheters

Q.    Hemostasis (Femoral & Radial)

  1. Manual Technique
  2. Topical Accelerators
  3. Compression Products (C-Clamps, FemoStop)
  4. Mechanical Closure devices (Hemoband, etc.)
  5. Biosealants
  6. Collagen Plugs
  7. Sutures/Staples
  8. Pressure Dressings
  9. Complications

a.    Hematoma

b.    Vasovagal Reactions

c.    Pseudoaneurysm

d.    Retroperitoneal Bleed

e.    AV Fistula

f.    Limb Ischemia

R.    Diagnostic Specialty Procedures

  1. Fractional Flow Reserve (FFR)
  2. Intravascular Ultrasound (IVUS)
  3. Intra-Cardiac Echo (ICE)
  4. Optical Coherence Tomography (OCT)
  5. Near Infrared Spectroscopy (NIRS)
  6. Endomyocardial Biopsy

S.    Provocative Maneuvers

  1. Hypertrophic Cardiomyopathy 
  2. Myocardial Viability
  3. Coronary Spasm

T.    Interventional Procedures

1.     Percutaneous Coronary Interventions (PCI)

a.    Anticoagulation/Antiplatelet Agents/Glycoprotein IIb/IIIa Inhibitors

2.    Stents (Bare Metal, Drug Eluting, Bioabsorbable)

3.    Intra-Aortic Counter Pulsation/Balloon Pump

4.    Embolic Filters

5.    Laser

6.    Atherectomy (Rotational, Directional, Laser)

7.    Thrombectomy (Mechanical and Manual Aspiration)

8.    Fibrinolytic Therapy

9.    Aspiration and Distal Embolic Protection Devices

10.    Valvuloplasty and Percutaneous Valve Replacement (TAVR) and Repair (TMVR) 

11.    Structural Heart Interventions (PFO/ASD/VSD/PDA/LAA Closure)

12.    Pericardiocentesis

a.    Anterior Approach

b.    Subxyphoid Approach

c.    Echo Guidance

13.    Percutaneous LVADs (Impella, Tandem Heart) and Cardiopulmonary Support – CPS

14.    Transseptal Approach

15.    Investigational Therapies

16.    Clinical Research Trial

VI. Hemodynamics

A.    Hemodynamic Pressure Recognition

1.    Normal Pressures and Hemodynamic Values

a.    Waveform Identification (Atrial/Venous – a, x, c, v, y, mean, ventricular-s, d, edp, arterial-s, d, m)

b.    Pressure Values (Intra-Cardiac & Vascular)

c.    Cardiac Cycle/Wigger’s Diagram

d.    Cardiac Output/Cardiac Index (Preload, Afterload, Contractility)

e.    Systemic and Pulmonary Vascular Resistance

f.    Poisieulle’s Law

g.    Starling’s Law

2.    Transducers & Fluid-Filled Pressure Monitoring Systems

3.    Time-Pressure Relationships

4.    Pullback Waveform Identification and Analysis

a.    LV to AO, PCWP to Pa to RV to RA

5.    Abnormal Pressure Recognition

a.    Valvular Stenosis

b.    Valvular Insufficiencies

c.    Other Gradients

d.    Constructive Pressures

e.    Restrictive Pressures

f.    Tamponade

g.    Heart Failure Pressures

h.    Cardiomyopathies

i.    Pericardial Disorders

6.    Provocative Maneuvers

7.    Pressure and Waveform Hemodynamic Identification and Analysis

8.    Analysis of Pulmonary Artery Monitoring (Swan Ganz) Data

9.    Quality Control (QC)

B.    Cardiac Output and Blood Flow Determinations

1.    Fick

2.    Angiographic

3.    Thermodilution

4.    Comparison of Various Cardiac Output Methods

5.    Shunts

6.    Regurgitant Fraction

C.    Hemodynamic Calculations

1.    Cardiac Output

2.    Cardiac Index

3.    Mean Atrial Pressure

4.    Systemic and Pulmonary Vascular Resistance

5.    Systemic and Pulmonary Blood Flow

6.    Shunts (Right to Left, Left to Right, Bi-Directional)

7.    Regurgitant Fraction

8.    Ejection Fraction/LV Tracing

9.    Valve Areas – Gorlin and Haaki Formulas

10.    Evaluation of Calculated Values

VII. Pharmacology

A.    Medical & Legal Aspects, Documentation

B.    Sympathetic/Adrenergic and Parasympathetic/Cholinergic Nervous Systems

C.    Indications, Contraindications, Mechanism of Action, Normal Dosages, Side Effects, and Patient Care Consideration of the Medications Listed Below (E 1-27)

D.    Routes of Administration

E.    Pharmacokinetics and Pharmacodynamics of:

  1. Vasopressors and Vasodilators
  2. Diuretics
  3. Antihypertensives
  4. Local Anesthetics
  5. Anticoagulants (Heparins, Low Molecular Heparins)
  6. Direct Thrombin Inhibitors (Bivalirudin)
  7. Fibrinolytics
  8. Nitrates
  9. Antiarrythmics
  10. Antianginals
  11. Calcium Channel Blockers
  12. Contrast Media
  13. Cardiac Glycosides
  14. Analgesics and Reversal Agents
  15. Sedatives and Reversal Agents
  16. Insulin Therapy
  17. Steroids
  18. ACE Inhibitors, Angiotensin Receptor Blockers (ARB’s), Aldosterone Antagonists
  19. Antiemetics
  20. Antibiotics
  21. Antihistamines
  22. Oxygen
  23. Beta Blockers
  24. Antiplatelet Agents (IIb/IIIas)
  25. ACLS (1st and 2nd Line)
  26. Cholesterol Lowering Agents
  27. Conscious Sedation

a. Monitoring, Aldrete Score, Malpatti Classification

F.    Drug and IV Drip Calculations

VIII. Cardiovascular Diseases, Assessment and Treatments

A.    Identification of Pathologies and Complications

B.    Evaluation of Statistical Data for Cardiovascular Diseases

C.    Etiology, Pathophysiology, Clinical Manifestations, and Treatment of:

1.    Coronary Artery Disease – Atherosclerosis

2.    Angina

a.    Stable, Unstable Variants (Printzmetal’s)

3.    Acute Coronary Syndromes – Myocardial Infarction (STEMI, UA/NSTEMI)

a.    No-Reflow, Microvascular Obstruction

4.    Heart Failure (Left Heart, Right Heart, Biventricular)

5.    Shock (Cardiogenic, Hypovolemic, Septic, Distributive)

6.    Valvular Heart Disease (Aortic, Mitral, Pulmonic, Tricuspid, Stenosis, Regurgitant/Insufficient)

7.    Heart Valves and Surgery

a.    Percutaneous repairs such as TAVR/TMVR

b.    Surgical Valve Repair and Replacement

8.    Cardiomyopathies (Dilated, Hypertrophic, Restrictive)

9.    Pericardial Diseases (Acute Pericarditis, Constrictive Pericarditis, Pericardial Effusion, Tamponade)

10.    Abdominal and Thoracic Aortic Aneurysms & Dissections

11.    Systemic and Pulmonary Hypertension

12.    Hereditary Diseases

13.    Pulmonary Diseases (COPD)

14.    Arterial Diseases

15.    Infectious Diseases

16.    Tumors

17.    Cerebrovascular Diseases

18.    Renal Disease

19.    Endocrine Disease

D.    Athlete’s Heart

1.    Common Cardiovascular Cath Lab Findings

E.    Surgical Procedures

1.    Coronary Bypass

2.    Minimally Invasive Coronary Bypass

3.    Surgical Valvular Repair/Replacement

4.    Transcatheter Valvular Repair/Replacement

5.    Heart Transplant

6.    Cardiac Implantable Electronic Devices (pacemaker, defibrillator, cardiac resynchronization therapy, implantable loop recorder)

7.    Investigational Clinical Procedures

F.    Ventricular Assist Devices

IX. Congenital/Pediatrics

A.    Congenital Anomalies

1.    Fetal Embryology/Circulation/Transition at Birth

2.    Common Anomalies

a.    ASD, VSD, PFO, PDA, Coarctation, Transposition, Tetralogy, AV Canal Defect, Hypoplastic Right and Left Ventricle, Truncus Arteriosus, Tricuspid Atresia, Total Anomalous Venous Return, Pulmonary & Aortic Stenosis

3.    Palliative and Corrective Surgical Interventions

a.    Prostaglandin E, Rashkind Atrial Septostomy, Pulmonary Artery Banding, Closure Devices, Arterial Switch, Blalock Taussig Shunt, Fontan Procedure, Norwood Procedure

4.    Catheter Interventions

B.    Pediatric Catheterization Techniques

X. Electrophysiology (Optional Content for RCIS Programs)

A.    Implantable Devices

1.    Permanent Pacemaker Implantation

2.    ICD Implantation

3.    CRT Devices, Loop Recorders, Subcutaneous ICD

B.    Diagnostic/Mapping Procedures

C.    Cardioversion

D.    Tilt Table/Syncope

E.    Radiofrequency Ablation – RFA

F.    3D Mapping Techniques (CARTO, Contact and Non-Contact Electroanatomical Mapping)

G.    Pulmonary Vein Angioplasty

H.    Drug Infusion Testing for the Diagnosis of  Brugada Syndrome and/or Inappropriate Sinus Tachycardia

XI. Clinical Competencies

A.    Pre- and Post- Cardiovascular Cath Patient Care and Teaching

B.    Monitoring – Recording

1.    Diagnostic – Left Heart, Right Heart, Vascular

2.    Interventional – Cardiac, Vascular

C.    Manipulation of Imaging Equipment

D.    Quality Control

E.    Scrubbing

1.    Diagnostic – Left Heart, Right Heart, Vascular

2.    Interventional – Cardiac, Vascular

F.    Circulating

1.    Diagnostic – Left Heart, Right Heart, Vascular

2.    Interventional – Cardiac, Vascular