Advanced Catheterization at UWMC
Key Points:
- The most accurate cath lab staffing (Attending, Card-I fellow, General fellow, Charge RN) schedule is available on amion.com with login "CathLab".
- This is a chance to refine your cath skills with respect to panning, catheter selection, radial access and perhaps help with some interventions.
- You will observe specialized procedures such as PFO closures, alcohol ablations, mitra-clips, TAVRs and valvotomies.
- Like the previous cath rotations, you will find that each attending does things very differently.
- Many procedures will go much longer that you have previously experienced at the VA or Harborview. Its worth it.
- A patient and enthusiastic attitude will get you far in getting you hands on experience in interventions and specialized procedures
- Keep the lab flowing. More cases for you and also everybody will be happy!
Responsibilities:
- This is a pure cath rotation. You should spend nearly 100% of the time in the cath lab.
- Your day will start at 7AM and occasionally go late into the night. See the checklist and learning objectives above.
- Check the ORCA schedule the day or week before to get an idea of the next day’s schedule. You can access this under the HOV-E/PROC tab in ORCA under "UW Cardiac Cath Lab".
- You are responsible for pre-cath evaluation of the patient including: pre-cath order sets before they show up. This includes cath and TAVR patients.
- You should know: indications for cath, review of labs, pertinent physical exam, and data including nuclear studies, echos, and previous caths. Review of studies should occur the night (or weekend) before. INR should be below the attendings’ threshold before bringing the patient back to the lab
- We have found that prepping an entire week of patients is easier than doing it every night, because nights can get late if you procrastinate. Do yourself a favor, sit down on Sunday and prep the entire week. You and the lab will thank yourself.
- You should obtain the informed consent in the holding area before the patient is prepped.
- In some cases, the attending will know the patient’s history intimately from a conversation with the referring physician. More often, they will not know the patient. Do a brief presentation of pertinent details and be sure to go over previous caths if available.
- In general, you should scrub in for every coronary case possible. When there are two simultaneous cases going on and you can choose which one you should be involved in, though should default toward working with the doc of the day.
- Very occasionally you will be asked to evaluate a patient who needs emergent cath (ST elevation in ER during the day or an inpatient with ongoing MI).
- If you are already scrubbed in for a case, it is reasonable to ask an interventional fellow or the CCU fellow to do the initial triage and management.
- ttend cath conference Tuesday mornings.
Tuesday UW Cath Lab Conference Recent Presentations:
- Vascular Access, Michael Stadius, MD
- Coronary Stents, Ravi Hira, MD
- Optical Coherence Tomography, Patrick Goleski MD
- Hybrid PCI, Creighton Don, MD