What Is a Cath Lab Nursing Specialty? The Ultimate Guide
According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States. In 2020, 697,000 people in the US died from heart disease, constituting one in five deaths. In this context, it is no surprise that over 1 million cardiac catheterization procedures are performed annually in the US to diagnose and treat patients with coronary heart disease and other related disorders.
Yes, you guessed it: These procedures would not be possible without the assistance of cardiac cath lab nurses. Whether you are still in nursing school or have years of work experience under your scrubs, read on to learn all there is to know about cardiac cath lab nursing to help you decide if this specialty is the right career move for you.
What Does CCL Stand For?
The abbreviation CCL stands for cardiac catheterization laboratory, more commonly referred to as cardiac cath lab or simply cath lab. Cath lab is a medical procedure that provides x-ray images of a patient’s heart and blood vessels to diagnose coronary artery disease.
What Does Cath Lab Mean in Medical Terms?
Cardiac catheterization or angiogram is a procedure through which a catheter—a small, flexible tube—is inserted into a large vessel in a patient’s upper thigh or arm and guided through the arteries to the heart. A contrast dye injected into the catheter shows blood flow through the arteries of the heart. This dye allows doctors to identify the location and size of possible blood-flow restrictions, such as narrowed or blocked arteries. This information, in turn, helps cardiologists develop a treatment plan.
Numerous procedures may be carried out in a cath lab by a cardiologist and a team of nurses and technicians. A cardiac catheterization or an angiogram may be performed due to an emergency, such as a heart attack in progress. Cardiac cath lab procedures are also performed as diagnostic tools to check for blockages. These catheterization procedures include the following:
These are non-surgical cardiac interventions utilizing special catheters to “open” blocked arteries that supply blood to the heart. These procedures begin in the same way as diagnostic procedures; however, in this case, the cardiologist will open the blocked artery through the interventional procedure. The procedure lasts between one and a half to two and a half hours, with additional time for preparation. Patients sometimes need to stay overnight in the hospital.
During this procedure, a cardiologist will use a catheter with a small balloon attached at the end, which can be inflated from the outside. A cardiologist threads the balloon catheter to the part of the artery that has become blocked by plaque, a fatty substance that doesn’t allow blood to flow properly. At this point, the balloon is inflated and deflated many times, compressing the plaque and stretching the artery open to increase blood flow.
A stent is a tiny, metal mesh tube that is used along with balloon angioplasty. The stent is connected to a balloon-tipped catheter and threaded through the artery until the location of the blockage. When the balloon is inflated, the stent opens and becomes embedded permanently within a blocked artery to keep the artery open and prevent it from collapsing or reblocking with plaque. Multiple stents may be used depending on the number of blockages.
During rotoblation, a catheter with an acorn-shaped diamond-coated tip is guided to a blocked artery. Then, the diamond-coated tip spins, grinding away the built-up plaque. The small particles of plaque wash away in the bloodstream and are filtered out by the liver and spleen.
A cutting balloon catheter has a balloon tip with small blades. When the balloon is inflated, the blades scrape some of the plaque from the artery wall, and the balloon compresses the remaining plaque into the artery wall, opening the narrowed artery.
Pacemakers are battery-powered devices the size of matchboxes that help the heart beat in a regular rhythm and, therefore, are used with patients with a slow and irregular heart rhythm. They are implanted under the skin and fatty tissue near the collarbone.
To treat vascular diseases, such as peripheral artery disease (PAD), a cardiologist inserts a catheter in the femoral artery in the groin and threads it until the blocked artery in the patient’s leg. Next, a balloon is inflated to open the narrowed or blocked blood vessel. In some cases, this is then held open with a stent. This treatment does not require surgery, simply a small opening in the skin about the size of a pencil tip.
Recent studies have shown that rapid cardiac intervention is the most effective treatment for saving heart muscle in cases of ST-elevation myocardial infarction (STEMI), a serious type of heart attack with a great risk of complications and death. In these situations, emergency balloon angioplasties are performed, or stents are implanted.
What Is a Cardiac Catheterization Lab Unit in a Hospital?
By definition, a cardiac catheterization laboratory or a cardiac cath lab is a specialized area in a hospital where doctors perform catheterizations, which are minimally invasive tests and advanced cardiac procedures that help diagnose and treat cardiovascular disease. These units are equipped with advanced imaging technology, which allows the care team to diagnose and treat blockages and other problems without surgery.
Routine procedures are scheduled during daytime hours; however, cath lab staff must be ready to perform emergency catheterizations around the clock.
The following are diagnostic cath lab procedures:
- Constriction and restriction studies
- Coronary, renal, peripheral, carotid, and other forms of angiography
- Endomyocardial biopsy
- Intracardiac and intravascular ultrasound
- Evaluation of complex valvular disease
- Coronary physiology, microcirculation, and endothelial assessment
- Services for people having organ transplants
- Left and right heart hemodynamic assessment
In addition, the following catheterization procedures are performed to treat or manage conditions:
- Balloon atrial septostomy
- Balloon valvuloplasty and transcatheter aortic valve replacement
- Balloon dilatation and stent placement
- Angioplasty and stenting as a treatment for peripheral artery disease (PAD)
- Carotid angioplasty and stenting
- Closure of periprosthetic valve leaks
- Clot removal with an aspiration device
- Coronary catheterization and stents to treat coronary artery disease
- Enhanced external counterpulsation as a treatment for chest pain
- Percutaneous mitral valve repair
- Plaque removal with a rotating device
- Pulmonary artery angioplasty to open lung arteries blocked with chronic clots and improve pulmonary hypertension
- Pulmonary vein stenting to treat blocked veins
- Septal ablation
- Stereotaxis magnetically assisted intervention
- Transcatheter insertion of coil or occluder
- Ventricular assist devices (VADs)
Depending on the facility, cardiac cath labs may be part of coronary artery disease clinics. Cath labs may also be divided into two units: one for coronary diagnostic and intervention procedures and another for electrophysiology studies to diagnose and treat abnormal heartbeats or arrhythmias.
What Is the Role of a Cardiac Cath Lab Nurse?
Cath lab nurses assist cardiologists in diagnostic cardiac catheterizations and interventional procedures. They also assess patients and manage patient care in the cath lab, including monitoring patients for improvements or complications and administering medications.
“Our lab also has techs and nurses doing the same roles and we all rotate between scrub, monitor, and circulator. It helps a lot since in this case you get to learn all the roles and see the bigger picture. How the lab has roles set up differs from place to place. In some, the techs will only scrub and nurses monitor and circulate. In others techs scrub and monitor and nurses only circulate. Some have a dedicated monitor. Some have a dedicated sedation and medication nurse. How the roles are set up will change things a lot.” Reddit – u/jack2of4spades
What Does a Cath Lab Nurse Do?
Depending on the facility and a cath lab nurse’s specific role, they may have different responsibilities. Here are some of the potential duties of a cath lab nurse:
- Performing nursing assessments to gather data and identify the patient's needs
- Checking clinically important aspects related to the patient's entrance into the cath lab
- Assisting physicians during catheterization procedures, angioplasties, pacemaker implantations, and other cardiac procedures
- Understanding the functioning of special devices, including rotoblators, intra-aortic balloon pumps, AngioJets, thrombus aspiration systems, cutting balloons, and filter wires
- Assisting with all peripheral devices
- Collaborating with cardiologists and other members of the healthcare team
- Providing care based on established standards of practice, policies, and protocols
- Ensuring that patients are admitted to, transferred from, and discharged from the cath lab in an efficient manner
- Demonstrating critical thinking skills for problem-solving and anticipating patient care needs
- Documenting assessments, delivery of care, and patients' responses to care in the medical record
- Administering moderate sedation to patients under the direct supervision of a physician
- Demonstrating the ability to function in all aspects of diagnostic and interventional catheterization, including scrubbing, circulating, monitoring, and recording procedures
- Participating in after-hour and on-call coverage
- Assisting as part of a team to provide support in the cath lab and with interventional radiology
- Understanding policy and procedure for emergent patient needs and codes
- Stocking supplies used in the radiology setting
How to Become a Cath Lab Nurse and How Long Does It Take
Cath lab nurses are registered nurses (RNs). Therefore, the minimum educational requirement is a two-year associate’s degree in nursing (ADN), although many employers prefer a four-year bachelor’s of science in nursing (BSN).
Depending on the employer, cath lab nurses may also need some or all of the following certifications, training, and experience:
- Basic Life Support (BLS) certification
- Advanced Cardiovascular Life Support (ACLS) certification
- Pediatric Advanced Life Support (PALS) certification
- Completing a Basic Dysrhythmia class
- Telemetry experience
- Experience with evaluation and programming of pacemakers and implantable cardioverter defibrillators (ICDs)
- Experience with advanced cardiac rhythm interpretation
- IV therapy certification
- Intra-aortic balloon pump (IABP) management
- Advanced electrocardiogram (EKG) knowledge
- Ability to function in all nursing roles of diagnostic and interventional catheterization, including scrubbing, circulating, monitoring, and recording procedures
- Knowledge of cardiac medications, emergency management of cardiac patients, current clinical practice guidelines in cardiology, and secondary prevention
- One to two years of work experience in critical care or cardiology catheterization lab
Cardiac Cath Lab Nurse Certification
In addition to basic requirements, such as RN licensure and BLS certification, many employers prefer to hire nurses who have pursued specialized certifications.
The American Nurses Credentialing Center (ANCC) offers the Cardiac Vascular Nurse – Board Certified (CV-BC™) credential for nurses with entry-level clinical knowledge and skills in the cardiac-vascular specialty after initial RN licensure. The following are eligibility requirements for this certification:
- Holding a current, active RN license
- Having practiced the equivalent of two years full-time as a registered nurse
- Accruing a minimum of 2,000 hours of clinical practice in cardiac-vascular nursing within the last three years
- Completing thirty hours of continuing education in cardiac-vascular nursing within the previous three years
The American Association of Critical Care Nurses (AACN) offers the Acute/Critical Care Nursing – CCRN® (Adult) certification. This credential is for nurses who provide direct care to critically ill adult patients. Eligibility requirements include the following:
- Holding a current, active RN license
- Practicing as an RN or advanced practice registered nurse (APRN) for 1,750 hours providing direct care for critically ill adult patients during the previous two years, with 875 of those hours accrued in the year preceding the application
- Alternatively, practicing as an RN or APRN for a minimum of 2,000 hours providing direct care for critically ill adult patients during the previous five years, with 144 of those hours accrued in the year preceding the application
The Registered Cardiovascular Invasive Specialist (RCIS) examination is for healthcare professionals working in cardiac catheterization. Nurses interested in this certification must have one year of experience working full-time in invasive cardiovascular technology and complete 600 cardiac diagnostic/interventional procedures, whether as part of work experience or as clinical experience obtained during a formal educational program.
How Much Does a Cath Lab Nurse Make?
Cath lab nurses are generally RNs working in the hospital setting. Therefore, a cath lab nurse’s salary is approximately $85,020 annually. However, cath lab nurses generally earn more because of mandatory after-hour and on-call coverage.
“The plus side is a lot of places have "call back" with a guaranteed time. So if your pager goes off at 2am, you instantly get paid say 2 hours of regular or time and half. If it gets canceled or it only takes 30 minutes, you still get at least 2 hours of pay. That call back and overtime adds up and is why cath lab nurses usually make more than other nurses.” Reddit – u/jack2of4spades
What Is Cardiac Cath Lab Nursing Like?
Besides getting objective information about job requirements, certifications, and potential salary, aspiring cath lab nurses will want to hear first-hand accounts of nurses working in the cardiac cath lab to better gauge if this specialty is for them.
“The transition from ICU to CCL can be rough because you need to get used to not knowing everything about your patient and only doing the here and now. It's more similar to the ED where they come in, you learn the pertinents, do your thing for those, and kick them out. On the flip side, that ICU experience is needed since you'll be managing sedation, drips, vents, etc.” Reddit – u/jack2of4spades
“So much of what your job will be depends on the facility. For example- At my hospital the nurses chart or circulate, we don’t scrub. Other places the RNs do scrub. When we chart we sit in the control room, we aren’t standing in lead as someone else mentioned. We’re only in lead if we’re circulating. RNs don’t pull sheaths in my lab, the recovery nurses pull them. Call also varies greatly depending on the facility. We take 8-10 days per month.” Reddit – u/jardalecones21
In addition to reading first-hand testimonials, why not get your own hands-on experience? Picking up per diem nursing shifts is a great way to experience nursing in diverse settings and roles—and accrue the necessary work experience to qualify for master’s programs and specialized nursing certifications.
Is Cath Lab Nursing Stressful or Hard?
No ultimate cath lab nursing guide could be complete without covering the cons. Here are some of the aspects of cardiac cath lab nursing that nurses find challenging:
“Some of the docs have pretty big egos…Some of the new cardiology fellows are insufferable personalities. A bad attitude can really bring the room down, but the majority of the fellows are nice and respect the staff.” Reddit – u/itsthebigt
“…and of course, call. I personally love being on call because for me it is extra money, and nothing beats the adrenaline rush of saving a life!! What we do is amazing. That being said, I never sleep well on my call nights… if you get called at 3 AM and have to be at work at 7 the next morning.” Reddit – u/smansaxx3
Why Choose Cardiac Cath Lab Nursing
Despite dealing with difficult personalities and occasionally being on call, here is why cath lab nurses love their jobs:
“I love it. Our lab is weird in that we do pre, intra, and post procedure with all the same staff. It's great because if you get a bad patient, you're only with them for a short while before you move them back to the unit. Unlike ICU where you could potentially be stuck with them for days at a time.” Reddit – u/itsthebigt
“The people I work with are freaking amazing! They have become like family to me and we go out a lot even outside of work. I have never felt more "at home" in any of the places I've ever worked.” Reddit – u/smansaxx3
What Makes a Good Cath Lab Nurse: Tips for New Nurses
In addition to licensure, certifications, and work experience, employers look for nurses with certain knowledge and skills. The following are some of the soft skills that make for great cath lab nurses:
- Effective communication skills
- Ability to problem solve, manage stress, and handle emergent patient situations
- Ability to work well with patients, doctors, and other members of the cath lab team
- Ability to coordinate care between departments
- Basic computer knowledge and skills
- Ability to calculate correct doses by applying necessary mathematical formulas
Furthermore, here are some tips from experienced cath lab nurses that can help new nurses transition smoothly to the specialty:
“There are a variety of complications during procedure you need to be alert for so good assessment skills are important. The interventionalist will have you bringing supplies etc. So learning where everything is, setting up a table, having some IV skills is a good thing to have.” Reddit – u/rowsella
“You have to be able too work well with a team. We have a great group and we all can joke around with each other while still doing our jobs and being 100% in the case. Things can go south very quickly in a cath procedure, so you always need to be ready for that one patient in a thousand who's going to throw some vtach, or maybe the doc will perforate a coronary artery…You have to be able to keep your cool in a high emergency or code situation.” Reddit – u/itsthebigt
Final Thoughts on Cath Lab Nursing
Cath lab certainly has its perks: It’s relatively laid back—with the occasional emergency to keep things interesting; nurses work with one patient at a time, and it offers higher-than-average pay. That said, no single specialty can fit every nurse's personality, so if Cath lab doesn’t seem right for you, continue exploring other options. One of these nursing specialties is bound to be perfect for you!