Current through Register Vol. 24-18, September 15, 2024
(1) A cardiovascular invasive specialist
assists in cardiac or vascular catheterization procedures in the role of
either:
(a) A monitoring technologist, who
documents every action during a catheterization procedure and monitors the
patient's status, reporting any irregularities to the surgical team;
(b) A circulating technologist, who provides
assistance to the surgical team from outside the sterile field; or
(c) A sterile/scrub technologist, who
directly assists the physician during the catheterization procedure.
Except as provided in subsection (8) of this section, no
cardiovascular invasive specialist shall perform the tasks of more than one
role during any individual procedure. All intraprocedure tasks in any role must
be performed under personal supervision.
(2) The preprocedure tasks a cardiovascular
invasive specialist may perform in any role include:
(a) Prepare sterile table and necessary
supplies;
(b) Verify patient
identification;
(c) Verify or
facilitate patient consent;
(d)
Verify history and physical information to include:
(i) Chief complaint;
(ii) History of present illness;
(iii) Current medications;
(iv) Laboratory results;
(v) Test reports, as necessary, such as
X-rays and electrocardiograms;
(vi)
Past medical history;
(vii) Family
and social history; and
(e) Obtain blood samples as allowed under WAC
246-926-180(3).
(3) The intraprocedure and
post-procedure tasks a cardiovascular invasive specialist may perform in the
role of a monitoring technologist include:
(a) Operate physiologic monitoring and
recording equipment;
(b) Capture
and input data for procedural calculations;
(c) Monitor, identify, measure, and record
information from electrocardiograms or ECG, intracardiac electrograms, and
pressure waveforms;
(d) Document
each step and action during a procedure; and
(e) Inform the physician and team members of
noted abnormalities.
(4)
The intraprocedure tasks a cardiovascular invasive specialist may perform in
the role of a sterile or scrub technologist include:
(a) Administer local anesthetic as allowed
under WAC
246-926-180;
(b) Gain arterial or venous access;
(c) Insert and flush vascular
sheath;
(d) Assist with insertion
and manipulation of guidewires, catheters, and pacing leads;
(e) Assist with implantation of leads and
devices for implantable devices, such as pacemakers or implantable
cardioverter-defibrillators or ICDs;
(f) Close implantable device
pockets;
(g) Assist in ablation of
intracardiac lesions;
(h) Assist
with performing intracardiac mapping;
(i) Assist with performing intracardiac lead
extraction;
(j) Assist with
obtaining invasive hemodynamic data, cardiac outputs, and blood
samples;
(k) Inject contrast as
allowed under WAC
246-926-180 for visualizing
cardiovascular anatomical structures either manually or with the aid of a
mechanical contrast device;
(l)
Administer medications related to cardiac or vascular catheterization as
directed by the physician;
(m)
Assist with obtaining tissue samples for biopsy; and
(n) Operate intravascular ultrasound or
intracardiac echocardiography, fluoroscopy, and other imaging modalities
excluding computed tomography as defined in WAC
246-226-010(1).
(5) The intraprocedure tasks a
cardiovascular invasive specialist may perform in the role of a circulating
technologist include:
(a) Maintain sterile
field and equipment supply;
(b)
Set-up and operate ancillary equipment to include:
(i) Contrast injectors;
(ii) IVUS/ICE;
(iii) Fractional flow reserve/coronary flow
reserve (FFR/CFR);
(iv)
Atherectomy/thrombectomy devices and consoles;
(v) Intra-aortic balloon pump;
(vi) Percutaneous ventricular assist
devices;
(vii) Pacemakers,
automated implantable cardioverter defibrillators (AICD), and temporary
pacemakers;
(viii) Pacemaker and
AICD programmers;
(ix) Ablation
devices;
(x) Intracardiac mapping
devices;
(xi) Lead extraction
devices;
(xii) Electrophysiologic
stimulators;
(xiii) Other
diagnostic, interventional, and mechanical support devices;
(xiv) Activated coagulation time (ACT) and
other coagulation studies;
(xv)
Whole blood oximetry; and
(xvi)
Arterial blood gas (ABG).
(6) The post-procedure access site tasks a
cardiovascular invasive specialist may perform in the role of either
circulating technologist or sterile/scrub technologist include the following:
(a) Manually remove vascular
sheath/catheter;
(b) Secure
retained sheath/catheter;
(c) Use
compression devices;
(d) Use
vascular closure devices; and
(e)
Instruct patient on care of site.
(7) The post-procedure patient care tasks a
cardiovascular invasive specialist may perform in any role include the
following:
(a) Monitor and assess patient
heart rate, blood pressure, respiratory rate, oxygen saturation, and level of
consciousness;
(b) Identify,
monitor, and compress rebleeds and hematomas;
(c) Assess distal pulses; and
(d) Document patient chart as
appropriate.
(8) On an
individual case basis and at the sole discretion of the physician, a
cardiovascular invasive specialist may assume the dual role of monitoring and
circulating technologist during an individual procedure. Such dual role
approval shall be documented in the patient chart.
(9) Nothing in this chapter shall be
interpreted to alter the scope of practice of any other credentialed health
profession or to limit the ability of any other credentialed health
professional to assist in cardiac or vascular catheterization if such
assistance is within the profession's scope of practice.
Statutory Authority:
RCW
18.84.040 and
43.70.250. 12-10-094, §
246-926-400, filed 5/2/12, effective
5/3/12.
