Defining the Roles Within the Cardiovascular Interventional Clinical Setting
Keith Boles
Forsyth Technical Community College
Abstract
Since the discovery of X-ray by Roentgen in 1895, the medical field has and still continues to undergo numerous improvements. The use of X-ray has been a globally used and accepted method of treating cardiovascular disease. With the ever increasing advancements in the cardiovascular interventional field comes the ever increasing responsibility of the need for an educated and capable clinical team. Physicians train intensively for their respective specialties, but what about the remaining cardiovascular team members? The scope of this manuscript is to define the qualifications of the clinical team and define how they play a role in a good clinical outcome for the patient.
Introduction
The field of Interventional Cardiovascular Technology is a growing industry.
According to the United States Department of Labor, “Cardiovascular technologists and technicians held about 45,000 jobs in 2006.” (Department of Labor, p.3, 2006) The study goes on to say, “Employment of cardiovascular technologists and technicians is expected to increase by 26 percent through the year 2016, much faster than the average for all occupations.” (Department of Labor, p.3, 2006) In the field of Interventional
Cardiovascular Technology there are primarily two areas that perform cardiovascular procedures. One of the most widely known areas is the Cardiac Catherization Laboratory or the Cardiac Cath Lab. The other area is that of the Peripheral Vascular Laboratory.
The Cardiac Catherization Lab typically performs angiography and other endovascular

procedures on the coronary vessels which supply the heart itself with oxygen rich blood.
The Peripheral Vascular Laboratory performs angiography and other endovascular procedures on the remaining blood vessels which supply the remaining organs of the body. Depending on the hospital or location where these labs are, these labs may be headed by a team of Cardiologists, Vascular Surgeons, Radiologists or a mixture of all three types. The emphasis of this manuscript is not on the Physicians, but rather the ancillary clinical cardiovascular staff. These staff members may include a combination of nurses, radiologic technologist, respiratory therapists or cardiovascular interventional specialists. This manuscript deals with several different ideas and concepts dealing with what risks, responsibilities, and roles that these members of the interventional cardiovascular team will encounter. First of all, there are numerous risks that involve both the patient’s health as well as the team member’s health and well being. Secondly, a description of the reponsibilites of each team member and how they directly effect good patient care. Thirdly, what are the roles of each team member and if they differ from role to role.
These three topics are stated in the following three questions. The first question is in regards to the risks associated with the interventional cardiovascular field. What risks are there for patients and staff in this field of medicine? The second question is in regards to the responsibilities of the staff. What are some of the responsibilites that the cardiovascular team should carry? The last question deals with the particular roles of the interventional cardiovascular team. What are the specific roles that the team fall into?
The previously stated topics are addressed in this same order in the manuscript under the headings of defining the risks, defining the responsibilties, and defining the roles.

Defining the Risks
Many occupations have some form of risk. The risks may be considered small or they may be considered very major. The risks may only effect the employee or it may effect the lives of others directly or indirectly. The field of Interventional Cardiovascular
Technology is an occupation whose risks effect both the lives of the patients and the lives of the cardiovascular team. The question remains then, what are these risks? The risks can be divided into two areas: patient risks and personnel risks. The first risk area that will be addressed are risks that are associated with the patient. One of the largest risks that exist for both the patient and the cardiovascular team members is in the area of radiation protection. When Wilhelm Roentgen first discovered the X-ray, he was oblivious to the fact of the dangers of radiation. Other scientists, such as Dr. John Hall-
Edwards, continued to build on Roentgen’s discovery, but were not careful in regards to radiation protection. “By the time the malignant end-process was meticulously described in 1908 by Dr. John Hall-Edwards of Birmingham, the damage had already been done…”
(Guy, p.2, 1995) Many safety devices and housings for the X-ray tubes were developed over the years to reduce the amount of radiation exposure to both patients and clinical staff alike. Yet, still today, many cardiovascular staff and Physicians fail to follow the cardinal principles of radiation safety. The acronymn ALARA stands for As Low As
Reasonably Achievable should always be the primary goal for the cardiovascular professional. Some of the various professional organizations, such as the ASRT
(American Society of Radiologic Technologists) began pushing for better enforcement of radiation protection in 1997. “In 1997, the ASRT began a campaign to protect patients from overexposure to radiation during radiologic procedures and help reduce the cost of

administering health care.” (ASRT website, 2008) “Repeated radiologic examinations cost the U.S. health care system millions of dollars annually in needless medical bills.”
(ASRT website, 2008) Ten years after the first push by the ASRT, a bill known as the
Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation
Therapy (CARE) bill is currently under consideration by Congress. The CARE bill, if passed, “…will most likely be the document upon which HHS will base their education and credentialing standards.” (Draft HHS Regulations, 2008) The HHS (Health and
Human Services) will be able to give guidelines and recommendations to various groups that give credentials such as the ARRT (American Registry of Radiologic Technologists) and CCI (Cardiovascular Credentialing International) who credential RCIS (Registered
Cardiovascular Invasive Specialists). Radiation protection is a major issue and concern for patients that undergo these procedures and the cardiovascular staff that assist with these procedures. Other risks that patients may encounter are too numerous to list, but are considered as a risk versus a benefit of having the procedure. If one were to place all of these additional risks into one category, that category would be under malpractice risks.
Countless news reports have been documented nationally and around the world for careless errors made by the clinical staff and Physicians. Many of these “errors” are simply careless and preventable. Proper care and training is a must for any, cardiovascular or otherwise, who work in the medical field. There are many risks that involve the patient, but what about the risks to the cardiovascular personnel? As previously mentioned, radiation protection is of utmost importance for the clinical staff as well. The less time they are exposed to radiation, the greater the distance from the source of the radiation, and the more shielding from the source of radiation are all key factors

that every staff member must consistently obey and follow. Other risks, that are also preventable, include needle sticks and proper sharps safety techniques that are taught in the academic setting can decrease the number of incidents that occur annually. The use of proper personal protective equipment (not including lead aprons for radiation protective purposes) which include eyewear to prevent eye splashes and adequate outerwear to prevent blood or other bodily fluid from coming into contact with the cardiovascular staffs’ garments. Risks in the cardiovascular setting are present every case. How then, can these risks be averted and avoided on a consistant basis?
Defining the Responsibility
There is a growing trend with the Interventional Cardiovascular field for
Results

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