Key Responsibilities and Required Skills for Cath Lab RN

🎯 Role Definition

The Cath Lab RN provides specialized nursing care for patients undergoing diagnostic and interventional cardiac and vascular procedures (coronary angiography, PCI, peripheral interventions, structural heart cases, electrophysiology cross-coverage). This role combines advanced patient assessment, invasive procedure support (scrub or circulating responsibilities), vigilant hemodynamic and rhythm monitoring, conscious sedation support, post-procedure recovery and education, and active participation in quality, safety and regulatory initiatives. The Cath Lab RN is a critical team member who ensures safe, efficient throughput and superior patient outcomes in a high-acuity procedural environment.

📈 Career Progression

Typical Career Path

Entry Point From:

Progressive Care Unit (PCU) / Telemetry
Medical-Surgical Step-Down with cardiac monitoring experience
Critical Care Unit / ICU (preferred)

Advancement To:

Senior Cath Lab RN / Lead RN — (charge responsibilities, scheduling)
Clinical Nurse Specialist or Nurse Educator for Interventional Cardiology
Interventional Cardiology Coordinator or Program Manager
Procedural Team Supervisor or Director of Cardiac Services

Lateral Moves:

Electrophysiology (EP) Lab RN
Structural Heart Program RN (TAVR, MitraClip)
Cath Lab Clinical Research Nurse / Clinical Trials Coordinator

Core Responsibilities

Primary Functions

Perform comprehensive pre-procedural assessments including history, focused cardiac and vascular exam, allergy and renal risk evaluation for contrast exposure, medication reconciliation, and verification of informed consent to ensure patient readiness for diagnostic angiography and interventional procedures.
Prepare the cath lab environment and equipment before each case: confirm sterility, set up monitoring (ECG leads, arterial lines if indicated), calibrate hemodynamic transducers, prime flush systems, and verify functionality of imaging, fluoroscopy, suction and emergency cart.
Serve as scrub or circulating nurse during diagnostic and interventional procedures — maintain sterile field, pass instruments, prepare and label contrast and medication syringes, assist with device exchanges, and coordinate instrument trays for percutaneous coronary intervention (PCI), peripheral angioplasty/stenting, thrombectomy, and structural interventions.
Continuously monitor patient hemodynamics and cardiac rhythm intra-procedure; recognize and promptly communicate arrhythmias, ischemic changes, hypotension, or other critical trends to the physician and team while initiating appropriate nursing interventions.
Administer conscious sedation, analgesia and procedural medications per protocol or physician order; titrate sedation, monitor respiratory status and level of consciousness, and intervene for airway compromise or oversedation as needed.
Manage vascular access sites intra- and post-procedure: assist with sheath insertion and removal, apply hemostasis or device-based closure systems (e.g., Angio-Seal), monitor for bleeding, hematoma, distal pulses and signs of limb ischemia, and escalate complications immediately.
Provide immediate bedside management of acute complications (cardiac tamponade, acute MI/STEMI activation, anaphylaxis to contrast, vascular perforation) including initiation of ACLS algorithms, external pacing, balloon pump or mechanical circulatory support coordination, and rapid transfer to higher-level care if necessary.
Administer and titrate vasoactive medications and antithrombotic agents (heparin, bivalirudin, glycoprotein IIb/IIIa inhibitors, antiplatelet therapy) during procedures in collaboration with physicians and pharmacy to achieve target anticoagulation and hemostasis goals.
Monitor and mitigate contrast-induced nephropathy risk by following hydration protocols, verifying baseline renal function, and coordinating with physicians for contrast dosing adjustments and post-procedure monitoring.
Educate patients and family members pre- and post-procedure about the treatment plan, procedure expectations, activity restrictions, signs of complications, discharge instructions and follow-up care to promote safe transitions and compliance.
Perform thorough post-procedure assessments in the recovery area including serial vital signs, cardiac rhythm observation, neurovascular checks, access site inspection, pain management, and documentation of procedural outcomes and nursing interventions in the electronic medical record (EMR).
Accurately document all procedural events, medications, device usage, hemodynamic data, time-outs, and patient education in the EMR for legal, billing, and quality tracking purposes; ensure coding and charge capture accuracy for services rendered.
Maintain strict adherence to radiation safety principles: wear and monitor personal dosimeters, utilize shielding and distance best practices, collaborate with imaging techs on fluoroscopy time reduction, and participate in radiation safety program requirements.
Ensure sterile processing, inventory control and readiness of disposables, implants and specialty catheters; communicate supply needs to materials management to prevent case delays and ensure cost-effective utilization.
Facilitate interdisciplinary communication and team coordination with interventional cardiologists, anesthesiologists, radiology techs, perfusionists (if applicable), case managers and transport services to optimize case flow and patient throughput.
Participate actively in STEMI and code STEMI pathways, acting as primary RN for emergent transfers, rapid triage, case preparation and post-revascularization care to expedite door-to-balloon metrics and improve outcomes.
Precept, orient and evaluate new Cath Lab RNs, technologists and students; provide competency validation, bedside coaching on procedures, sterile technique, device handling and institution-specific protocols to build a high-performing procedural team.
Contribute to continuous quality improvement by collecting data for registries (e.g., NCDR), participating in morbidity and mortality reviews, identifying system issues (turnover time, infection risk), and implementing evidence-based practice changes to improve care quality.
Ensure compliance with state and federal regulatory requirements, hospital policies, infection control standards and clinical practice guidelines; participate in internal audits and corrective action plans when indicated.
Troubleshoot and escalate technical equipment issues during procedures, coordinate timely biomedical engineering support or vendor intervention and document equipment-related events per institutional policy.
Support participation in clinical research and device trials by screening candidates, obtaining research consents (per protocol), collecting accurate trial data, and adhering to Good Clinical Practice (GCP) and study-specific procedures.
Provide cross-coverage for electrophysiology or hybrid operating room cases as needed, assisting with mapping, device implant support and peri-procedural nursing responsibilities for complex arrhythmia or structural heart interventions.
Lead or participate in patient safety huddles, debriefings and simulation sessions to rehearse emergency scenarios (tamponade, arterial rupture, cardiac arrest) and improve team coordination and response times.

Secondary Functions

Collaborate with vascular access teams, radiology and pharmacy to standardize pre-procedure protocols, contrast management, and anticoagulation pathways that reduce complications and length of stay.
Collect and contribute data for departmental performance dashboards (case mix, door-to-balloon times, infection rates, complication rates) to support executive reporting and operational planning.
Support vendor relations and device management by maintaining familiarity with new interventional technologies, attending in-service training, and advising on supply utilization and formulary decisions.
Participate in staff development initiatives such as simulation training, competency reviews, and procedural skills fairs to elevate clinical outcomes and staff retention.
Assist in developing patient education materials and discharge checklists specific to coronary and peripheral interventions to standardize messaging and reduce readmissions.
Engage in multidisciplinary rounds and care coordination activities for complex patients requiring ICU-level monitoring after high-risk interventions.
Drive adoption of evidence-based protocols for sedation, anticoagulation reversal, and vascular closure to optimize safety and resource utilization.
Provide weekend and on-call procedural coverage as part of an agreed staffing model to support 24/7 emergent interventional service lines.

Required Skills & Competencies

Hard Skills (Technical)

Advanced cardiac monitoring and rhythm interpretation — immediate recognition and management of arrhythmias, conduction blocks and ischemic changes.
Hemodynamic monitoring and interpretation of arterial and intracardiac pressures; ability to assist in pressure wave assessments during cardiac catheterization.
Vascular access management — sheath insertion/removal assistance, manual and device-assisted hemostasis, assessment for bleeding and distal perfusion.
Sterile technique and intra-procedural aseptic management as scrub or circulating nurse in the cath lab setting.
Contrast media handling and nephroprotection strategies, including pre/post hydration protocols and eGFR-based decision-making.
Proficiency in conscious sedation and procedural analgesia monitoring, including airway vigilance and adjunctive airway support when required.
ACLS and BLS certified with hands-on experience implementing resuscitation algorithms in the procedural suite.
Familiarity with common interventional devices and mechanical circulatory support (IABP, Impella) and temporary pacing systems — safe handling and troubleshooting basics.
Radiation safety practices: proper use of lead shielding, dosimetry, minimizing fluoroscopy time and adherence to ALARA principles.
Electronic Medical Record (EMR) proficiency for documentation, order entry, and billing/coding support (e.g., Epic, Cerner, Meditech).
Knowledge of antithrombotic and vasoactive pharmacology relevant to cath lab procedures (heparin, bivalirudin, antiplatelets, vasopressors).
Basic competency in using telemetry and bedside diagnostic tools (12-lead ECG, pulse oximetry, noninvasive blood pressure, capnography as indicated).

Soft Skills

Calm, decisive critical thinking under pressure with the ability to prioritize rapidly in emergent situations.
Excellent verbal and written communication to coordinate multidisciplinary teams and provide clear patient and family education.
Strong teamwork and collaboration skills to function effectively with physicians, techs, anesthesia and OR staff.
Detail-oriented with meticulous documentation habits and a commitment to compliance and patient safety.
Teaching and precepting ability to coach new staff and students and to translate complex procedures into understandable instructions.
Time management and organizational skills to ensure efficient case flow, minimize turnover time and manage competing priorities.
Emotional resilience and empathy for patients undergoing high-anxiety procedures, providing reassurance and clear guidance.
Continuous improvement mindset — openness to feedback, data-driven problem solving and process optimization.
Cultural competence and sensitivity to diverse patient populations, including health literacy adjustments and language access needs.
Leadership potential for charge responsibilities, staff scheduling and quality initiatives.

Education & Experience

Educational Background

Minimum Education:

Current, unrestricted Registered Nurse (RN) licensure in state of practice.
Associate Degree in Nursing (ADN) or equivalent.

Preferred Education:

Bachelor of Science in Nursing (BSN).
Certifications or coursework in interventional cardiology nursing or critical care (e.g., CCRN, RCIS familiarity is a plus).

Relevant Fields of Study:

Nursing (ADN, BSN)
Critical Care Nursing
Cardiovascular/Coronary Care specialization programs

Experience Requirements

Typical Experience Range:

1–5 years of progressive clinical nursing experience; most employers prefer 1–3 years of telemetry, progressive care or ICU experience prior to cath lab hire.

Preferred:

2+ years of direct experience in a cardiac catheterization lab, interventional radiology, electrophysiology lab, or high-acuity cardiac unit.
Demonstrated competency in invasive cardiovascular procedures, sterile technique, and emergency response in the procedural setting.
Current ACLS and BLS certifications; NIH Stroke certification or specialty certifications may be preferred for some organizations.