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Cath
Rotations · Cath · Workflows
The three you will reach for
The same cards as the library below, put where they are asked for fifty times a week.
Pre-Procedure Workflow
How it goes
- Open the cath board and identify the patient, the procedure, the attending and the room.
- Review the indication and the story in the chart before entering the room.
- Review prior cardiology notes and identify the patient’s primary cardiologist, if there is one.
- Meet the patient in person before the cath. Hear their story rather than relying on copied-forward documentation.
- Confirm there is a cardiology H&P or note within 30 days. If the most recent acceptable cardiology evaluation is more than 30 days old, write a new H&P before the procedure can happen.
- Review the pertinent ECG, echo or stress imaging, prior cath, labs, kidney function, hemoglobin and platelets, medications, and anticoagulants and antiplatelets as relevant.
- Confirm informed consent, and discuss indication, risks, benefits and alternatives with the patient or their representative.
- Discuss the indication, history, exam, prior work-up, planned access and procedural strategy with the attending before the case.
- Confirm AUC and appropriateness thinking where relevant. If PCI or revascularization is possible, be ready to discuss revascularization considerations.
- Use ultrasound for vascular access as the local orientation expects. If you are unsure or uncomfortable, stop and ask for help.
Orders & Order SetsUnder Review
The exact Cerner pre-cath and post-cath order-set names, and the exact default outpatient IV fluid type and rate if a standardized order exists. The disposition rules below are the program’s; the names of the sets that carry them are not recorded.
Answered by: Program
Documentation & TemplatesUnder Review
The exact Cerner template and SmartPhrase names, and the name of the cath reporting system. §08 is explicit that a template name must never be hardcoded until it has been verified in the local Cerner build.
Answered by: Program
A procedure report, minimum
Complete it promptly and no later than end of day. A standard the program stated — the template name behind it is not recorded.
- Access
- Procedures performed
- Hemodynamics and angiography
- Findings
- Complications
- Disposition
- Recommendations
Patient Preparation
Everything that has to be true before the patient is in the room.
Pre-procedure workflowThe ten steps, in order
How it goes
- Open the cath board and identify the patient, the procedure, the attending and the room.
- Review the indication and the story in the chart before entering the room.
- Review prior cardiology notes and identify the patient’s primary cardiologist, if there is one.
- Meet the patient in person before the cath. Hear their story rather than relying on copied-forward documentation.
- Confirm there is a cardiology H&P or note within 30 days. If the most recent acceptable cardiology evaluation is more than 30 days old, write a new H&P before the procedure can happen.
- Review the pertinent ECG, echo or stress imaging, prior cath, labs, kidney function, hemoglobin and platelets, medications, and anticoagulants and antiplatelets as relevant.
- Confirm informed consent, and discuss indication, risks, benefits and alternatives with the patient or their representative.
- Discuss the indication, history, exam, prior work-up, planned access and procedural strategy with the attending before the case.
- Confirm AUC and appropriateness thinking where relevant. If PCI or revascularization is possible, be ready to discuss revascularization considerations.
- Use ultrasound for vascular access as the local orientation expects. If you are unsure or uncomfortable, stop and ask for help.
H&P status — the 30-day ruleThe checkpoint that decides whether the case can happen
How it goes
- Find the most recent acceptable cardiology evaluation.
- 30 days old or less: update it as needed.
- More than 30 days old: the fellow writes a new H&P before the procedure can occur.
Identify patient and indicationOff the board: patient, procedure, attending, room
How it goes
- Open the cath board and identify the patient, the procedure, the attending and the room.
- Review the indication and the story in the chart before entering the room.
- Review prior cardiology notes and identify the primary cardiologist, if there is one.
Review the prior work-upECG, echo or stress, prior cath, labs, renal function, meds
How it goes
- Pertinent ECG, echo or stress imaging, and any prior cath.
- Labs: kidney function, hemoglobin and platelets.
- Medications, and anticoagulants and antiplatelets as relevant.
Meet the patientIn person, before the cath
How it goes
- Meet the patient in person before the cath.
- Hear their story rather than relying on copied-forward documentation.
- Confirm symptoms, exam and expectations.
Informed consentIndication, risks, benefits, alternatives
How it goes
- Confirm informed consent with the patient or their representative.
- Discuss the indication, the risks, the benefits and the alternatives.
Staff the strategy with the attendingBefore the case, not during it
How it goes
- Discuss the indication, history, exam and prior work-up.
- Discuss the planned access and the procedural strategy.
- Confirm AUC and appropriateness thinking where relevant; be ready to discuss revascularization if PCI is possible.
Case Setup
The room, the access plan and the equipment. Most of it is attending-specific.
Room and attending assignmentStay with one attending and one room for the day where you canUnverified
How the fellow-to-room assignment is made and where it is published, and whether it is set before the day starts.
Answered by: Program
Access planRadial or femoral, and whyUnverified
Attending-specific radial versus femoral tendencies, needle and wire strategy, and access-site prep preferences. §07 stores these per attending rather than as one lab-wide rule.
Answered by: Contributed by fellows, reviewed by the program
Ultrasound-guided accessExpected locally; ask for help if you are not comfortable
How it goes
- Use ultrasound for vascular access as the local orientation expects.
- If you are unsure or uncomfortable, stop and ask for help.
Sheath and catheter setupSizes, wires, manifold, specialty equipmentUnverified
Attending-specific preferred diagnostic catheter types, sheath sizes, wires, manifold preferences and specialty equipment.
Answered by: Contributed by fellows, reviewed by the program
Procedural medicationsThe cocktail, which is per attending and per patientUnverified
Each attending’s pre-medication cocktail: lidocaine amount, whether it is mixed with nitroglycerin and in what ratio, nitroglycerin amount, verapamil use and dose, and any other routine vasodilator. No dose appears anywhere in this repository until the program supplies it.
Answered by: Contributed by fellows, reviewed by the program
Sheath-site securementDraping, securement and hemostasis habitsUnverified
Whether each attending uses Tegaderm or another method to secure the sheath, and their draping, setup and hemostasis preferences.
Answered by: Contributed by fellows, reviewed by the program
Post-Cath Care
The outpatient default and the inpatient default are different. Read the right one.
Outpatient cath — default checklistOrder set, hydration, TR Band, med rec, follow-up, communication
How it goes
- Use the Cath post-op order set.
- Give a 1 L IV fluid bolus for kidney protection, typically over a few hours — unless attending or patient-specific factors call for a different plan.
- Check the TR Band order when radial access was used.
- Set an appropriate TR Band duration. It varies with anticoagulation and heparin exposure and with attending and local protocol.
- Complete medication reconciliation. If medications were stopped, changed or added, make sure the medication list and the discharge plan reflect it.
- Place follow-up with the patient’s primary cardiologist: 4–6 weeks after a diagnostic cath with no intervention, 2–4 weeks after a stent.
- Make sure the findings and the plan reach the patient and family and the referring or primary cardiology team.
Inpatient cath — default checklistNot the outpatient one with the same steps
How it goes
- Use the appropriate post-cath orders and TR Band or sheath orders.
- IV fluids can still be used where clinically appropriate. With significant heart failure, kidney failure or any other concern about volume loading, ask the attending rather than giving the outpatient bolus automatically.
- Do not routinely do medication reconciliation or place outpatient follow-up orders just because the patient had a cath — those are generally the inpatient consult or primary team’s, unless you are asked.
- Communicate the cath findings, the intervention status, the access-site plan and anything time-sensitive directly to the inpatient team.
TR BandOrder selected, duration set, removal and monitoringUnder Review
How it goes
- Check the TR Band order is selected when radial access was used.
- Set an appropriate compression duration — it varies with anticoagulation and heparin exposure and with attending and local protocol.
The exact TR Band duration and removal algorithm, and how heparin or ACT changes the duration. §11 marks this NEED VERIFIED LOCAL DETAILS and it is not guessed here.
Answered by: Program
HydrationOutpatient default 1 L; inpatient individualized
How it goes
- Outpatient default: 1 L IV fluid bolus for kidney protection, typically over a few hours.
- Inpatient: still appropriate at times, but with significant heart failure, kidney failure or another volume concern, ask the attending rather than giving the bolus automatically.
- An attending or patient-specific plan overrides the default.
The exact default outpatient IV fluid type and rate, and the exceptions, if a standardized order exists.
Answered by: Program
Medication reconciliationOutpatient: yours. Inpatient: generally the consult team’s
How it goes
- Outpatient: complete it, and make sure any medication stopped, changed or added is reflected in the medication list and the discharge plan.
- Inpatient: do not do it routinely just because the patient had a cath — it is generally handled by the consult or primary team unless you are asked.
Follow-upDiagnostic 4–6 weeks; stent 2–4 weeks
How it goes
- Diagnostic cath with no intervention: follow-up with the primary cardiologist in 4–6 weeks.
- After a stent: 2–4 weeks with the primary cardiologist.
- Inpatient: outpatient follow-up orders are generally not the cath fellow’s unless asked.
Access-site monitoringSheath management, and what to escalateUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Related guideDocumentation
The notes, and the templates behind them.
H&P / H&P updateWhen the prior cardiology note is too old, or something material changed
What this needs
- Indication
- Relevant history and exam
- Medications
- Labs and imaging
- Plan
These are the fields the program asked a contributor to fill in, not the answers. The answers have to come from the program.
Procedure reportComplete promptly, and no later than end of day
What this needs
- Access
- Procedures performed
- Hemodynamics and angiography
- Findings
- Complications
- Disposition
- Recommendations
These are the fields the program asked a contributor to fill in, not the answers. The answers have to come from the program.
The exact cath reporting software name and the login workflow.
Answered by: Program
Post-procedure noteAccess site, complications, orders, disposition
What this needs
- Access-site status
- Immediate complications
- Post-op orders
- TR Band or sheath plan
- Medication changes
- Disposition
These are the fields the program asked a contributor to fill in, not the answers. The answers have to come from the program.
Discharge documentationOutpatient: med rec, site care, follow-up timing, warning signs
What this needs
- Outpatient medication reconciliation
- Access-site instructions
- Follow-up timing
- Warning signs
- Intervention-specific instructions
These are the fields the program asked a contributor to fill in, not the answers. The answers have to come from the program.
Related guideResults communicationSay it, then record who you said it to
How it goes
- Communicate important findings directly rather than relying on the report being read.
- Document who was notified.
SmartPhrases / templatesA library, once the local build has been verifiedUnverified
The exact Cerner template and SmartPhrase names. §08 forbids hardcoding a template name that has not been verified in the local Cerner build, so none is listed.
Answered by: Program
Practical Tasks
The things that are obvious once and impossible the first time.
Find the primary RNUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Contact the charge RNUnverified
How the charge RN is reached, and whether the role is published anywhere a schedule could read.
Answered by: Program
Locate equipmentRadial and femoral supplies, ultrasound, sheaths, catheters, hemostasisUnverified
Where each of these is stored in the lab.
Answered by: Program
Add an urgent caseUnverified
How an add-on or urgent case is actually placed on the board, and who approves it.
Answered by: Program
Arrange a monitor or follow-upUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Related guideFind the primary cardiologistPrior notes first, then the DirectoryUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Related guideTroubleshooting
The eight the program named. Each one is a question somebody has been asked at 7:05.
No current H&PThe prior cardiology evaluation is more than 30 days old
How it goes
- The fellow writes a new H&P before the procedure can occur.
- It has to establish the indication, the relevant history and exam, medications, labs and imaging, and the plan.
Anticoagulation issueUnverified
Local ACT and heparin targets by procedure, and how an anticoagulated patient is handled pre-cath. §11 marks this NEED VERIFIED LOCAL DETAILS.
Answered by: Program
Renal or volume concernAsk the attending rather than giving the default bolus
How it goes
- Inpatient with significant heart failure, kidney failure or another concern about volume loading: ask the attending rather than automatically giving the outpatient 1 L bolus.
- Contrast minimization and post-procedure monitoring apply either way.
BleedingUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Radial spasmUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Access failureUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Delayed caseUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Post-procedure complicationRecognize and escalateUnverified
Nobody has written this one yet. It stays empty rather than being filled with something plausible — a workflow a fellow would act on has to come from the program.
Related guideReview status
Everything on this page is maintained by the fellowship. A card with no mark has been reviewed; Under Review and Unverified mean it is provisional. Use the strip at the foot of the page to propose a change.
Still needed from the program
Listed rather than guessed. These are the facts this page cannot answer.
- Order setsThe exact Cerner pre-cath and post-cath order-set names.
- IV fluidThe exact default outpatient IV fluid type and rate, and the exceptions, if a standardized order exists.
- TR BandThe exact TR Band duration and removal algorithm, and how heparin or ACT changes the duration.
- Cath reportingThe exact cath reporting software name and the login workflow.
- TemplatesThe exact Cerner template and SmartPhrase names, verified in the local build. §08 forbids hardcoding one that has not been.
- EquipmentWhere the radial and femoral supplies, ultrasound, sheaths, catheters and hemostasis devices are stored.
Last updated 2026-09-19 · Program, Cath Work Guide specification, 2026-09-19
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