Cath lab nursing – it's a risky business

Abstract

Abstract Background The continuing evolution of transcatheter therapies and improvements in x-ray imaging technology has led to an exponential increase in the numbers and complexity of fluoroscopically guided cardiac procedures. There is also heightened concern regarding the associated increase in radiation exposure to the patients and staff. The effects of x-rays at high doses is well documented, but the effects of protracted exposure to low levels of radiation are less well understood (1) and may include malignancy (2), circulatory disease (3), and chromosomal aberrations (4). The link between the occupational exposure in the cath lab and the development of posterior cataracts has been well established (5). Dose levels to the doctors performing the procedures has been a focus of previous research, but there is recent evidence that nurses may be exposed to similar, if not higher levels of occupational radiation. The lack of literature explicitly investigating nursing dose is concerning. Purpose This prospective single-centre observational study compared the occupational temple dose to staff during cardiac angiography. Methods Radiation levels were measured via dosimeter badges worn near the left temple of the cardiologist (n=14), scrub (n=28), and scout (n=29) nurse between Feb 2017 and August 2019. Procedures were categorised into coronary angiography (CA) and percutaneous coronary intervention (PCI). Cases that included any supplementary investigations such as left-ventriculogram, fractional flow reserve measurement, graft vessels, right heart study, rotablation, or aortograms were classified “CA+” or “PCI+”. Non-parametric statistical testing was performed. Results There is a correlation between higher dose to the scrub nurse during CA and CA+ when compared with the cardiologist (p=0.001). Interventional procedures were associated with a higher dose to the cardiologist when compared to the scrub nurse (p=0.000), and increased dose to the scout nurse (p<0.000) when compared to scout dose during CA and CA+. Conclusion The previously held assumption that the doctor is exposed to higher levels of radiation during angiography may no longer be applicable in modern departments, possibly due to the increased awareness and appropriate use of ceiling-mounted lead shielding. Nurses are typically involved in a greater number of procedures and have a potentially extended career in the cath lab setting compared with doctors. Hence, workplaces must provide adequate training and protective equipment to nursing staff to facilitate all team members to minimise the potentially detrimental effects of occupational radiation exposure. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The first author would like to acknowledge the PhD study support provided via an Australian Government Research Training Program Scholarship Occupational dose during angiography