Identify appropriate instruments and use according to recommended standards of practice.
Prepare biopsied tissue for pathological examination according to guidelines for specific tissue type, include appropriate transport media slide preparation and documentation.
Close and dress wound according to recommended standards of practice.
Order appropriate follow-up imaging studies appropriate to biopsy site and procedure.
Conduct a Joint Commission recommended “time out” procedure.
Appropriately intervene for complications.
Unintended damage to surrounding structures due to extravasations
Advise patient of needed follow-up care.
Manage pain and sedation for patients receiving diagnostic testing or therapeutic treatment.
Prescribe pharmacologic and nonpharmacologic interventions as allowable by state and federal statues.
Monitor patient response to sedation and provide intervention according to accepted standards of practice.
Overview for the Nuclear Cardiology Curriculum
The knowledge and skills of Nuclear Medicine Advanced Associates will be tested and utilized to their capacity in the nuclear cardiology arena. Communication skills on many levels will be essential as the NMAA obtains informed consent from patients, discusses image acquisition with the technologists and clinical staff, and relays outcomes to physicians. It is likely that the actual duties of NMAAs working in nuclear cardiology will vary depending on whether they are employed in a nuclear medicine department within the hospital or in an outpatient cardiology clinic. Many who work in cardiology clinics may have already assumed expanded role responsibilities, and very often these individuals have advanced credentials as nuclear cardiology technologists.
The NMAA will work under the direction of the supervising physician, taking responsibility for all phases involved in obtaining an appropriate and technically accurate test in a safe and professional manner for each individual patient. Although nuclear cardiology can be assumed to cover all aspects of cardiac imaging with radiopharmaceuticals, the emphasis of this aspect of the curriculum will be on myocardial perfusion imaging. Knowledge of cardiac physiology and pathology, stress testing techniques and effects, drug interactions, emergency procedures, ECG and image interpretation, and clinical pathways will be emphasized. The NMAA will build on the clinical skills learned during technologist training such as establishing intravenous lines, ECG lead placement, and image acquisition to obtain advanced proficiencies including but not limited to ECG and image interpretation, outcomes management, and advanced life support.
Clinical Nuclear Medicine:
Cardiology Competencies and Content
Successfully complete and maintain Advanced Cardiac Life Support credentialing.
Assess normal ECG to determine patient safety for stress testing.
Identify the leads are associated with the various arteries and walls of the heart.
Understand the conduction systems within the heart.\
Assess abnormal ECG conduction in preparation for stress testing.
New or old left bundle branch block
New or old ST elevations or ST depressions
Develop procedural policies and standards for pre-cardiac emergencies that might occur within the department as directed by institutional policy and practice standards.
Identify the signs and symptoms of symptomatic bradycardia and symptomatic tachycardia.
Arrhythmic heart beats
Shortness of breath
Disturbances in vision
New onset of confusion
Changes in level of consciousness (LOC)
Hypo or hypertension (unstable patient)
Follow a step-by-step course of action for patients who develop asymptomatic bradycardia or tachycardia while in office (before, during or after stress test).
Facial droop (ask patient to show teeth and smile)
Arm drift (ask patient to extend arms, palms down, with eyes closed
Speech (ask patient to say “You can’t teach an old dog new tricks”)
Follow a step-by-step approach to handling other patient incidents.
Exercise induced hypotension or hypertension
Identify and delegate personnel to perform various tasks in preparation for cardiac emergencies.
Crash cart checks: see competency #5
Required training or drills
Incorporate the appropriate federal, state, and institutional guidelines into departmental policies and procedures.
Develop procedural policies and standards for cardiac arrest emergencies that occur within the department as directed by institutional policy and practice standards and provide indicated intervention for a cardiac emergency event.
Establish IV access.
Identify and administer the appropriate medications for commonly occurring cardiac arrythmias under the direction of the supervising physician.
Use only if amiodarone not available
Pulseless ventricular tachycardia
Use only if amiodarone not available
Perform cardiac compression or defibrillate patient if required.
Placement location of defibrillating pads on a patient needing to be cardioverted, defibrillated or transcutaneously paced
Manual and automated defibrillators
Cardiac compression methodology
Facilitate the ordering of labs or other tests as needed for a cardiac arrest eventunder the direction of the supervising physician.
Required lab work
CBC (complete blood count)
Chemistry (Chem-7, SMA-7, BMP, etc)
Cardiac enzyme markers (troponin, CK-MB)
Protime and Partial Protime (PT, PTT, INR)
Facilitate admission of patient to hospital if necessary.
Provide indicated intervention for non-cardiac emergency events.
Obtain blood sugar
Indications for administering oral medications/food versus intravenous dextrose
Medications as needed
Medications as needed
Manage crash cart for compliance.
Follow the appropriate guidelines in implementing regulation for managing the department’s crash cart.
Inventory crash cart components according to institutional policy.
Personnel responsible for checking the crash cart
Frequency of checks
Testing the defibrillator
Pads on the crash cart
Portable oxygen tank level
Properly dispose of expired drugs.
Replace expired drugs.
Perform quality assurance testing on defibrillator and document results.
Take comprehensive patient history and evaluate for patient pathology.
Interview patient and document on department form a complete past and current cardiac history.