Training activity information
Details
Prepare and maintain good quality haemodynamic and ECG monitoring throughout a case in the cath lab
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to preparing and maintaining good quality haemodynamic and ECG monitoring in the cath lab.
- Consider how the learning outcomes apply, specifically concerning interpreting haemodynamic data and troubleshooting where required, alongside effective communication with the team.
- What does achieving and maintaining optimal trace quality (ECG and pressure waveforms), correctly setting up pressure transducer technology, and managing artefacts look like for this activity?
- Discuss with your training officer to gain clarity on expectations for setup protocols, recognition of optimal trace quality, managing common issues like drift, and effective communication.
What is your prior experience of this activity?
- Think about what you already know about setting up physiological monitoring systems (e.g., pressure transducers and ECG leads) and recognising normal pressure waveforms and common issues.
- Consider possible challenges you might face during the activity, such as equipment malfunctions, ensuring sterile connections for invasive lines, managing cables, or troubleshooting abnormal recordings, and think about how you might plan to handle them.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom when troubleshooting technical issues or interpreting complex pressure waveforms.
- Acknowledge how you feel about embarking on this training activity within the dynamic cath lab environment.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to equipment setup, trace optimisation, rapid troubleshooting of pressure transducer technology and communicating monitoring status clearly.
- Identify specific insights you hope to gain regarding the practicalities of maintaining monitoring during dynamic procedures or the principles of abnormal recordings and associated pathology.
What additional considerations do you need to make?
- Consult actions identified following previous experience of cath lab observations or general patient monitoring.
- Identify important information you need to consider before embarking on the activity, such as the principles of haemodynamic monitoring systems, the specific procedure type, and the patient’s baseline ECG and pressure status.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst setting up or maintaining the monitoring systems?
- Are you encountering situations such as:
- Technical difficulties leading to poor signal quality e.g., severe ECG artefact or pressure transducer drift despite initial setup checks?
- The haemodynamic trace showing unexpected abnormal recordings e.g., damping or severe pressure drops that are difficult to correlate with the procedure step?
- An equipment malfunction e.g., loss of communication with the monitoring system requiring urgent action?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your technical troubleshooting approach in the moment?
- Consider the steps you are taking in the moment, such as:
- Rapidly re-zeroing the haemodynamic system or adjusting transducer position to resolve drift or waveform issues?
- Alerting the team immediately to significant changes in ECG or haemodynamic data quality?
- Seeking immediate advice from a senior colleague regarding the interpretation of an abnormal pressure waveform e.g., suspected pulmonary hypertension waveform?
- How are you feeling in that moment? For instance, are you finding it difficult to interpret complex waveforms while troubleshooting? Is it affecting your confidence in maintaining accurate monitoring?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully restoring signal quality? Or are you needing support because the interpretation of complex waveforms or haemodynamic data requires specialist knowledge?
- What are you learning as a result of the unexpected development? For example, are you mastering efficient troubleshooting techniques for pressure transducers? Or gaining insight into how procedures affect haemodynamics in real-time?
On action
What happened?
- Begin by summarising the key points of the experience of setting up and maintaining haemodynamic and ECG monitoring during the cath lab case.
- Consider specific events, actions, or interactions which felt important, such as the equipment used, how you ensured good signal quality, and any issues you encountered (e.g., artefacts, disconnections).
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, troubleshooting a pressure transducer setup issue or adapting to maintain monitoring despite dynamic procedural steps. How did you feel during this experience?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding monitoring requirements in the cath lab. What strengths did you demonstrate e.g., knowledge about specific monitoring equipment? What skills and/or knowledge gaps were evident e.g., pressure transducer setup or techniques for reducing artefacts?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved?
- Identify any challenges you experienced, such as maintaining monitoring during the procedure, and how you reacted to these. How does this activity contribute to your procedural support and patient safety skills?
- Identify anything significant about the activity, such as needing to seek advice or clarification on complex pressure waveform interpretation or escalation protocols.
- Acknowledge any changes in your own feelings now you are looking back on the experience.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including consulting resources or experienced colleagues.
- What will you do differently next time to ensure reliable and high-quality monitoring in future cases? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any aspect of the activity further, such as improving your skills in monitoring setup, troubleshooting, or maintenance in the cath lab?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? What specific actions did you previously identify you would need to take to improve your practice related to pressure transducer setup, troubleshooting, and maintaining signal quality?
- Have you completed these previously identified actions? For example, if you planned to review the physics and instrumentation of pressure transducer technology, how did completing this action impact your subsequent performance when dealing with haemodynamic monitoring artefacts?
- Engage in professional storytelling with peers, near peers, or colleagues about challenging monitoring setup issues or instances where signal quality was critical for a procedural decision. How have discussions with the cath lab team refined your skills in clear communication and real-time troubleshooting?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on monitoring setup will support you in preparing for observed ‘in-person’ assessments for the module.
- How has your practice related to physiological monitoring developed and evolved over time? For example, how have the technical skills developed here informed your ability to interpret invasive haemodynamic data?
- What transferable skills e.g., technical proficiency or systematic troubleshooting did you develop through this activity, and how will this foundational understanding of monitoring help you evaluate and integrate new monitoring technologies in the cath lab environment in the future?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 6 |
Outcome
Interpret haemodynamic data for patients presenting to the cardiac cath lab with a range of conditions, recognising the role of these procedures within the patient pathway, limitations of diagnostics and troubleshooting where required. |
| # 8 |
Outcome
Demonstrate the ability to communicate effectively with patients, carers and the wider multidisciplinary team. |