1. Prepare Patient in the Room

• Ideally be in room for time-out prior to pt transfer)
• Help transfer to table
• Set up armboard with bluey (if radial access), foot pedal, and control panel (unscrew lock on RHS and pull up and drag to the left, ensuring arrow does NOT reach end of metal bar. Leave the attached lead shield sticking out so nurse can easily drape)
• Introduce yourself and ask for height/weight + pregnancy if required
• Confirm correct pt (check wristband or as per timeout)
• Bring bed into holding bay, and if needed, get it ready for end of examination (e.g., flatten and prepare slide-board)

2. Set Up Documentation

• Open EMR cathlab list and add documentation for radiation dose and protocol (do this first to ensure EMR accurately displays the dose as per time)
• Open patient file by double-clicking the first column arrow
• Go to documentation and click the + sign to add a new entry
• Title: Radiation dose and protocol (cardiac)
• Using auto-text (supervisor will show you how to set up later), pre-fill the area being x-rayed (usually thorax), date, and consultant's name
• Save (only sign at the end once dose details are typed in. Once saved, the title cannot be edited so double-check!)
• Open Microsoft Teams and add the case to the excel spreadsheet (for our own record-keeping purposes)
• Type in key details including start time of the case

3. Set Up X-ray Equipment

• Open patient on Siemens
• Find the patient on scheduler (will only appear if arrived by cardio tech!)
• Reference with sticker and enter carefully:
• Height and weight
  (Will be used for dose modulation! Can enter in feet/inches and convert to metric on the system!)
• Ward
• Consultant's initials

  ❗ They will be annoyed if incorrect ❗

• Bring the tube in by selecting bottom left button (custom preset 1) and pushing joystick forward.
• Once the cardiologist has inserted the sheath (will pull out a green tube and put on teggy), you can turn down the lights.
• Open the patient on the Sony screen (controls what appears on monitors inside and outside the lab)
• Set haemo on the screen inside (lab) and left CR (control room) screens
• Bring up previous imaging on connected PC and be ready to display on Sony 1 if needed
• Change the screen display setting (e.g., half/half live and assist screens)

4. During the Examination

Changes depending on procedures and cardiologists workflow, but generally:

• Be ready to save reference images (showing stenosis) in initial runs. Otherwise, can open on syngo and take note of good reference images, and go back quickly to reference when Dr busy setting up for intervention.
• Listen out for the cardiologist asking to 'fluorosave' (saving fluoro runs, not needed for acquisitions which are auto-saved)
• Collimate to the border of the heart when possible and move filter to block glare
• Start on 25 mag, then go down to 20 once engaged in artery
• Be ready to change the screen display setting (e.g. if using IVUS select a format with Sony)
• Label images and send to PACS (or take note of run # and label at the end)

5. Ending Examination

• Disable radiation and bring the tube out (preset position: transfer patient)
• Remove plastic cover over II and put away to re-use as foot pedal cover!
• Help transfer patient back into bed
• Remove armboard and move pedal back
• Bring the bed in
• Wipe down armboards and table
• Change bin liners (bottom corner cupboards, fit with the blue band)
• Grab new bedsheet, blanket, and 2 saline bags for the techs from the adjacent storeroom if they haven't already got it themselves
• Close patient on the computer after they have left the room ❗ once closed cannot be opened again ❗ before going back to fill in the excel spreadsheet
• Add any intervention performed in comments (e.g., LCx stent x 2)
• Update the procedure if necessary (e.g., LHC PCI)
• Complete EMR documentation (click sign to complete)