4.2 Support Equipment & Procedure Documentation
Key Takeaways
- Match the oxygen device to the need: nasal cannula for modest hypoxemia, non-rebreather for high FiO2 in a breathing patient, bag-valve-mask for apnea, and an advanced airway with ETCO2 confirmation.
- Chest tubes stay unclamped unless a physician orders a brief clamp; keep drainage below the chest. Foley and other drainage bags stay below the bladder or source.
- Confirm IV or sheath patency and have Yankauer suction on and within reach before contrast or sedation.
- Document fluoroscopy time as duration, cumulative air kerma in mGy as the skin-dose-related metric, and DAP as kerma times field area; about 2–5 Gy is an NCRP-style teaching magnitude for substantial-dose discussion, not an ARRT cutoff.
- Record contrast name, concentration, and volume, plus pacemaker or ICD manufacturer and mode; magnet use is physician-directed.
Support Equipment & Procedure Documentation
Outline 1.C.2 is equipment the CI technologist must monitor and maintain: oxygen delivery systems, chest tubes, indwelling catheters, drainage bags, intravenous (IV) lines, and suction. Outline 1.C.3 is what you write down: radiographic exposure factors, contrast parameters, fluoroscopy time, cumulative dose or air kerma, dose-area product, physiologic monitoring, medications, complications, and implantable devices. On the ARRT CI exam, documentation is not clerical extra credit. It is a scored patient-care skill, and a missing air-kerma value or an untested suction canister is the same class of error as a missed allergy.
Quick Answer: Match the oxygen device to the need. Keep chest-tube drainage unclamped unless a physician orders a brief clamp, and keep it below the chest. Confirm IV patency and have Yankauer suction ready before contrast or sedation. Record fluoro time (duration), air kerma in mGy (skin-dose related), and DAP (kerma × area). Magnet use on a pacemaker or ICD is physician-directed.
Oxygen delivery systems
Start with what is already on the patient's face and whether it matches the SpO2 and work of breathing.
A nasal cannula at 1–6 L/min supplies a modest increase in inspired oxygen (roughly 24–44% FiO2, mouth-breathing dependent). It is the default for a comfortable patient with mild desaturation.
A simple mask needs enough flow to flush exhaled CO2 (typically at least 5 L/min).
A non-rebreather (NRB) at 10–15 L/min with an inflated reservoir is the step-up when you need high FiO2 and the patient is still breathing. If the reservoir collapses, the flow is too low.
A bag-valve-mask (BVM) is for apnea, arrest, or a patient who will not protect the airway. Use two-person technique when you can, an E-C clamp, 100% oxygen, and watch the chest — not the bag — for rise. Capnography on the mask, when available, tells you that you are actually ventilating.
An advanced airway (supraglottic device or endotracheal tube) is placed by a credentialed provider. The CI technologist assists, does not freelance intubation, and then confirms ETCO2. An advanced airway is not a reason to stop watching the bag and the chest.
Do not leave a cannula in place “because it was in holding” while SpO2 is 82% and the patient is using accessory muscles. Escalate the device and the team.
Chest tubes
After pericardial drainage for tamponade, pleural injury, or a hybrid case, a tube may sit in the field. Connect it to a closed drainage system (collection chamber, water seal, suction control). Suction versus water seal is a physician order. Tidaling with respiration is expected on water seal; continuous bubbling on the water-seal chamber is an air leak until proven otherwise.
Never clamp a chest tube casually. Clamping a tube that is still draining air can convert a simple leak into tension pneumothorax. If a physician orders a brief clamp for a specific test or transport step, stay at the bedside and unclamp at the first distress. Keep the drainage system below the chest; raising it above the insertion site risks reflux. Do not lift the atrium onto the sterile field or the patient's abdomen “to get it out of the way.” If the system is knocked over, restore upright position and report a possible loss of water seal.
Indwelling catheters, drainage bags, and IVs
A Foley catheter bag stays below the bladder, without a dependent loop of urine sitting on the floor and then being raised above the bladder (reflux and infection). The same gravity rule applies to other closed drains: below the source, not clamped unless ordered.
IV patency is a contrast-safety check. Before any iodinated injection or vasoactive medication, confirm blood return or a free flush without infiltration, the correct lumen, and no air. A power-injected ventriculogram through an infiltrated peripheral IV or a cracked sheath side-arm is a preventable disaster. Heparinized flush does not belong in a line if heparin-induced thrombocytopenia (HIT) is on the chart.
Suction
Yankauer rigid suction for the oropharynx (vomit, blood) and a flexible catheter for nares or a tube must be on, tested, and within reach before sedation starts. Patients on dual antiplatelet therapy and anticoagulants vomit bright blood into the airway more often than lecture slides admit. Suction that is “in the cabinet” is not ready.
Documentation as a scored skill
Write contemporaneously, not from memory at 17:00. The outline's list is the exam's list.
Radiographic exposure factors. Record what the system used: mode (fluoro versus cine/acquisition), pulse rate, magnification, and the technique factors the equipment stores. This is how a physicist or a later operator reconstructs why today's skin dose is high.
Contrast administration parameters. Agent name, concentration (mg iodine/mL), volume, route (coronary, left ventricle, aortic, IV), and lot or expiration if the facility requires it. A milliliter total without a concentration is an incomplete dose.
Fluoroscopy time is duration, usually minutes. It is not skin dose. A twenty-minute steep-angle case in a large patient can out-dose a forty-minute simple diagnostic.
Cumulative dose or air kerma at the interventional reference point is displayed in mGy (or Gy). It is the metric most closely related to peak skin dose and deterministic injury (epilation, erythema, rare necrosis). Teaching and NCRP-style substantial-radiation-dose-level discussion commonly uses an order of magnitude of about 2–5 Gy (2000–5000 mGy) for when labs talk about possible skin effects and structured follow-up. That range is a radiation-protection teaching magnitude, not a published ARRT exam cutoff. Labs set their own notification policies. Transient erythema is often discussed near the lower end of that range.
Dose-area product (DAP) (also called kerma-area product) is air kerma × irradiated field area, reported in mGy·cm² (or Gy·cm²). A large field can produce a high DAP with a modest peak skin dose; tight collimation can keep DAP lower while a small hot spot is still high. Record both air kerma and DAP. Surveyors want the pair because they answer different questions: how much the skin saw versus how much radiation left the tube into the field.
Physiologic monitoring. Document baseline and significant events: ST elevation, AV block after RCA injection, lowest MAP, SpO2 nadir, ETCO2 trend during sedation.
Medications. Name, dose, route, time, and who gave them — heparin, reversal, sedation, atropine, vasopressors.
Complications. Access hematoma, dissection, perforation, arrhythmia requiring shock, contrast reaction. If it happened, it is in the record the same day.
Implantable devices. Pacemaker or implantable cardioverter-defibrillator (ICD) manufacturer, model if known, laterality, pacing mode (for example DDD or VVI), and whether a recent interrogation exists. Magnet application to suspend ICD tachytherapy or force asynchronous pacing is physician-directed. The CI technologist does not apply a magnet because of ECG artifact or because a vendor representative is in the room. Document that a magnet was used only if the physician ordered it, and document the mode afterward if known.
What to document and why a surveyor or the exam cares
| Item | What you actually write | Why it is scored / surveyed |
|---|---|---|
| Exposure factors | Fluoro vs cine, pulse rate, magnification, stored kV/mA | Reconstructs a high-dose case; supports ALARA review |
| Contrast parameters | Agent, mg I/mL, milliliters, route | Dose for nephropathy and reaction follow-up; incomplete if volume lacks concentration |
| Fluoroscopy time | Minutes of pedal time | Duration only — not gray of skin dose |
| Air kerma / cumulative dose | mGy at the interventional reference point | Best routine proxy for skin dose; 2–5 Gy is NCRP-style teaching magnitude, not an ARRT cutoff |
| DAP | mGy·cm² (kerma × area) | Stochastic/field-size metric; complementary to air kerma |
| Physiology | Rhythm events, MAP, SpO2, ETCO2, LOC | Proves the streams in 1.C.1 were watched |
| Medications | Name, dose, time, route, giver | Heparin, sedation, and reversal disputes are chart fights |
| Complications | What, when, what was done | Delayed documentation looks like concealment |
| Implantable device | Maker, mode, laterality; magnet only if ordered | Magnet use is physician-directed, not a technologist reflex |
Exam traps
- Equating fluoro time with gray of skin dose.
- Inventing a single ARRT gray “pass/fail” number.
- Clamping a bubbling chest tube for convenience.
- Applying a magnet to an ICD without a physician order.
- Recording contrast milliliters without the concentration.
After pericardiocentesis, a chest tube is in place and the water-seal chamber shows continuous bubbling. The patient is stable. The CI technologist's CORRECT action is to:
Which statement correctly describes radiation documentation for a CI procedure?
Immediately before a power-injected left ventriculogram under moderate sedation, which equipment check is the PRIORITY for the circulating CI technologist?