3.2 Records, Labs, Allergies & Consent

Quick Answer: Before invasive cath lab procedures, validate the chart: confirm indication and prior studies, review allergies (especially contrast, iodine, latex, and drug reactions), verify current labs including renal function and coagulation, assess antiplatelet/anticoagulant timing, confirm NPO status, and ensure informed consent is signed and matches the planned procedure.

Record and laboratory validation is not clerical busywork — it is the last structured checkpoint before the patient enters the sterile field. RCIS Domain A Task 3 tests whether you know which data matter, what abnormal values imply, and when to halt the case until the physician resolves an issue.

Medical Record Review

Systematically review these chart elements:

Compare the scheduled procedure to the consent document. A consent for "left heart catheterization" does not cover PCI unless addendum or separate consent exists per institutional policy.

Complete Blood Count (CBC)

There is no universal platelet cutoff — institutions and operators vary — but platelets below approximately 50,000/µL commonly trigger physician consultation, and counts below 20,000/µL are generally prohibitive for invasive arterial work without hematology input. Know your facility threshold for exam scenarios.

Basic Metabolic Panel (BMP)

Electrolyte and metabolic abnormalities can precipitate arrhythmias during catheter manipulation and contrast administration:

Coagulation Studies

Oral anticoagulant management varies by procedure urgency and bleeding risk. For elective diagnostic cath, many centers target INR ≤ 1.5–1.7 or hold warfarin with bridging per protocol. For PCI, anticoagulation strategy is operator-specific. The RCIS technologist reports values and confirms last dose timing — the physician decides whether to proceed, bridge, or reverse.

Antiplatelet and Anticoagulant Status

Accurate medication reconciliation prevents catastrophic bleeding and stent thrombosis:

Document last dose date and time on the pre-procedure checklist. When a patient arrives on dual antiplatelet therapy for recent stent placement, stopping therapy for an elective procedure may be contraindicated — flag this to the physician immediately.

Creatinine, eGFR, and Contrast Risk

Iodinated contrast is nephrotoxic, especially in patients with chronic kidney disease (CKD), diabetes, heart failure, or hypovolemia. Calculate or verify estimated GFR (eGFR) from serum creatinine, age, sex, and race/ethnicity per the lab report.

Additional risk reducers the team may employ: hold metformin 48 hours post-contrast (per facility policy to reduce lactic acidosis concern), IV isotonic hydration before and after, use lowest adequate contrast volume, and consider alternative imaging when eGFR is severely reduced.

Report acute creatinine rise compared to prior baseline — this may indicate acute kidney injury and warrants physician review even if absolute value seems acceptable.

Pregnancy Testing

Ionizing radiation and contrast expose the fetus to risk. For women of childbearing potential, verify pregnancy status within the institution's required window (commonly 24–72 hours or day-of test per policy) before any fluoroscopy case. A negative urine or serum hCG must be documented unless the case is a true emergency and testing is impossible — and even then, the team minimizes exposure.

NPO (Nothing by Mouth) Status

NPO guidelines reduce aspiration risk during moderate sedation and emergencies:

*Always follow your institution's and anesthesia department's policy — exam questions usually reflect ASA-style guidelines.

Clear liquids include water, pulp-free juice, black coffee, and tea without milk. Not clear: milk, formula, alcoholic beverages, particulate juices. Chewing gum and hard candy may violate NPO at some centers — confirm policy.

If a patient ate recently, the case is typically delayed unless it is a life-threatening emergency (e.g., STEMI primary PCI), where aspiration risk is weighed against mortality benefit.

Allergy Verification

Never rely on verbal report alone — read the allergy list in the chart and ask the patient to confirm. High-yield cath lab allergies:

Communicate allergies aloud during team briefings and ensure armband/allergy band is visible.

Informed Consent

Valid consent requires the performing physician (or delegated provider per state law) to explain:

• Nature of the procedure and alternatives
• Material risks: bleeding, vascular injury, contrast reaction, kidney injury, stroke (for certain procedures), radiation exposure, need for emergent surgery or transfusion
• Benefits and consequences of refusal

The RCIS technologist verifies consent is signed, witnessed per policy, and matches the scheduled procedure before scrubbing. If the patient has new questions or appears uncertain, pause and notify the physician — do not pressure the patient to proceed.

Emergent cases may proceed under implied consent when the patient cannot participate and delay would cause harm; document circumstances thoroughly.

Putting Validation Together: A Pre-Procedure Matrix

When any checkpoint fails, the RCIS role is to communicate clearly and stop the line until the physician resolves the issue. Validation complete means the team can enter the time-out with confidence that hidden landmines — unchecked INR, undocumented contrast allergy, or missing consent — have been cleared.