MAJOR DUTIES: Serves in a multi-role (scrub, monitor, and circulator) capacity as a Cardiovascular Medical Instrument Technician and functions cooperatively as a member of the cardiovascular laboratory team which performs diagnostic and therapeutic procedures as a service to physicians who directly supervise the procedures. The technician assists physician(s) and team members during a variety of highly complex, potentially life-threatening invasive cardiovascular procedures on stable and unstable patients throughout the lifespan continuum. 1. SCRUB - Participates with physician in planning procedures then initiates preparation for physician-directed procedure and independently either makes recommendations about procedures or, in some situations, makes changes to procedures. Assists in identifying and selecting patient/procedure-specific catheters, supplies, equipment, and contrast medium and volume and then manipulates or changes supplies or instruments in order to meet the requirements of the procedure. Varies technique to accommodate patient's condition and changes conventional methods to produce acceptable results. Sets up sterile field and prepares heparinized saline solutions. Maintains aseptic technique, manipulates wires and catheters, anticipates catheter tip location, operates fluoroscopic single-plane and bi-plane x-ray equipment and selects appropriate angulations and positions x-ray table and image intensifier for optimal display of angiographic anatomy while assisting physician throughout the following procedures: Selective vessel and heart chamber pressure recording; selective vessel and chamber blood sampling and/or shunt detection studies via oximetry; selective contrast angiography (aortic, coronary, left ventricle, peripheral vascular, pulmonary, and renal) via manual or power injection of radiopaque contrast media; angiojet, coronary rotational atherectomy; coronary intravascular ultrasound, angioplasty and stent implantation; foreign body retrieval from heart or great vessels; permanent pacemaker implantation and/or leadwire insertion; venous access device implantation; transvenous temporary pacing catheter insertion; thermodilution catheter insertion and cardiac output measurement; intra-aortic balloon catheter insertion; endomyocardial biopsy; pericardiocentesis; drug response studies; electrophysiology studies; ablations; automatic implantable cardiac defibrillators; pharmaceutical or exercise stress angiography; intracoronary anticoagulant, thrombolytic, and/or nitrate administration; wound closure and dressing application; blood drawing for point of care testing such as blood coagulation timing and blood oximetry; and hemostasis via manual compression, external hemostatic device application, or internal hemostatic device insertion. 2. MONITOR - Operates an interactive computerized digital subtraction angiographic system in order to produce coronary and left ventricular graphic images, and to perform pulmonary, aortic, and peripheral arterial imaging. Coordinates a delicate balance of radiographic techniques (x-ray factors), patient positioning, and computer assisted acquisition and display so as to provide optimal patient care in the cardiac catheterization laboratory. Enters patient data and acquisition/procedure parameters through the computer keyboard. Uses a variety of menu-driven programs to display, redisplay, and manipulate images in real time to allow physicians optimal visualization of anatomy so they may determine adequacy of procedure or interventions performed. Performs post-processing of images to include assessment of quantitative and qualitative coronary artery stenosis, left-ventricular volumes, left ventricular wall motion, presence or absence of abnormal communication between chambers and many other available programs. Stores data and images on one or more storage media (e.g., videotape, hard drive, compact disk, etc.). Reviews and/or records patient history and supporting clinical data prior to each of the procedures listed above. Uses electrophysiologic and angiographic monitors with interactive, menu-driven programs to enter patient data and acquisition/procedure parameters. Monitors hemodynamic values, waveforms, pressure gradients and electrocardiogram tracings; differentiates normal from abnormal and informs team of changes in patient status. Records anatomical, physiological, and/or pathological data for further diagnosis. Keeps record of procedures performed and related data. Processes automated and other records obtained during the procedure. Identifies, files, and stores records and retrieves them as needed. Operates and maintains equipment for viewing records. Initiates ACLS protocol as needed. 3. CIRCULATOR - Retrieves images for replay as well as roadmap. Performs replay review of images to include quantitative and qualitative assessment of artery stenosis; ventricular volume, ejection fraction, and wall motion; and valve area. Reviews finished cine recordings and suggests changes in x-ray techniques to obtain records of optimal quality while ensuring maximum safety. Responsible for all required daily maintenance and preventive maintenance of cine processing equipment. Identifies, files, and stores such records including a complete record of all patient x-ray parameters. Operates, maintains and stores projection, tape replay, and other equipment for viewing records. Attends to patient's safety and comfort needs before, during, and after procedure. Positions patient initially and as needed during the procedure to ensure patient comfort and optimal study results. Connects monitoring equipment and ensures proper function and data collection during procedure. Anticipates, locates and opens sterile/non-sterile supplies. Operates defibrillator and pacemaker generator as well as radiographic contrast injector, cardiac output, intravascular ultrasound, angiojet, atherectomy, rotablator, and intra-aortic balloon pump consoles. Monitors and ensures compliance with aseptic technique and radiation safety principles. Repositions monitors and equipment as x-ray table and image intensifier are moved. Performs point-of-care testing such as blood coagulation timing and blood oximetry. Monitors patient's response to intravenous sedation/analgesia medication administration. Maintains safe and clean lab environment during the procedure. Applies noninvasive cardiovascular techniques of electrocardiography (12-lead ECG) and assists with synchronized cardioversion and transcutaneous pacing. Transports patients. Provides technical and administrative support and advice to technicians, nurses, students and physicians regarding new supplies, equipment, and procedures. Develops procedural instructions to insure proper performance of procedures. Participates in policy/procedure review and revision process. Collects and compiles data for formal and informal research efforts. Maintains and calibrates equipment. Conducts quality control checks; performs corrective actions as needed. Assists in controlling and maintaining supply inventories. Cleans instruments and maintains sterile instrument inventory. Practices and promotes compliance with Infection Control, Radiation Protection, and Fire and Safety regulations. Supports ACLS protocol as needed. 4. INSTRUCTOR - Trains cardiovascular technicians, nurses, students and physicians in all phases of radiographic operations related to the performance of cardiac catheterizations. Participates in the on-going catheterization research program at Brooke Army Medical Center, contributing to development of the radiographic portions of pharmacological left ventricular angiographic manipulations, new cine recording techniques, computer techniques for cine recording processing and left ventricular densitometry, and collecting and analyzing DSA data on volume studies, etc. (10%) Performs other duties as assigned.