“The beauty of this work is the appreciation. You’re helping people who feel like they’re dying. You see people come in while they’re still being resuscitated and a few days later they’re doing better. You’re pulling people out of death. But unfortunately it doesn’t always go well … sometimes you also see people die in front of you. That affects you. That’s why I want my knowledge and experience to be good. And that when I look at myself in the mirror, I know that I did everything I could to save someone.”
Nick van Baaijen works as an interventional nurse in the cardiac catheterization department at UMC Utrecht. It is a small team of sixteen nurses. Alternately, he works in one of the five cardiac catheterization rooms. Various examinations and treatments take place in this department, such as angioplasty, cardiac catheterization, ablation or placement of a pacemaker. Emergency patients with heart attacks also come in. Nick assists the cardiologist with examinations and treatments. This ranges from indicating materials, monitoring patients’ heart rhythms to CPR. In this diary, he talks about his daily work.
“After a half-hour bike ride, I arrive at work. The day begins with the weekly clinical class. This time about the heart rhythm. A colleague explains what kind of heart rhythm disorders there are and how you can recognize them on a heart film. Always nice to further expand and refresh your knowledge. After the clinical lesson, I start in the intervention room. The first patient is a 60-year-old woman with chest pain and shortness of breath. She comes for an angiography of the coronary artery. The cardiologist inserts a thin tube through the artery in her groin and administers contrast medium through a special catheter, directly into the coronary artery. I have to stay sharp at all times and keep a close eye on everything, including the monitor that shows the heart rhythm. Sometimes injecting the contrast medium or accidentally touching the heart with a wire can cause a cardiac arrhythmia. During the X-ray examination, the contrast medium in the coronary arteries makes the blood vessels visible and clearly shows where the narrowing is. A narrowing in one vessel can sometimes be resolved right away. For multiple constrictions, we discuss with the team what the best solution is: angioplasty, placing a stent or a bypass operation. During the treatment, I record all actions in the system, so that afterwards we remember exactly what we did. There are actually two angioplasty operations scheduled for today, but an emergency patient comes along. This happens on average once or twice a day. It may be a patient with an infarction or resuscitation. You then have about 20 minutes to get everything ready before the patient arrives.”
“Today we have two patients, a 50-year-old man and 45-year-old woman, scheduled. They both have a hole in a middle wall in their heart, through which blood leaks. This is often a congenital heart defect, sometimes discovered by accident. Patients have symptoms such as dizziness or fatigue on exertion, for example. We normally close the hole by inserting a kind of umbrella. The disadvantage of this is that blood can stick to it, so these patients have to take blood thinners for six months. In both patients today we are using a new suturing technique (Noblestitch). Here the doctor sutures the hole. This method has been in use here for 1.5 years and you can see that it usually works, but sometimes the hole is too large and the blood keeps leaking through. In that case, we still place an umbrella cap. During the treatment, I assist the doctor and provide the necessary materials. The treatment goes well in both patients. ”
“The first patient, whom I see this morning, is a 60-year-old man with heart failure. His heart is not pumping blood around enough, making him short of breath and tired. He is receiving a CRT-D (Cardiac Re-synchronization Therapy Defibrillator) today. This delivers a stimulus to the right and left ventricles with each heartbeat, improving the heart’s pumping function. In case of a dangerous cardiac arrhythmia, the defibrillator delivers an electric shock. During surgery, I monitor his heart rate. The operation goes well.
The next patient comes for pacemaker replacement; this takes half an hour and can be done under local anesthesia. To replace the pacemaker, the doctor opens the old scar and inserts the new box. On average, a pacemaker lasts eight years, but if the pacemaker needs to stimulate the heart often, the battery runs out sooner.”
“A special day today! We have a high-risk catheter treatment scheduled using an Impella. The Impella is a small pump, mounted on a hollow catheter, which is delivered to the left half of the heart through an artery in the groin. The inflow port of the pump is located in the left ventricle of the heart; it actively pumps blood into the aorta. At the end of the catheter outside the body are a control box and the power supply for the pump. I provide all the necessary materials sterile in advance so that everything is ready for treatment. This is the first time we are going to insert this device; in this case for an angioplasty in a 50-year-old man. This patient falls into the high risk category because he has a severely impaired pumping function of the heart. Inserting an Impella prior to treatment protects him from a rapid drop in blood pressure during the procedure. The Impella is my area of interest, so I provide its control during the treatment. After the angioplasty, the Impella is taken out again.”
“On average every six to seven weeks I have weekend shifts for when emergency patients come in. During a weekend shift, there are only two of you. That means that during a treatment I indicate material, monitor the monitor and write down all the actions. Normally there are three of us. This is really about teamwork and trusting each other. When I am called, I have to be in the cardiac catheterization room, dressed and ready to go, within thirty minutes. That’s no problem for me because I live close to the UMC Utrecht. This weekend it was my turn again and I ended up being called twice. Once for a patient with a heart attack and once for someone who needed resuscitation after cardiac arrest.
The heart is always complicated; the rhythm can suddenly change and then you have to switch quickly. It can just happen that while I’m at an angioplasty, I have to run to another room to resuscitate someone. That happens every week, where I regularly save someone’s life – that’s what I do it for and what makes my job so special!”
