Title: Nurse Practitioner as First Assistant in Cardiac Catheterization
Advisory Ruling Number: 0201

The Massachusetts Board of Registration in Nursing issues this Advisory Ruling on Nursing Practice pursuant to Massachusetts General Laws, chapter 30A, section 8 and chapter 112, section 80B.

Date Issued: June 2002
Date Revised:

Scope of Practice: Nurse Practitioner

To guide the practice of the nurse practitioner (NP) whom within their scope of practice may function as a first assistant during cardiac catheterization procedures.

Cardiac Catheterization is an invasive procedure in which one or more catheters are introduced into the heart and selected blood vessels primarily to assess the patency of the patient's coronary arteries and to determine the appropriate treatment or diagnosis.

For each cardiac catheterization in which the NP is the first assistant, there must be a clearly identified primary operator. A primary operator is a physician who is credentialed and experienced in all aspects of the performance of the procedure, including preprocedural and postprocedural care of the patient. The primary operator must be scrubbed and able to provide hands-on supervision during the cardiac catheterization.

The * First Assistant is proficient in both the technical and cognitive aspects of cardiac catheterization including:

  1. Preprocedural assessment and evaluation
  2. Indications, risks and benefits
  3. Cardiac anatomy, physiology and pathophysiology
  4. Technical proficiency
  5. Emergency and resuscitative measures
  6. Radiation safety
  7. Postprocedural care

Nurse Practitioners shall not perform cardiac catheterization as the primary operator.

NP as a first assistant at cardiac catheterization will have documented evidence (either through the educational program leading to authorization as an advanced practice nurse or through mandatory continuing education) of the knowledge, skills and abilities leading to competency of performing as a first assistant member of the catheterization team pursuant to 244 CMR 4.05.

NP as a first assistant at cardiac catheterization will successfully meet the credentialing criteria of the employing agency.

NP as a first assistant at cardiac catheterization will do so only in facilities that have institutionally generated, approved and signed policies, procedures and protocols indicating the role and functions of the NP as a member of the cardiac catheterization team pursuant to 244 CMR 4.22 (1) (2).

NP as a first assistant at cardiac catheterization will be held accountable and responsible for his/her own actions pursuant to Massachusetts General Laws chapter 112, section 80B, 244 CMR 4.00 et al and 244 CMR 9.00 et al.

NP as a first assistant at cardiac catheterization will have the role and functions incorporated into his/her practice guidelines which must be approved and signed by the Medical and Nursing Leadership responsible for the cardiac catheterization service pursuant to 244 CMR 4.22 (4).

The patient will be informed of the role and functions of the NP as first assistant at cardiac catheterization and demonstrate acknowledgement.

NP as First Assistant at Cardiac Catheterization will enter accurate documentation (preprocedural- intraprocedural-postprocedural) in the medical record as indicated by facility policy and procedure.

* In some instances the First Assistant is referred to as secondary operator or physician extender

This information is provided by the Division of Health Professions Licensure within the Department of Public Health.