Royal Brompton has a busy transcatheter valve service, assessing and treating patients with aortic and mitral valve disease.
Most of our patients are older and often have significant co-morbidities, making them high risk for conventional surgery.
What is the role of the CNS?
The primary role of the clinical nurse specialist (CNS) is to support patients, relatives and ward staff throughout the patient journey - from assessment through to the procedure and beyond.
Along with the transcatheter valve team administrator, the CNS will arrange admissions and organise investigations. She is also available on the wards to help facilitate these investigations and to assess the patient, which often includes a six-minute walk test.
They are also responsible for liaising with representatives from the medical device companies that manufacture and supply the valves and equipment.
The service has three multidisciplinary team (MDT) meetings per week, where patient cases are discussed and plans formulated. The CNS is responsible for ensuring that these plans are given to, and discussed with, the patient and to the relevant staff.
The nurse works with the MDT to plan and coordinate the procedure itself, liaising with the patient, relatives, consultants, lab staff and schedulers.
Another important role of the nurse specialist is to provide teaching for ward staff on the aortic and mitral valve transcatheter approaches and the assessment process. The CNS works with the practice educators and provides teaching sessions as requested.
The CNS developed a flowchart for aortic valve assessment: "Transcatheter aortic valve implantation (TAVI) protocol investigations" as a reference for staff, as well as integrated care pathways (ICPs). Both are in use on the wards.
Transcatheter valve clinics
Patients are invited to attend the transcatheter valve clinic before and after their procedure. It is a nurse-led clinic that runs twice a week.
Before the procedure
Patients may attend the Monday morning clinic, often with their relatives, to find out more about the assessment process and the procedure itself, and to undergo investigations such as blood tests, chest X-ray, ECHO and six-minute walk test.
After the procedure
Post-procedure patients usually attend the Thursday afternoon clinic. After their procedure, patients are seen at six weeks, three months, six months and then yearly, dependent on clinical condition and distance to travel. At the annual appointment, the patient has blood tests, a review of medications, a chest X-ray, ECHO and the six-minute walk test, if appropriate.
If the patient lives a significant distance away, their local cardiologist will often see them, following discussion with the transcatheter valve team.
Telephone support for patients and relatives has become a vital part of the nurse specialist’s role.
Aside from the patient-focused responsibilities, the CNS is involved with collecting data and assisting with the coordination of research projects.
Support: Leah Martin, Transcatheter valve team administrator
Telephone: 020 7351 8371