RCIS Registered Cardiovascular Invasive Specialist

Examination Overview

Courtesy Lancaster General Hospital

Cardiovascular Credentialing International

Credentialing Cardiovascular Professionals Since 1968

Apply online at www.cci-online.org

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Registered Cardiovascular Invasive Specialist (RCIS)This Examination Overview is meant to assist you as a prospective candidate of the Registered Cardiovascular Invasive Specialist (RCIS) credentialing program. It provides an overview of the Qualification Requirements and Examination Content. For more details on CCI policies, the testing process, and procedures to submit an application, please visit www.cci-online.org to view or download the Applicant Handbook. Examination fee is $365 USD and all exam fees include a $100 USD non-refundable filing fee.

Qualification RequirementsAll applicants must meet the following criteria:1. Have a high school diploma or general education diploma at the time of application.2. Fulfill one (1) of the qualifications of the exam for which you are applying. See qualifications listed in the tables below.3. Provide typed documentation to support the qualification prerequisite under which you are applying. Required documentation for each qualifi-

cation is listed below. CCI reserves the right to request additional information.

* If an individual’s procedures were completed during a formal educational program, then those procedures completed WOULD count toward the minimum of 600 diagnostic/interventional procedures under qualification RCIS235-2013.

** An accredited program is accredited by an agency recognized by the Council for Higher Education Accreditation (CHEA), United States Department of Educa-tion (USDOE), or Canadian Medical Association (CMA) that specifically conducts programmatic accreditation for cardiovascular technology, diagnostic cardiac sonography, or vascular technology.

Qualification Prerequisite (All applicants must fulfill one of the following)

RCIS235-2013A graduate of a diploma, associate, or baccalaureate academic program in health science (includes, but not limited to, cardiovascular technology, ultrasound, radiologic technology, respiratory therapy, or nursing)ANDOne year full-time work experience in invasive cardiovascular technologyAND600* cardiac diagnostic/interventional procedures in their career which is defined as work experience and/or clinical experience gained during a formal educational program.

In the verification letter(s) the medical director(s) and/or program director(s) must confirm the number of studies performed during the applicant’s employment and/or during the academic program.

RCIS5A graduate of a NON-programmatically accredited program in invasive cardiovascular technology which has a minimum of one year of specialty training and includes a minimum of 800 clinical hours* in the specialty in which the examination is being requested.

IMPORTANT: If an individual’s clinical hours were completed after graduation or if the hours are not a requirement for their educational program, then those hours WOULD NOT count toward the 800-hour minimum under qualification RCIS5. All clinical hours must be earned in a setting in which patients are being tested or medically treated.

RCIS4Applicant must be a graduate of a programmatically accredited program** in invasive cardiovascular technology.

Supporting Documentation

RCIS235-2013Completion certificate and/or educational transcriptANDEmployment Verification Letter ANDClinical Experience Letter (only required for applicants submitting verification of the number of studies completed during a formal educational program)

RCIS5Completion certificate and/or educational transcriptANDStudent Verification LetterANDClinical Verification Letter

Students applying to take examination prior to graduation will be required to submit this documentation

RCIS4Completion certificate and/or educational transcriptANDStudent Verification Letter

Students applying to take examination prior to graduation will be required to submit this documentation

These examination matrices are provided to illustrate the general distribution of questions and the relative weight or emphasis given to a skill or content area on the examination.

Matrix for Exams Administered on or after July 1, 2019Content Category Approx. % of ExamA Conducting Pre-Procedural Activities 10%B Conducting Diagnostic Procedures 42%C Conducting Interventional Procedures 33%D Responding to Emergency Procedures and Protocols 6%E Conducting Post-Procedural Activities 9%TOTAL 100%

Matrix for Exams Administered before July 1, 2019Content Category Approx. % of ExamA Conducting Pre-Procedural Activities 10%B Conducting Intra-Procedural Activities 40%C Performing Invasive Procedures 40%D Conducting Post-Procedural Activities 10%TOTAL 100%

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Registered Cardiovascular Invasive Specialist (RCIS)

Publication Date: November 2018. This document supersedes all documentation previously released.

The task lists below describe the activities which a Registered Cardiovascular Invasive Specialist is expected to perform on the job. All examination questions are linked to these tasks.

Task List for Exams Administered before July 1, 2019Duties and Tasks % of Exam

A Conducting Pre-Procedural Activities 10%1 Prepare procedure room (e.g., set up equipment, QC, QA)2 Review patient chart (e.g., lab results, consent, verifying orders, medical

record)3 Prepare patient for procedure (e.g., patient ID/verification, start IV,

educate patient)4 Set up sterile field (e.g., patient, procedure table, equipment)

B Conducting Intra-Procedural Activities 40%1 Monitor vital signs of patients (e.g., heart rate rhythm, blood pressure,

respiratory rate, O2 saturation)2 Evaluate hemodynamic data (e.g., pressure waveforms, CO, Fick, Shunt,

PVR, SVR, valve areas)3 Perform 12-lead ECG analysis (e.g., infarct, bundle branch, ischemia,

tamponade)4 Understand pharmacologic effects of medications (e.g., ACLS, recognize

side effects/adverse reactions, pain management) 5 Monitor ACT (Activated Clotting Time)6 Ensure radiation safety (e.g., time, distance, shielding)7 Position radiographic equipment (e.g., C arm, pan table, angles & views)8 Acquire/interpret radiographic images (administer contrast)9 Administer conscious sedation (e.g., levels, Aldrete, assessing effects)10 Place arterial lines11 Place venous lines12 Perform intra-coronary injection13 Perform cardiac outputs (e.g., TDCO)14 Perform endomyocardial biopsy15 Respond to intra-procedural emergency situations (e.g., anaphylaxis,

cardiac arrest, cardiogenic shock, tamponade, ACLS)

C Performing Invasive Procedures 40%1 Perform adult cardiac catheterization2 Perform Intra-vascular ultrasound (IVUS)3 Perform Intra-cardiac echocardiography (ICE)4 Perform Fractional Flow Reserve (FFR)5 Perform device implants (e.g., pacemaker, ICD)6 Perform coronary balloon angioplasty (including CTO devices)7 Perform peripheral interventions (e.g., carotids, renals, SFAs, vena cava

filters)8 Perform coronary stenting9 Perform rotational atherectomy10 Perform laser interventional procedures11 Perform IABP insertion (intra-aortic balloon pump)12 Insert and operate transvenous temporary pacemaker13 Perform pericardiocentesis14 Perform transcatheter valve repair/replacement15 Perform structural heart disease interventions (e.g., ASD/PFO, VSD, PDA)16 Perform percutaneous valvuloplasty17 Operate thrombectomy equipment (e.g., Angiojet, aspiration catheter)18 Implant percutaneous left ventricular assist device (e.g., LVAD, Impella)19 Assist with transseptal puncture20 Insert distal protection devices

D Conducting Post-Procedural Activities 10%1 Obtain femoral hemostasis with manual pressure2 Obtain femoral hemostasis with collagen closure device3 Obtain femoral hemostasis with mechanical device4 Obtain radial hemostasis manually or with mechanical device5 Manage access site complications6 Respond to post-procedure emergency situations (e.g., vasovagal,

anaphylaxis, retroperitoneal bleed)

TOTAL 100%

Task List for ExamsAdministered on or after July 1, 2019Duties and Tasks % of Exam

A Conducting Pre-Procedural Activities 10%1 Prepare procedure/control room (e.g., set up equipment, radiation safety,

sterile technique, QC, QA) 2 Prepare patient for procedure 3 Review and validate patient or procedure information (e.g., medical records,

lab values, time out, consent, presentation)

B Conducting Diagnostic Procedures 42%1 Monitor vital signs of patients (e.g., heart rate, rhythm, blood pressure,

respiratory rate, O2 saturation, ETCO2) 2 Assist/perform left heart catheterization (e.g., pressure waveforms, pull-back) 3 Assist/perform right heart catheterization (e.g., cardiac output, Fick, shunts,

PVR, SVR, valve areas, congenital procedures) 4 Perform 12-Lead ECG analysis (e.g., infarct, bundle branch block, ischemia,

tamponade) 5 Assist in the performance of intra-cardiac imaging procedures (e.g., ICE,

identify structures) 6 Assist in the performance of intra-vasuclar imaging procedures (e.g., IVUS,

OCT, identify structures) 7 Identify structures on cardiac ultrasound images 8 Assist/perform fractional flow reserve (FFR) and instantaneous fractional

reserve (iFR) studies 9 Ensure radiation safety (e.g., time, distance, shielding, ALARA) 10 Assist in performing radiographic procedures (e.g., set-up, positioning,

operation) 11 Acquire/interpret radiographic images (e.g., cardiac, peripheral vascular) 12 Assist/perform with endomyocardial biopsy 13 Recognize pharmacologic effects of medications (e.g., recognize side effects/

adverse reactions, pain management) 14 Assist in obtaining vascular access (e.g., femoral, radial, brachial, jugular,

peripheral)

C Conducting Interventional Procedures 33%1 Assist in performing device implants (e.g., pacemaker, ICD, CRT devices,

loop recorders) 2 Assist in performing coronary interventions (e.g., balloon angioplasty,

stenting) 3 Assist in performing complex coronary interventions (e.g., CTO, atherectomy,

alcohol ablation) 4 Assist in performing peripheral interventions (e.g., renals, lower extremities,

vena cava filters, stenting) 5 Assist in performing complex peripheral interventions (e.g., carotids, critical

limb salvage, atherectomy) 6 Assist in performing mechanical circulation support (e.g., IABP, LVAD,

Impella) 7 Assist with insertion and operation of transvenous temporary pacemaker 8 Assist in performing pericardiocentesis 9 Assist with in performing cardiac thrombectomy (mechanical and

aspirational) 10 Assist with performing peripheral thrombectomy (mechanical and

aspirational) (e.g., thrombolysis) 11 Assist with the insertion of distal protection devices (e.g., cardiac, peripheral) 12 Assist in performing structural heart therapies (e.g., ASD, PFO, VSD, PDA,

LAA) 13 Assist in performing percutaneous valve interventions (e.g., valvuloplasty,

TAVR, annuloplasty, paravalvular leak, valve repair) 14 Assist in performing endovascular procedures (e.g., aortic aneurysm, aortic

dissection, coarctation)

D Responding to Emergency Procedures and Protocols 6%1 Respond to emergency situations (e.g., STEMI, chest pain, pulmonary

edema, cardiogenic shock, limb ischemia, stroke, administer medications, vasovagal, anaphylaxis)

2 Maintain and operate emergency equipment (e.g., defibrillator, code cart, suction, airway management)

E Conducting Post-Procedural Activities 9%1 Obtain arterial and venous hemostasis 2 Manage access site complications (e.g., bleeding, occlusion) 3 Manage post-procedure complications (e.g., stroke, rhythm) 4 Provide patient education 5 Report and transfer of care

TOTAL 100%

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Registered Cardiovascular Invasive Specialist (RCIS)

Knowledge ListThe list below describes general areas of knowledge that are needed in order to perform the tasks identified. This knowledge will apply across multiple tasks.

Mathematics• Calculation/conversion skills• Units of measurement• Shunt calculations, VOA

Medical terminologyCardiovascular anatomy and physiologyCardiovascular pathology and pathophysiologyBody mechanicsRegulatory and compliance standardsPatient care and assessmentNormal and abnormal lab valuesECG interpretation and analysisPharmacology and medication administrationHemodynamic waveform recognitionImaging

• Angiography• Radiation safety• Operation of radiographic equipment• IVUS• ICE

Sterile techniqueUniversal precautionsDiagnostic and interventional procedures

• Cardiac procedures• Vascular procedures• Device implants• Procedural indications, contraindications, and complications

HemostasisEmergency procedures and equipment

Sample Questions1. Based on the following data: O2 Consumption = 250 ml/min.,

AO = 21.0 vol. %, PA = 16.0 vol. %, BSA = 1.8 M2. What is the approximate cardiac output for the patient? a. 2.5 L/min. b. 4.0 L/min. c. 5.0 L/min. d. 6.0 L/min.

2. Positioning the image intensifier as close to the patient as possible: A. Increases scatterB. Decreases scatterC. Increases exposure timeD. Decreases exposure time

3. Which of the following hemodynamic pressures would be used to check for mitral stenosis? a. LV systolic & Aortic systolicb. LV systolic & PCWc. LVedp & PCWd. LVedp & Aortic diastolic

4. If a patient had a large S-wave in lead VI and a large R-wave in V5, you might suspect: a. LVH b. IV Strain c. Hyperkalemia d. Anterior Infarction

5. What is most likely indicated from the following oximetry samples? Position Saturation% Position Saturation% SVC 70% RV 86% IVC 71% PA 86% Hi RA 78% LA 94% Mid RA 86% LV 94% Low RA 83% AO 94% a. ASD with left to right shunt b. PDA with left to right shunt c. VSD with left to right shunt d. Tetralogy of Fallot with bidirectional shunt

Answers 1. c 2. b 3. c 4. a 5. a

RCIS ReferencesThe textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later edi-tions of these or other references available that also present accept-able coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material.

1. Aehlert, Barbara. ECGs made easy - Book and Pocket Reference Package. 5th ed. St. Louis: Mosby, 2012.

2. Moscucci, Mauro. Grossman & Baim’s cardiac catheterization, angiography, and intervention. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2013.

3. Daily, Elaine Kiess, and John Speer Schroeder. Techniques in bed-side hemodynamic monitoring. 5th ed. St. Louis: Mosby, 1994.

4. Darovic, Gloria Oblouk. Hemodynamic monitoring: invasive and noninvasive clinical application. 3rd ed. Philadelphia: W.B. Saun-ders Co., 2002.

5. Kern, Morton J., Sorajja, Paul and Lim, Michael. The cardiac catheterization handbook. 6th ed. Philadelphia: Saunders Elsevier, 2015.

6. Safian, Robert D., and Mark Freed. The manual of interventional cardiology. 3rd ed. Royal Oak, Mich.: Physicians’ Press, 2001.

7. Watson, Sandy, and Kenneth A. Gorski. Invasive cardiology: a manual for cath lab personnel. 3rd ed. Sudbury, MA: Jones and Bartlett Learning, 2010.

Online Self-Assessment Practice Examinations are available for purchase for self-evaluation purposes. It is important to note that the results of the self-assessment exam do not guarantee or indicate individual success on the CCI exam, nor should the self-assessment serve as the only means for preparing for the CCI examination. To order the self-assessment examinations online visit www.cci-online.org.

CCI Applicant Handbook is required reading prior to apply-ing for a CCI exam. Included is important information regarding the application policies, CCI procedures, and the testing process. Download at www.cci-online.org/applicanthandbook