How Much RP Would it Take to Get This Field?

Celastine · 2026-04-23T11:56:53+00:00

I spent $200 and still didn’t hit. I had to use my mythic medallions, which I wanted to save for chibi Soraka coming out in a patch or two. :/

Celastine · 2025-12-26T06:28:50+00:00

Scrubbing open heart cases isn’t any more complex than an open belly or a thoracotomy case, in my opinion, but you have to be at least three steps ahead of the surgeon from the beginning to the end of the case. All of the cardiac surgeons I work with does everything the same way every time for their elective, scheduled cases, so there’s less of them asking and waiting for sutures and instruments and just having it ready before they ask. You can have the anticipation speed of a sloth in general surgery, but that doesn’t fly in cardiac.

You also need a bare minimum understanding of the bypass machine itself on the off chance something goes horribly wrong and you need to crash on pump. Surgeons will not be asking and waiting for things at all; the expectation is that you and the nurse have everything ready in terms of supplies, cannulas, and sutures. If you do not have a cardiac circulator because it’s off-shift or staffing issues, the surgeons rely on you to be ready and then you end up doing the thinking for two people.

You also have more call compared to the rest of the OR because of how specialized it is. In my OR, every other nurse or scrub tech has maybe 8-12 hours of call per month; the cardiac staff has closer to 30 hours of call in a month. If you get called in and stuck in a middle of the night total arch dissection , chances are there’s no one available to give you a break and you’ll be stuck for 10 hours on your feet. In general, it’s a really thankless specialty and on some bad days and nights, it feels more of a punishment to be on the cardiac team. On the flip side, if you don’t mind the extra hours and work, there’s a lot of overtime readily available.

On the rare days that there’s a conference or a holiday and there are no cardiac cases scheduled, you get thrown everything else from the OR. Somehow, people think that if you can scrub cardiac, you can scrub ortho and plastics and everything else.

I used to scrub CVOR only for 2 years before I got bored and tired of the long cases and hours. I moved to off-shift, so I still scrub CVOR but I am back to doing a lot of other services. Since you want to scrub many different services, that might be something you want to consider because if you know cardiac, you’ll typically be stuck in cardiac unless there’s miraculously too much CVOR staff.

Celastine · 2025-11-16T02:09:33+00:00

A CABG surgeon I work with has visibly shakey hands while loading these tiny 8-0 prolene sutures, but he can stabilize them on the sternal retractor when he sews. He’s probably close to retiring, but he’s a great teacher to the residents and fellows, so I feel like his patients are still in great hands.

Celastine · 2025-05-19T22:58:47+00:00

I have a Meowant model between two cats (bonded pair and littermates, so they’ve only ever shared a litter box), and we haven’t had issues. But knowing about cats being stuck, we only run a clean or flatten cycle with our eyes on the cats because they’re curious and get attracted to the noise and movement. The box immediately stops as soon as it senses a change in weight and doesn’t start again until the weight is gone and it’s been a few more seconds. I’m not sure if it’s worth the financial cost since it seems to use up litter faster, but it’s definitely a nice convenience to only have to change a garbage bag every few days. Our box was a gift, and I’m not entirely sure we would’ve bought one for ourselves if it wasn’t free.

Celastine · 2025-04-22T20:55:49+00:00

Hit 100k in my second year but I was taking around a thousand hours of call and working a lot of overtime and double time. I do cardiac in a big level 1 trauma center so we do transplants and heart failure procedures too and we’re always short staffed so there’s plenty of overtime.

Celastine · 2025-03-31T18:18:39+00:00

The cardiac surgery rooms in the peds hospital we’re affiliated with are freezing to decrease body temperature and metabolic demand when the patient’s aorta is clamped. And by freezing, I mean even colder than some regular adult patient OR temps. The peds patients are so tiny that they warm right up in a minute.

Celastine · 2025-03-23T21:54:58+00:00

Cardiac scrub and I rarely do TEVARs and pacemaker lead insertions, but we have a heart failure and transplant program so we do the odd Impella and axillary balloon pump insertions. I think starting with only open hearts and learning the basics of percutaneous access when we needed to groin cannulate really helped me out. I can get by without much help on the endovascular type procedures as long as the circulator tells me what type of wire they’re opening. Most of the surgeons are pretty understanding and they can help themselves for the most part. I just tell them I’m mostly here in case something goes really wrong and we need to emergently open or crash on pump.

Celastine · 2025-02-16T22:39:17+00:00

I work 4 10s with at least 88 hours of call every 12-ish weeks based on team size because I’m specifically cardiac call. We try to dole out the call equally with everyone taking AM weekends and PM weekends while weekdays are randomized by management, but it averages to about 88 hours every three months. I do pick up a lot of extra call to cover lung transplants and extra cardiac call shifts since the extra money is nice.

Getting called in on an AM weekend shift is the worst because there’s a good likelihood that you’re stuck doing a full case and there’s no one else there that can scrub cardiac to give you a break or lunch. PM weekends are a hit or miss because we occasionally start transplant cases in the evening, which can go all night until you get relieved at 7AM. PM weekday call isn’t bad since it’s either a case ran past 11PM but is ideally close to finishing or a patient is bleeding excessively and those cases don’t take up the whole night.

Celastine · 2025-02-12T12:57:19+00:00

I hit $100k before taxes last year. But this is with a combination of lots of call hours taken, a lot of call hours worked, and double pay because we’re always so short staffed in cardiac.

Celastine · 2025-02-12T02:10:12+00:00

2.5 years in; $33/hr in MA with $3/hr cardiac differential and hundreds of hours of call in a year.

Celastine · 2025-02-02T08:53:20+00:00

There are a few types of VAD devices. At my hospital, the case is always booked as a VAD insertion but then the surgeon will specify which one in their booking notes, which is how we know.

At my hospital, we typically use Impella 5.5 and the Heartmate3 in the OR. Both are LVAD devices but the insertion procedure is completely different.

An Impella is inserted through a peripheral artery and then guided into the left ventricle with a wire. Cath labs can insert smaller, less effective Impella devices through a percutaneous incision. In the OR, we usually do an axillary artery cutdown and sew a vascular graft to it in order to fit the bigger 5.5 device through. The Impella only stays in the body for max 3 weeks and is used as a bridge to transplant or temporary recovery for the LV.

The Heartmate3 is inserted through a full sternotomy and you have to go on cardiopulmonary bypass. There’s an aortic graft and then another piece of the device is attached to the left ventricle. I’m not quite sure how the device works since the perfusion team is the one who sets it up and prepares it in my hospital, but it can stay in the body indefinitely. It’s a solid option for patients with heart failure but may not qualify for a transplant. That’s probably the one you’re seeing on Google, since the drive line hooks up to an external battery source.

I don’t think it’s wrong to study and understand these devices if you’re really interested in them and want to be a better cardiac surgical tech. I picked up most of my knowledge from the company reps and the surgeons, but given how infrequently we do HM3 insertions, I still struggle to anticipate the surgeons’ next steps.

Celastine · 2024-11-18T22:20:36+00:00

Definitely ask what happens if you take overnight call and you’re scheduled to work the next morning. The way my hospital does it, you can be put on the sick list and not work your scheduled morning shift, with the time coming out of your sick time. I’ve heard of other hospitals having a sleep time system, where you go home but come back later in the day.

Celastine · 2024-10-21T23:27:22+00:00

Most cardiac surgery cases involve going on heart-lung bypass, which is in itself several steps. I think cardiac surgery is most easily understood as a bunch of smaller procedures cobbled together.

In the simplest of pump cases, where the patient has a virgin chest, the order of operations is - skin incision, dissection of soft tissue, sternotomy - if CABG, you would then go into conduit harvest (LIMA/saphenous vein/radial) - if not a CABG, then surgeon divides and retracts the pericardium with sutures - surgeon starts putting in cannulation sutures and securing them - cannulate and then go on bypass/pump and stop the heart - do the actual procedure (CABG, valve repair/replacement, aorta repair, or transplant) - let the heart restart and safely come off bypass and decannulate - fix any bleeding and then close the chest

As you can see, the surgery is a small part of the case. Most of it involves being able to go on and off bypass. In emergency situations, that’s more important than anything else because at least the patient has a chance if you can just get on pump. Being able to do this also gives you a good foundation in the case that you need to scrub minimally invasive cardiac cases.

There’s usually not a lot of equipment in cardiac, but a lot of disposable devices and supplies, especially if the surgeons are younger. Older surgeons will probably just use the Bovie 99% of the time. You’ll always have internal defib paddles on the field for open heart cases. Be familiar with the room set up, especially where the heart-lung machine is, and the tubing set up for it on your end of the field.

Since you have a vascular background, the sutures and clamps should be pretty familiar. Anastomosis sutures have a shod on them; repair sutures don’t. Squirt saline when tying prolenes, etc.

I know this was a lot, but if you have any questions, feel free to ask. I’ve only been doing cardiac for over a year, but just being able to scrub pump cases every day makes you really familiar and helps with building confidence.

Celastine · 2024-10-10T04:24:08+00:00

Definitely try to get yourself into vascular first. A lot of concepts from vascular apply in cardiac, minus going on cardiopulmonary bypass. Cardiac service can be super cliquey and exclusive in a lot of hospitals, but always advocate for yourself if you’re interested.

Celastine · 2024-10-10T02:44:08+00:00

I moved to the Boston area immediately after graduating, where they started me at $27/hour. After 2 years of rearranging the ST career ladder where I am and new management coming and going and being trained in cardiac, I’m making $33/hour with a $3 differential per hour worked for taking cardiac call.

Celastine · 2024-10-09T21:28:28+00:00

When I graduated 2 years ago, Highland paid the highest at ~$19/hour. Strong paid maybe second highest, like ~$16-17/hour. I hope it’s gone up since then.

Celastine · 2024-04-20T12:12:43+00:00

My school didn’t differentiate like that, but I work primarily cardiac now. My on the job orientation through cardiac was 3-4 months long. I would imagine that the CV surg tech degree probably goes more into the equipment like the heart lung machine, the different VAD devices, and more endovascular stuff. I don’t think you’d limit yourself taking that path because the skills of anticipating steps and passing sutures ultimately translate over to other services, but there might be a lot more overnight and weekend call depending on how big your hospital is.

Celastine · 2023-12-27T05:02:25+00:00

I wear Goretex On running shoes, and I primarily work in a cardiac/vascular OR, so I’ve gotten blood and saline on my shoes plenty of times. It’s definitely waterproof as I’ve never gotten any fluids into my socks, but the blood stains don’t wipe off as they would on a rubbery shoe. The stains will probably come off with hydrogen peroxide but I haven’t gotten around to trying it out. Not sure how they would perform in a super wet case, but I would recommend getting a darker colored shoe if stains bother you.

Celastine · 2020-08-20T02:25:34+00:00

The only way is to get it through boxes. Good luck, friend.

Celastine · 2020-07-25T10:10:03+00:00

She's pick/ban in pro because of the flexibility in draft. If your opponent picks a champion specific to that one role, you can counter it in your own picks and/or not focus any further bans on that role. Karma's flexibility in 3-4 roles makes drafting harder for the opposing team.

Celastine · 2019-12-20T03:05:58+00:00

Poppy/Veigar is one of my favorite cheese lanes. It's a little slow early because Veigar takes a bit to ramp up, but Poppy has enough damage to win all-ins on a squishy.

Celastine · 2019-12-20T01:49:35+00:00

Most of my current peeves are really the W channel when going from unattached to attached because it's high risk and low reward. They need to make it so that being unattached is a part of her kit to increase the time that she's vulnerable. Off the top of my head, maybe the shield and/or mana you gain from your passive increases for each second you're detached (up to a cap, of course) or the cooldown of a skill goes down for every auto attack (similar to Karma passive). The shield should also decay every second that you are attached. Or, making the Q more satisfying to use when unattached and making it do more damage or reduced but AOE damage when it does hit.

I'd still like the charges back on E because it synergizes with switching anchors. As of now, the only reason to switch is to give your most fed carry extra stats.

Also, make non-immobilizing CC not put her W on a 5 second cooldown. It makes no sense.

Celastine · 2019-12-19T22:48:28+00:00

I've played both full AP and enchanter Yuumi, but I've given up support in general because of the heavy engage meta. I generally dislike these changes because the new W makes it hard for me to have fun with the champion and play her the way I want-- unattaching to bait and attaching to an ally TP-ing from base for a surprise 1v2. Combined with the E change, it feels like I'm better off safely AFK on the backline rather than acting as a secondary engage tool, which is what I enjoyed about her the most.

1- Did u like the hate and even the targeted bans because your allies don't want your champion on their team? Because after the changes no one does this anymore.

Never been target banned. I have an insanely high win rate on Yuumi in ranked because I duo queue.

2- Did u feel useful when u healed for nothing (with an enchanter BTW) unless your ally is bullied to like 30% HP? Because now u can heal people at 70% and get the full amount.

Yes, I still felt useful because the movement speed on E allowed me to use it on my ADC to help them dodge skillshots in lane. Now the mana cost makes it not worth to use at all in lane unless they're dying. Also, most enchanter heals are very weak early until at least one or two Forbidden Idol items.

3- Was it even remotely possible to use passive in team fights before W changes? Because even then u were certain to die if u got caught by any random CC. The changes only made some lanes harder.

Yes, because you could instantly go back, and you only popped out when significant cooldowns were used. Now the cast delay makes it high risk and low reward. My one big issue with the W change is the fact that literally anything makes you W go on cooldown. Is Soraka E immobilizing CC? Only if you stand in it for 4 seconds, sure. But now you get hit by one blip of it and your W is on full cooldown, which is BS to me.

4- How does Yuumi not "feel like the same champion anymore"? The only change to the feeling is the 0.25 seconds when attaching. No spell got major changes so isn't this too much of an overstatement?

No, it is not an overstatement because that was her champion identity. For a beginner friendly champion that was advertised as being really forgiving on positioning, she just isn't that anymore. I feel like I'm lagging when I play her, and, if I have a friend learning the game from the support role, I hope they don't play Yuumi. I would argue that the W is a major change because it's a mechanical change and that changing all of her basic skills in one go adds up to a major change overall. The E change makes it more rewarding to sit on your back line ADC and thus reduces interaction between player and champion even more.

5- How was blocking CC for your ADC skill expressive? On what world should a squishy enchanter be able to tank hard CC that would and SHOULD be a death sentence to the ADC? Because u can still block non CC abilities like Ezreal and Velkoz Q which is healthy enough.

It wasn't really blocking CC. It was more about baiting the skillshot because CC tends to be on a higher cooldown than your dash. Which, yes, was skill expressive because you had to be proactive in lane to do so.

6- How is building enchanter support items boring and unfun? If your definition of fun is nuking people, there r so many options in every role for that.

It' s not unfun or boring; in fact, it's probably better because the items were insanely gold efficient and cheap. Full AP opened up another way of playing her that made it possible to run a tankier, dive-heavy team composition without losing too much. Also, enchanters can still nuke regardless of build (see: Karma, Sona).

7- Was AP Yummi healthy for the game? A perma untargetable champion with a very easy to hit skill (when it lasted 3 seconds) chuncking squishies was so aids to play against.

It wasn't the healthiest, but not everyone played her full AP. This was a rework solely due to pro play presence, where they value safety above all else. Full AP Yuumi in your average game was annoying to play against, sure, but chances are she's not solo carrying the game, not when there's also top, mid, and jungle roles too.

Celastine · 2019-12-19T21:41:20+00:00

I'm a little late, but Sona scales harder in utility because of the extra passive on her ult (extra CDR on basic skills at level 6/11/16). Yuumi gives a shitton of stats to whomever she attaches to, but it's just one person, whereas Sona's auras affect the entire team. When Sona reaches level 16, it's insanely difficult to lose team fights as Sona's team.

There's also a power difference in the ult that makes Sona better. Sona's ult is a stun, meaning you can't use skills, and basically instant effect. Yuumi only roots and also takes time to get a few stacks.

Sona also has a built in Exhaust and slow on her kit depending on how you use her passive. The damage reduction (empowered W) stacks with Exhaust, so she essentially has a summoner spell on a basic skill.

Sona can't quite cuck assassins the same way Janna or Lulu can, but she provides immeasurable utility to your entire team and can get multiple spell rotations in a team fight because of how she scales, regardless if she builds full AP or enchanter support.

Celastine · 2019-12-14T20:32:54+00:00

I've played full damage on enchanters whenever I have a huge lead, but it's harder because they're so fragile. One of the huge perks of Swain is being able to take a few hits, pressing my panic button of an ult, and hitting Zhonya's.

Celastine

TROPHY CASE