Competency in invasive line monitoring (Swan Ganz, a-lines), pacemaker management (epicardial, transvenous), chest tubes, cardiac medication administration (inotropes, vasopressors, sedation/paralytics), ventilator/trach management, and cardiac rhythm interpretation. Support team includes charge nurse (rarely with patient assignment), 24/7 HUC, dedicated CVICU Intensivist, on-call CT Surgeon, onsite Hospitalist, General Intensivist, and ICU-designated RT.