Chicago Illinois,
CLINICAL EVENTS CALENDAR
- StartJul 15,2010EndJul 17,2010Third Annual Cardiovascular Interventions: Head-to-Toe Meeting: Napa Valley, CAhttp://www.h2tmeeting.org/
- StartJul 18,2010EndJul 18,2010Super Tech Course for CSI (Diamondback): Hands-on, presented by Orlando Marrero, RCIS, MBA, Winter Haven Hospital, FLOrlando.Marrero@WinterHavenHospital.org
- StartJul 18,2010EndJul 21,2010Pediatric & Adult Interventional Cardiac Symposium With Live Case Demonstrations: Sheraton Hotel & Towers, Chicago, ILhttp://www.picsymposium.com
- StartJul 19,2010EndJul 23,2010Hawaii 2010: Principles and Perspectives in Interventional Cardiologywww.hawaiippic.com
Clinical Editor's Corner
How Do We Decide When 3-Vessel CAD is Too Much for PCI?
You finish the coronary angiograms on the 78-year-old grandfather who reported 6 months of chest pressure and shortness of breath with activity. His high blood pressure was well treated, as was his cholesterol. He did not have diabetes. He had a positive stress perfusion imaging study 1 week ago. His coronary angiograms show 3-vessel (3V) coronary artery disease (CAD) with a proximal 70% narrowed calcified left anterior descending artery (LAD), 90% mid-circumflex and two lesions (60%, 80%) in the mid and distal right coronary artery (RCA), proximal to the posterior descending artery (PDA). The left ventriculogram (LV) gram was normal. How do we decide whether his CAD is too much for percutaneous coronary intervention (PCI)? Which revascularization approach [PCI vs. coronary artery bypass graft surgery (CABG)] should be recommended?
Anti-Platelet Therapy and Resistance: How common is it and what should we do about it?
Eight months after treating a man with a severe left anterior descending artery (LAD) stenosis with a single drug-eluting stent, your patient returns with unstable angina and acute renarrowing of the distal portion of the stent with a lucency on the angiogram. Percutaneous coronary intervention (PCI) is urgently performed. Subacute stent thrombosis is the likely diagnosis and occurred despite the patient receiving clopidogrel (Plavix, Bristol-Myers Squibb and Sanofi-Aventis) 75mg/day, aspirin 81 mg/day, and his routine statin and antihypertensive medications. Did the Plavix fail? Was the patient a non-responder to anti-platelet agents? How should we approach the management of this patient after his second intervention?
A Review of Anti-Platelet Agents for PCI
The STEMI Box– Shorten D2B and Cath Lab Prep in the Emergency Department
(Note: Please visit http://cathlabdigest.com/articles/Letter-Clinical-Editor to read this month's "Letters to the Clinical Editor." The letters missed the March print edition and will be published in the April edition).
How Many People Do You Need to Do a Cardiac Cath?
We changed the daily tour of duty for our cath lab team. Instead of 10-hour days with one shift to run 2 labs, we split overlapping 8-hour shifts. This brought up the question, “Exactly how many people (and what kind of training) should you have to do a cardiac cath?”
The answer to this question depends on several factors. Decisions for more or less staff will mostly depend on what type of case, such as interventional vs. diagnostic cath, elective vs. emergency, and what type of practice (private vs. university training hospital) as well as state regulations for hospitals. Although I
Dynamic Leadership in the Cath Lab: Balancing Taking Charge and Being Part of the Team
The Cath Lab Basics 2009 course series ended in Tampa the first Saturday in December. Dr. Mike Lim and I enjoyed conducting a one-day ‘cath conference’ with the 180 cath techs and nurses from the region. Sitting at lunch, I asked my table of nurses from Venice, Florida, “What is the single biggest problem you have in your lab?” I was expecting comments like, “It’s the hemodynamics” or “I struggle with coronary anatomy” or “I don’t like covering the on-call nights.” But I was surprised to learn from them that their biggest problem was the personal dynamics with one of t
Changing Behavior and Culture in the Cath Lab: Addressing Motivations and the ODNT (Old Dog/New Trick) Syndrome
I was recently asked at our Cath Lab Basics 2009 course in Seattle, “What can the techs/nurses do to introduce a new and better way of doing something in the lab to the physicians and ultimately to the patients?” For example, how does one implement physicians changing to routinely using 6F rather than 8F guides for percutaneous coronary intervention (PCI), performing intravascular ultrasound (IVUS)/fractional flow reserve (FFR), or starting the radial approach? In other words, can you cure the “OD can’t learn NT syndrome” (remembering that some of the old dogs are not really so old)?
Working With Industry Representatives and Conflicts of Interest in the Cath Lab
Your cath lab director is on the speaker’s bureau for a pharmaceutical company that promotes antiplatelet agents. Does this mean you cannot buy this drug to use in the cath lab? Does this mean the doctor cannot perform a procedure with this drug because he has a perceived conflict of interest? Of course not, but it is important to understand and work with our industry and the conflicts of interest which inevitably occur in most businesses, including the business of medicine.
Industry and cath lab relationships
In the last few years, major universities and hospital systems ha
Is the Hybrid Cath Lab the Way of the Future?
Last fall, I visited Vanderbilt University Medical Center in Nashville, Tennessee, and was shown their marvelous hybrid cath lab/OR. An interventional procedure was underway, to be shortly followed by a left internal mammary artery (LIMA) procedure, without moving the patient off the table, just rearranging the equipment to bring the surgical team up to the patient. This “one stop” revascularization procedure was a technological tour-de-force. The concept of combining an operating suite with a cardiac cath lab — a hybrid cath lab [or if you’re a surgeon, a hybrid operatin room (OR)]
Cost-Effective Health Care and Research: FAME Fits
In this issue of Cath Lab Digest, Dr. William Fearon from Stanford University talks about the FAME (Fractional flow reserve vs. Angiography in Multivessel Evaluation) study1 and how using fractional flow reserve (FFR) with a pressure wire was a highly successful approach to cost-effective stenting in patients with multivessel coronary artery disease (CAD) compared to using traditional angiography alone. FAME fits with cost-effective healthcare in a big way.
How does FAME make percutaneous coronary intervention (PCI) cost effective?
First, what does cost-effective health care mean?
What is the SYNTAX Score and How Should We Use It?
In recent years, studies of multivessel coronary angioplasty randomized patients between surgery and intervention. The fairness of this randomization assignment has become a subject of great interest, since it may influence outcomes. One of the most prominent recent studies, the SYNTAX trial, compared multivessel percutaneous coronary intervention (PCI), including patients with left main narrowings, to coronary artery bypass surgery. The results of this randomized study demonstrated that patients who had SYNTAX scores >34 appeared to do much better with bypass surgery than those with lower SYN
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Cath Lab Surveys
Center for Education & Practice Development - Learning Module Femoral Artery Sheath Management(PDF) This learning module is designed for the Registered Nurse Division 1 working in areas where
patients are undergoing percutaneous cardiac catheterisation and interventions.
Cath Lab Digest Blogs
Seiji E. Kashiwabara, RN, NREMT-P
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