Digital June Issue
June 2008 - Volume 16 - Issue 6

Is Sterile Technique Vital in the Cath Lab?

The concept of asepsis, or the prevention of microbial contamination, evolved with the development of sterilization. Surgeons learned that all things that come in contact with a wound should be sterile. Following the development of sterilization, other aspects of aseptic technique evolved. These included the refinement of surgical techniques, methods and universal precautions to protect patients and personnel from infection.

Digital May Issue
May 2008 - Volume 16 - Issue 5

Unspoken Words

A female patient was diagnosed with triple-vessel disease, requiring coronary artery bypass surgery in 1985. After a 10-day length of stay, she was discharged to home and started on a regimen of cardiac medications. Within months, a complete recovery from surgery was achieved.

Digital April Issue
April 2008 - Volume 16 - Issue 4

Use of a New Guidewire: The Tigerwire

Cath Lab Digest talks with Prakash Krishnan, MD, Director, Endovascular Intervention, Cardiac Catheterization Laboratory, The Mount Sinai Medical Center, Assistant Professor of Medicine, Mount Sinai School of Medicine, New York about his use of the newly released Tigerwire (St. Jude Medical, St. Paul, MN).

Digital March Issue
March 2008 - Volume 16 - Issue 3

The Latest in Cardiac Magnetic Resonance Imaging (MRI)

Cath Lab Digest talks with Robert O. Bonow, MD, Goldberg Distinguished Professor at Northwestern University Feinberg School of Medicine; Chief, Division of Cardiology, Northwestern Memorial Hospital; Co-director, Bluhm Cardiovascular Institute, Chicago, Illinois

Digital February Issue
February 2008 - Volume 16 - Issue 2

An Evaluation Of Cath Lab Turnaround Time

With the rising cost of health care and decreasing reimbursements from third party payers, health care organizations must find a way to protect their bottom line.

Digital January Issue
January 2008 - Volume 16 - Issue 1

Takotsubo Cardiomyopathy, a.k.a, Transient Left Ventricular Apical Ballooning Syndrome: An Acute Coronary Syndrome Imposter

A 66-year-old female presented to the ED complaining of 8/10 retrosternal chest pain and dyspnea. She was triaged quickly and her intial ECG, done within minutes of her arrival, showed possible lateral infarct, T wave inversion in the precordial leads, and QT prolongation.

Digital December Issue
December 2007 - Volume 15 - Issue 12

Ask the Clinical Instructor: A Q&A column for those new to the cath lab

Vascular disease involves atherosclerotic and non-atherosclerotic stenosis of the arterial and venous system. The majority of percutaneous interventional and surgical procedures are performed in the arterial vasculature.

Digital November Issue
November 2007 - Volume 15 - Issue 11

Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach

Vascular disease involves atherosclerotic and non-atherosclerotic stenosis of the arterial and venous system. The majority of percutaneous interventional and surgical procedures are performed in the arterial vasculature.

Digital October Issue
October 2007 - Volume 15 - Issue 10

Fibromuscular Dysplasia in Children and Adolescents

Introduction. FMD is a non-atherosclerotic, non-inflammatory disease that predominately affects the renal and carotid arteries, although it has been described in all vascular beds.1 Approximately 60–75% of all FMD cases involve the renal rather then the carotid vessels; the renal predilection, however, may be greater in children. FMD more commonly affects women and younger individuals, though the sex distinction has not been proven in children. While its pathogenesis is not completely understood, hormonal, mechanical, and genetic factors, as well as mural ischemia, are thought to play a role.

Digital November Issue
September 2007 - Volume 15 - Issue 9

The Genous Bio-engineered R Stent
Cath Lab Digest talks with Robbert de Winter, MD, Director Cath Lab, Academic Medical Center, Amsterdam, Netherlands

The Genous Bio-engineered R stent (OrbusNeich, Wanchai, Hong Kong) is coated with antibodies that capture endothelial progenitor cells (EPCs) to speed up stent endothelialization. Compared to drug-eluting stents, the Genous stent thus far has been shown to accelerate vessel healing post stent placement and may reduce the risk of late stent thrombosis.

August 2007 - Volume 15 - Issue 8

Primary PCI and the Single INdividual Community Experience REgistry for Primary PCI (SINCERE) Database
Cath Lab Digest talks with Sameer Mehta, MD, FACC, MBA, Course Director – Lumen (Vascular Interventions Symposium) Miami, Florida

The SINCERE database was created to explore the feasibility of performing primary PCI for short door-to-balloon time ST elevation myocardial infarction (STEMI) interventions. SINCERE contains over 216 acute MI procedures performed by a single, highly experienced operator available 24/7 and working at 5 community hospitals.

July 2007 - Volume 15 - Issue 7

SPIRIT III: Comparison of the Xience V Everolimus-Eluting Coronary Stent System with the Taxus Paclitaxel-Eluting Coronary Stent System
Cath Lab Digest talks with Gregg W. Stone, MD, SPIRIT III Principal Investigator; Professor of Medicine, Columbia University Medical Center; Cardiovascular Research Foundation, New York City, New York

What is unique about the Xience™ V drug-eluting stent? There are several reasons Xience V (Abbott Vascular, Abbott Park, IL) is unique. A drug-eluting stent consists of three components: the drug itself, the polymer or other controlled-release mechanism (which controls the dose, consistency and release rate of the drug), and the stent platform. All three are important, and their successful integration is critical for an effective and safe drug-eluting stent.

June 2007 - Volume 15 - Issue 6

Embolic Protection — Its Role in Carotid, Coronary and Renal Intervention
Shazia T. Hussain, MD, MRCP, 1,2Diana A. Gorog, MD, PhD, MRCP Cardiology Department, East and North Hertfordshire NHS Trust, United Kingdom; Imperial College of Science, Technology & Medicine, London, United Kingdom

Abstract. The end-organ consequences of arteriosclerosis, namely heart attack, stroke and renal failure, are the leading cause of mortality and morbidity in the western world. Advances in percutaneous interventional techniques have meant that a fair proportion of this disease burden can be dealt with by percutaneous and nonsurgical options. Coronary angioplasty is an established way of dealing with simple and increasingly complex coronary disease.

May 2007 - Volume 15 - Issue 5

The COURAGE Trial: A Mid-Course Correction
Cath Lab Digest talks with William E. Boden, MD, FACC, Professor of Medicine and Public Health, Professor of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York

It’s fair to say that there was perhaps an initial overreaction when the study first came out, and at least a superficial unrest within the interventional community. Now that people have had an opportunity to read the study and digest the results, more people are embracing the trial results. Interventional cardiologists have indicated that perhaps the trial represents a much-needed mid-course correction and that it underscores the benefit of optimal medical therapy in reducing events.

April 2007 - Volume 15 - Issue 4

Laser Atherectomy in Peripheral Arterial Disease
Cath Lab Digest talks with Rajesh M. Dave, MD, FACC, FSCAI, Chairman, Endovascular Medicine, Pinnacle Health Heart and Vascular Institute Harrisburg Hospital, Harrisburg, Pennsylvania.

Can you discuss how laser atherectomy has evolved and overcome some of its initial challenges? Laser technology, as well as the catheter design, has evolved over a period of years to make the device safer and more effective. Early laser systems actually utilized a hot tip laser, which heated the tip of the catheter and also used a variety of wavelengths. Initial laser systems were not very successful. They caused damage to the arterial wall and were unable to penetrate especially difficult tissue. The early use of excimer laser was in late 1980s, when the catheter design was stiff and caused more perforation.

March 2007 - Volume 15 - Issue 3

Advancing the Field of Coronary Intervention: Magnetic Guidewire Navigation
Michael J. Lim, MD Assistant Professor of Medicine, Director, Cardiac Catheterization Lab and Interventional Fellowship Program, Saint Louis University, Saint Louis, Missouri

The advancement of new technologies in the arena of coronary revascularization continues to offer interventional cardiologists and cath lab personnel tools to treat their patients in exchange for the tremendous challenge of just trying to keep up with all of the equipment and techniques that may be utilized in a given lab.

February 2007 - Volume 15 - Issue 2

Is the Honeymoon Over? A Commentary on the Controversy Surrounding Drug-Eluting Stents and the DES Meta-Analysis
Kenneth A. Gorski, RN, RCIS, FSICP, Assistant Manager, Cleveland Clinic Cardiac Catheterization Laboratories; Chairman, Professional Standards Committee, The Society of Invasive Cardiovascular Professionals Cleveland, Ohio

How often have you heard that from a patient? This question has been posed to me numerous times over the course of the past twenty years. Sometimes the more you know, the harder it becomes to answer the question.

January 2007 - Volume 15 - Issue 1

Stent Thrombosis: A Wake-Up Call?
Cath Lab Digest talks with John McB. Hodgson, MD, FSCAI, Professor of Medicine; Chief, Academic Cardiology, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona about ways stent implantation can be optimized to avoid this complication.

Along with discontinued anti-platelet therapy, researchers are looking into the role of stent positioning and its association with stent thrombosis. What do we know so far?

December 2006 - Volume 14 - Issue 12

Structural Heart Disease Repair: A New Frontier for Interventionalists
Ramon Quesada, MD, Medical Director of Interventional Cardiology at Baptist Cardiac and Vascular Institute, Miami, Florida and ISET Course Director

These are exciting times for interventionalists interested in exploring new territory. Once solely a surgical domain, structural heart disease repair is the new frontier for endovascular therapy.

November 2006 - Volume 14 - Issue 11

Cath Lab Management: Cath Lab Expense/Cost Process Improvements
Dennis Holloway, MBA, CVT, Director of Diagnostic Cardiovascular Services, Bay Medical Hospital, Panama City, Florida

It is budget time, and the phrase of the day is “decrease expenses and increase revenue.” At the same time, DRG and APC reimbursement for cardiac services in some areas is being reduced. The Centers for Medicare and Medicaid Services (CMS) proposal is to “adopt both the HSRV cc weighting methodology and the consolidated severity-adjusted DRGs. More than 1000 hospitals in rural areas will see an average increase of 3.7 percent in FY 2007; urban hospitals will see an average increase of 3.4 percent in FY 2007. Cardiac specialty hospitals will see an average increase of only 1.2 percent in FY 2007 because of the refinements CMS is making to improve payment accuracy.”

October 2006 - Volume 14 - Issue 10

Carotid Artery Stenting: Case Selection, Training Requirements and Recommendations for a Successful Procedure
Rajesh M. Dave, MD, FACC, FSCAI, Chairman, Endovascular Medicine Pinnacle Health Heart and Vascular Institute Harrisburg Hospital, Harrisburg, Pennsylvania

On March 17, 2005, the Centers for Medicare and Medicaid Services (CMS) issued a decision memorandum supporting the use of carotid artery stenting (CAS) with embolic protection as a reasonable and necessary treatment for symptomatic patients having a carotid artery stenosis ≥ 70%, and symptomatic or asymptomatic patients enrolled in a clinical trial or a post market surveillance study who have a 50–70% stenosis or ≥ 80% stenosis, respectively.

September 2006 - Volume 14 - Issue 9

Lint and Particle Contamination During Diagnostic and Interventional Procedures in the Cardiac Catheterization Lab
Wava Truscott, PhD, Kimberly-Clark Health Care, Roswell, Georgia

Cardiac catheterization is an indispensable tool for the diagnosis and treatment of congenital and acquired cardiovascular disease.

August 2006 - Volume 14 - Issue 8

Seven Keys to Infection Control When Remodeling
Bill Petersen, Senior Project Manager, Design-Build division, HDR Inc., Omaha, Nebraska

Successful infection control requires attention and commitment to myriad details. Focusing on seven important areas helps develop the optimum environment.

July 2006 - Volume 14 - Issue 7

Treating CTOs: Technique and technology
Barry Rutherford, MD, St. Luke’s Hospital, Kansas City, Missouri

Can you describe the interventional program at St. Luke’s? We have a large subspecialty group practice with eight cardiac cath labs, three of which are dedicated to percutaneous intervention. We perform about 2000–2250 stenting procedures/year.

June 2006 - Volume 14 - Issue 6

Low Back Pain Among Radiologic Technologists
Joey C. Bergeron, BSRT(R)(CV)

Abstract: Low back pain is a leading cause of disability among working professionals, regardless of age or job function. This makes prevention and management of low back pain an important issue for managers. This paper offers a comprehensive look into the incidence, causes, and management techniques related to this condition. Specific information is also given about a survey conducted on a small group of radiologic technologists to help support current literature about the high incidence rate of low back pain among radiologic technologists.

May 2006 - Volume 14 - Issue 5

Down and Dirty: Basic Heart 101
Gerard Lagasse, RCIS, Borgess Medical Center, Kalamazoo, Michigan

Introduction: Why is there a need for this article? This article is a tutorial on the basic knowledge of heart function in order to help cath lab staff members become more comfortable in the cath lab. I have used this format for years to teach new staff at my facility about the heart. I have given it as a lesson while using a couple of colored pens and some blank paper, in the break room, between cases and when time permitted.

April 2006 - Volume 14 - Issue 4

Cardiac Alert System: The Golden Hour
Beth Hamstra, RN, RCIS, PhD, Clinical Manager, Invasive Cardiology Services, et al.

Scott Jones, a 50-year old construction worker, was just getting home when he noticed severe pain in his left chest and shortness of breath. His wife met him at the door and immediately called 911. Within minutes, Colorado Springs Fire Department paramedics were at the Jones’ home, assessing Scott and doing an ECG. Minutes later, the ECG had been faxed to Memorial Hospital, where an emergency department physician evaluated the ECG and, aided by the paramedic’s phone assessment of the patient, called a cardiac alert.

March 2006 - Volume 14 - Issue 3

The 2005 ACC/AHA/SCAI Percutaneous Coronary Intervention Guidelines: Summarizing changes and some of the major recommendations
Michael J. Lim, MD and Morton J. Kern, MD St. Louis, Missouri and Fountain Valley, California

In November 2005, the American College of Cardiology (ACC), American Heart Association (AHA) and Society of Cardiovascular Angiography and Interventions (SCAI) released the 2005 update to the guidelines for percutaneous coronary intervention. This guideline statement offers the first update involving all types of percutaneous coronary interventions (PCI) since 2001. Interventional cardiology continues to be a rapidly changing field. A substantial body of newly published literature, as well as changes in practice patterns, has occurred since the release of the previous PCI guidelines. Given this background, many of the writing groups’ recommendations have changed. This brief review will summarize the key changes in the latest update to the PCI guidelines. The full text of the guideline document is available for download in PDF format on the American College of Cardiology website (www.acc.org) or the Society for Cardiovascular Angiography and Interventions website (www.scai.org).

February 2006 - Volume 14 - Issue 2

Cath Lab Ergonomics
Al Moglia, CVT Oregon Heart and Vascular Institute, Eugene, Oregon

I graduated in June 2005 from Spokane Community College (Spokane, Washington) as an Invasive Cardiovascular Technician. Prior to my career change, I was formally involved with workplace ergonomics for 12 of my 32 years with Hewlett Packard (HP) and Agilent Technologies. I was certified by HP and Agilent Technologies to practice ergonomics. At the peak of our program, I was the manufacturing ergonomic focal point who reported to our corporate offices regarding our progress in meeting injury and ergonomic metrics. I also had the pleasure of being involved in some of the initial Washington State Ergonomic Toolbox Meetings, held in Spokane, Washington.

January 2006 - Volume 14 - Issue 1

Emerging Concepts in the Response to Antiplatelet Therapy
Matthew J. Price, MD Co-Director, Cardiac Catheterization Laboratory Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California

Platelet activation and aggregation is essential for the formation of thrombus, which normally represents a beneficial, hemostatic process after vascular injury (for example, after the removal of a femoral artery sheath using manual compression.)

January 2005 - Volume 13 - Issue 1

Cardiac & Vascular Trends 2005-2010
Richard N. Beveridge, MBA

Over the past decade, many trends have impacted cardiac and vascular services. Two of the most notable trends occurring in the cardiovascular (CV) arena are the projected increase in population in age categories which utilize cardiac and vascular services predominantly, and the impact that technology advances, particularly the drug-eluting stent, have had on procedure utilization

February 2005 - Volume 13 - Issue 2

The Role of the Nurse Practitioner in the Cardiac Cath Lab
Margaret Stuppy, BSN, RN, CCRN, RCIS

Anyone who has had the opportunity to work for several years in the health care field, particularly the cardiac cath lab, has seen many changes take place. Many changes were effective and welcomed. Some “improvements” had a lengthy adjustment period. As technology advances and changes occur in our present-day health care delivery, we must make ongoing adjustments to keep up with those changes. Even with new adaptations, there is still the same common denominator that we dealt with years ago — namely, the patient. Is our current system effective in delivering optimum patient care? Are our patients’ expectations being met? Are all of their questions being answered? Could care delivery be improved with the integration of a nurse practitioner into the system?

March 2005 - Volume 13 - Issue 3

Erogonomics Revisited: Carpal Tunnel Syndrome
Marsha Holton , RN, BS, CCRN, RCIS, FSICP

This is the first article of short series, which sets the groundwork for investigation into the potential injuries, specifically carpal tunnel syndrome, we as invasive specialists in the field might develop as we care for our patients. The second article will deal with the scientific data that the National Institute for Occupational Safety and Health (NIOSH) scientists and our cath lab personnel at Washington Adventist Hospital will be collecting. That data, and any intervention and protection from injury practices will be developed, collated, and published in the future.

April 2005 - Volume 13 - Issue 4

TAXUS V Clinical Trial Generates Excellent Safety and Efficacy Data in Most Challenging Lesions and High-Risk Patients
Stephen Ellis, MD

This monthly column in Cath Lab Digest reviews important points of distinction in DES, from characteristics to techniques, so that physicians and professionals have valuable and relevant information about this revolutionary technology.

May 2005 - Volume 13 - Issue 5

Useful Technique For Continuous Pulse Monitoring During Sheath Removal
Philip Cenci, RN

I work in a cardiac catheterization lab that does 13–22 cardiac diagnostic, percutaneous coronary intervention (PCI), and various peripheral cases per day. The majority of these patients require a manual hold after removal of the femoral or brachial artery sheath. This is performed by an RN in the post procedure recovery room. By policy, the holding time is a minimum of twenty minutes.

June 2005 - Volume 13 - Issue 6

Drug-Eluting Stent Solutions: Treating Diabetics With Coronary Artery Disease
James P. Zider, MD

This monthly column in Cath Lab Digest reviews important points of distinction in DES, from characteristics to techniques, so that physicians have valuable and relevant information about this revolutionary technology. This article, the first in a two-part series on diabetes, will discuss why diabetics are more predisposed to coronary artery disease (CAD) and will evaluate CAD treatment options for these patients. Part two will evaluate the data on drug-eluting stents (DES) in this patient population.

July 2005 - Volume 13 - Issue 7

Targeted Radioimaging Probes
Hu Liu, PhD

Cardiovascular disease (CVD) constitutes the greatest single serial killer in many parts of the world. According to the American Heart Association1, about 40% of deaths in the United States are due to CVD. The treatment of CVD is the most expensive item of disease categories, representing about $350 billion spent on fighting with CVD in the U.S. alone.

August 2005 - Volume 13 - Issue 8

The Role of Outcomes Research in Reducing Bleeding After Percutaneous Coronary Intervention
Patricia Busch, RN BSN, et al.

Complicating events, particularly bleeding events that occur post-procedurally in patients undergoing percutaneous coronary intervention (PCI) tend to be underestimated and under-recognized. A system that serves to track these complications can increase awareness and hence treatment and prevention. We performed this study to assess true rates of post-PCI complications at our institution, as well as the impact of using bivalirudin (Angiomax®, The Medicines Company, Parsippany, NJ) instead of heparin for anticoagulation during PCI.

September 2005 - Volume 13 - Issue 9

Bay Medical Cath Lab
Shirley Goodman, RN, BSN

What is the size of your cath lab facility and number of staff members? Bay Medical presently has four procedure rooms and a thirteen-bed preparation and recovery area. Our fifth procedure room is scheduled to open late this summer. Bay Medical has thirty-two staff members, including the director, supervisor, coordinator, support specialist, ACC data analyst, secretary, thirteen procedure RNs, eight radiology technologists and six staff in the preparation and recovery area. Nearly half of the staff members have an average of seven years' experience in the catheterization laboratory, with the rest of the staff average at two years. We are currently adding two RNs and two radiology technologists for our fifth lab.

October 2005 - Volume 13 - Issue 10

Bay Medical Cath Lab
Shirley Goodman, RN, BSN

Bay Medical presently has four procedure rooms and a thirteen-bed preparation and recovery area. Our fifth procedure room is scheduled to open late this summer. Bay Medical has thirty-two staff members, including the director, supervisor, coordinator, support specialist, ACC data analyst, secretary, thirteen procedure RNs, eight radiology technologists and six staff in the preparation and recovery area. Nearly half of the staff members have an average of seven years' experience in the catheterization laboratory, with the rest of the staff average at two years. We are currently adding two RNs and two radiology technologists for our fifth lab.

November 2005 - Volume 13 - Issue 11

Advances in Simulation Training for Cath Lab Staff
Emily Conner, RN, SimSuite Clinical Education Specialist

“Am I going to get a headache with this, doc?” asks Mr. Pepper in a gruff voice. Your patient is 64-year-old Mr. Pepper who is a former smoker with a history of coronary artery disease and laryngeal cancer treated with radiation. You’re not the doctor, and he’s not a real patient, but you will be treating your training case as if you were in a real invasive procedure environment. After receiving report and history on Mr. Pepper, you’re off to the simulated cath lab to evaluate your patient for carotid artery disease and the need for carotid artery stent implantation.

December 2005 - Volume 13 - Issue 12

Cath Lab Revenue Recovery & Reimbursement — The Tip of the Iceberg
Cheryl Morgan, RN, BSN, RCIS Reimbursement Coordinator, Cardiology Services; Robert Lynch, Director, Cardiovascular Services Morton Plant Hospital, Clearwater, Florida

Morton Plant Hospital first published an article on our reimbursement processes in the December 2001 issue of Cath Lab Digest (Is Your Cath Lab Seeing Red? Implementing a Revenue Capture Process Into Your CV Program). That was a long time and a lot of dollars ago! Morton Plant Hospital cath lab’s Revenue Recovery program has changed greatly since those days and we are pleased to bring fellow professionals an update on our efforts.