Smaller, sleeker technologies in conjunction with increasingly sophisticated medical procedures have changed the face of cardiac catheterization labs.

Changing Spaces
In the above floor plans, which represent a health care provider both in the mid-1990™s and today, we can compare and contrast the way in which cardiac cath labs have changed over the past 10 years. While lab configuration has not changed radically, subtle differences in design can allow a lab to operate more efficiently.

Central to the design of modern cath labs is the shrinking of electronic equipment across nearly every medical discipline. For much the same reason that computers the size of filing cabinets have shrunk to miniature handhelds many times more powerful, cath equipment has diminished in size and increased in power. Older cath technology, for example, utilizes an image intensifier using silicone tubes. Today™s leading-edge technology utilizes an imaging charge coupled device. It provides a new type of light sensor that transforms the image into digital images. New flat screens deliver increased clarity and precision imaging by avoiding the rounded, rolled picture of older monitors. The new technology is also improved in its geometry of detection.

In the past, as the health care provider™s earlier lab floor plan depicts (Figure 1), cath labs contained a separate electronics room, routinely measuring about 8 x 10 feet, that housed these large instruments. While this segregation was done in response to manufacturer™s recommendations, it also was done out of practicality: the machines often emitted a distracting, droning hum.

In current design (Figure 2), the electro-mechanical hum is all but eliminated, and in the current illustration, equipment may be contained in two full height closets measuring only 3 feet deep and 8 feet long. Having control room equipment within an arm™s length in the lab contributes to the staff™s operational efficiency.

While equipment has gradually become smaller over the past decade, the actual dimensions of cath labs have grown significantly bigger. This is the result of an increase in the variety of procedures that are offered today within the context of a cath lab. For instance, it is common for a patient to undergo more invasive procedures, such as angioplasty immediately following a catheterization.

The first diagram illustrates a spatial width of 19 feet, extremely tight given that an anesthesiologist with a cart connected to gases may tend to a patient.

Today, that space can be as great as 28 feet wide, an increase not only to accommodate a sizable anesthesiology cart, but to allow a growing number of staff to administer to the patient from all sides.

Other space-saving technology like digital imaging devices has changed the way images are stored. Images are captured directly to a computer and are archived on space-saving laser disks. Thus film processing areas and bulky film readers have been eliminated. Reading room dimensions are therefore streamlined, though not eliminated, because physicians continue to prefer to have a space set aside for this purpose. In addition, cath technology is primarily operated by computer, eliminating extensive storage closets, and thus allowing the control room to be situated within the lab, which greatly increases staff efficiency.

Something™s Gotta Give
Today, cath lab design requires a renewed sense of flexibility. Typically not as sterile as surgical operating rooms, these spaces may now have room and be adaptable for full surgical procedures. The best cath lab infrastructure should incorporate mechanical, air changing systems and lighting that is sufficiently flexible to perform minimally invasive procedures and those that require sterile conditions. To accommodate surgery, surfaces must be highly durable and easily cleaned.

Further, recent health code mandates scrub areas be placed outside the lab. Utilization of an entry vestibule (containing the scrub area), shown in the present-day diagram (Figure 2), has corresponding operational advantages. For example, the area is also a convenient place to house a warming cabinet for patient blankets and/or a place to conveniently place a flash sterilizer.

The cath lab is fast becoming a crossroads of diagnostic procedures and treatments for both cardiovascular disease and stroke. As it is designed for new procedures, the cath lab is integrating disciplines in the health care organization. Different modalities are now placed alongside cath equipment. This merging of disparate services impacts how a cath lab is perceived by medical staff. In the past the cath lab was a very self-sufficient, somewhat isolated area and procedure from other hospital disciplines and departments (except maybe the OR). Now, with the introduction of more anesthesia needs, possibly surgery opportunities, and of other imaging modalities, it is being viewed as a more open and integrated component of care. The current trend is a blurring of the typical lines between surgery, radiology (special procedures) and invasive cardiology.

From a planning perspective, adjacencies are more crucial than ever, resulting in support services which can be shared between departments. For existing cath labs undergoing renovation, a hospital™s master plan should be reviewed to see which departments might be relocated for improved adjacency with the lab.

Planning a cath lab that effectively supports medical advancements requires both increased space and flexibility. Updating cath lab design must take into account a smaller technological footprint but great strides in scientific technique.

Coleman DeMoss can be reached at Coleman.DeMoss@perkinswill.com.

Coleman DeMoss discloses an employment affiliation with Perkins & Will.