Other Physicians in CCL
Do any of your cardiac cath labs have physicians OTHER than cardiologists and EP physicians performing procedures in the cardiac cath lab procedure rooms?
Judy Parham
jparham@armc.org

Standard of PP Outcomes?
Hello! I am Rich Jacobs, RN. I am the Cath Lab and Non-Invasive Cardiology Manager with Glenwood Regional Medical Center in West Monroe, LA. I have been in this position for only 8 months, and I am trying to establish a standard of documentation for post procedure outcomes. Is there a nationally accepted table of post procedure outcomes? We currently document the diagnostic cases as either WNL, Single Vessel Dz. with options of Med. Treatment or PCI, then the same for Multi-Vessel findings. We also have options for CABG referrals and Abnormal Hemodynamics.

The thing that concerns me is that there is no real parameters other than the obvious. So, if you can fill me in on where to look for a "standardized" table we can refer to and use as a PI tool, we would greatly appreciate it.
Richard S. Jacobs, rjacobs@grmc.com

At The Cleveland Clinic
In the past, we have had Vascular Medicine Specialists, Vascular Surgeons, and Neurologists with privileges in our laboratory. Currently we have 1 Neurologist, who is part of our acute stroke team, performing carotid and cerebral procedures.
Kenneth A. Gorski, RN, RCIS, FSICP
Assistant Manager, Sones Cardiac
Catheterization Laboratories, The Cleveland
Clinic Foundation, Cleveland, Ohio
gorskik@ccf.org

Group Members Respond to...
Other Physicians in the Cardiac Cath Lab

Nephrologists/radiologists
We also have nephrologists that do procedures on clotted grafts used for hemodialysis access in our cath lab. Occasionally a radiologists will come and do a procedure on a patient already in the cath lab getting a PCI, say who needs a carotid angio done before they can start the PCI.
Annie Ruppert RN
Annie.Ruppert@sharp.com

1 neurologist/1 surgeon
We have 1 neurologist and cardiovascular surgeon who do procedures in our lab.
Carletta Williams, carletta@weirtonmedical.com

Interventional radiology combined
I have a diagnostic cath lab combined with an interventional radiology suite. We do caths and angios, PTAs, stents, facet blocks, etc.
Steve Gressmire RT(R)(CV) ARRT, AAMA
Cardiology Services Director
Northwest Mississippi Regional Medical Center
Clarksdale, Mississippi
Steve.Gressmire@nwmrmc.hma-corp.com

Specials team, rarely
Only if the Specials Room were down or they have a really big patient, but then the whole Specials team, including the radiologist, comes up.
Patti Coblentz
PatriciaACoblentz@ProvenaHealth.com

Vascular surgeon training
We have 1 vascular surgeon who is training to do peripheral and carotids when they open up. We have 1 cardiologist who does peripheral now.
Bill Colditz, RCIS
Manager Cardiac Cath Lab
Mercy San Juan Medical Center
wcolditz@chw.edu

No other physicians
Definitely NOT.
Patti Stephenson
pstephen.sv-2a.svpo@stvincentshealth.com

Peripheral area
Yes, we have vascular surgeons performing peripheral procedures in our peripheral area.
Thomas Gaylets
t9261@epix.net

Radiologists
Right now, we have a combined cath lab/special procedures lab, so we have radiologists performing procedures in our lab.
Terry Ward
tjward@sbcglobal.net

Lab too busy
Interventional radiologists wanted to come into the cath lab but our schedule is too busy to allow them time.
Anna Smith
annasmith@chi-east.org

Surgeons and cardiologists perform peripherals
At Bon Secours St. Mary™s Hospital in Richmond,Virginia, there are cardiologists and electrophysiologists, as well as surgeons, who utilize our three cath/peripheral labs and one EP lab. The surgeons perform abdominal aortograms with run-offs and PTAs if warranted; carotid angiography, with one surgeon training in carotid stenting; fistulograms and PTAs if warranted. Our surgeons™ diagnostic procedures often preceed their scheduled surgical procedures (i.e., carotid endarthrectomy, fem-pops, etc.). The cardiologists are not limited in their abilities either. Presently our cardiologists are performing peripheral interventions (carotid stenting, subclavian stenting, messenteric, celiac, renal stenting, AAA stenting [presently performed in the OR], and any lower extremity interventions). Our cardiologists consult with the neurologists prior to carotid stenting. The neurologist themselves do not utilize our lab.
Chris Reoch RCIS
reochris2000@comcast.net

Cath team steps up
We use, of course, mostly cardiologists. Occasionally a radiologist will use our lab, mostly for more complex cases where the expertise of the support personnel (US!!!) can be useful. Once in a while, a surgeon will do an IVC filter. We are trying to get the vascular surgeons to do some of their own diagnostic and interventional procedures, as some of them have been to the appropriate courses.
Alex Holmes
alex.holmes@tenethealth.com

Surgeons and fellows involved
We have two vascular surgeons, who use our peripheral room in our cath lab. They are training vascular surgery fellows, who spend the first year of their two years performing angiography.

They are credentialed through the medical staffing office to perform carotid angiography, aortography, AO-femoral runoff studies, and visceral angiography. In addition, they perform venography and place vena cava filters. In addition, they are permitted to perform any peripheral intervention.

In the near future, we may be training cardiac surgery fellows how to perform selective coronary and coronary bypass graft angiography. The reason is so they look at fresh CABGs prior to removing a patient from the OR table. This has become very important since open heart patients are being done off systemic bypass. With the new hybrid myocardial revascularization, the surgeons need to verify the patency of the LIMA graft to the LAD prior to closure of the incision. Many of these patients are being discharged on the third post-op day.
Chuck Williams BS, RPA, RT, RCIS, CPFT CCT
Cardiac Cath Lab
Emory University Hospital, Atlanta, Georgia
codywms@msn.com

2nd Email Discussion Topic: Standard of PP Outcomes?
Hello! I am Rich Jacobs, RN. I am the Cath Lab and Non-Invasive Cardiology Manager with Glenwood Regional Medical Center in West Monroe, LA. I have been in this position for only 8 months, and I am trying to establish a standard of documentation for post procedure outcomes. Is there a nationally accepted table of post procedure outcomes? We currently document the diagnostic cases as either WNL, Single Vessel Dz. with options of Med. Treatment or PCI, then the same for Multi-Vessel findings. We also have options for CABG referrals and Abnormal Hemodynamics.

The thing that concerns me is that there is no real parameters other than the obvious. So, if you can fill me in on where to look for a standardized table we can refer to and use as a PI tool, we would greatly appreciate it.
Richard S. Jacobs, rjacobs@grmc.com

Two system suggestions
The systems (at least software-wise) that use a standardization of outcomes are: Vericis (Camtronics) and WITT Biomedical.
Tim Revell , trev_7777@hotmail.com

Documenting diagnostics
Here we document the diagnostic cases as follows:
Normal = no blockage
Insignificant = < than 70 % blockage
Significant = > than 70 % blockage >>>>PCI vs CABG
Larry Sneed, BS,RCP, Coordinator, Cath Lab
Alamance Regional Medical Center
sneelarr@armc.com

Get with Guidelines
I do have some info on the PI Tools used for the AHA Program on CAD. As you are probably aware, JCAHO is planning to roll out their CAD and Stroke Certification programs. This information may be obtained by visiting these sites:
http://www.americanheart.org/getwiththeguidelines
(or) http://www.outcome.com/gwtg. This is an outcome-based program for hospitals to enroll in.
Steve Gressmire RT(R)(CV) ARRT, AAMA,
Cardiology Services Director
Northwest Mississippi Regional Medical Center
Clarksdale, MS
Steve.Gressmire@nwmrmc.hma-corp.com

BONUS!
The Cath Lab Digest Sedation of Patients Undergoing Bi-Ventricular PPM and/or AICD Discussion continues...

1. Who is responsible for the sedation/analgesia of patients undergoing a bi-ventricular PPM &/or AICD?
2. Are labs using CRNAs, anesthesiologists or is the circulating nurse enough?
3. If using a circulating nurse, how many circulators do you have in the room?
4. Is this different from other procedures done in your lab?
Dianna Johnson, RN, Heart Institute Manager
St. Francis Medical Center, Cape Girardeau, MO

We do what we term conscious sedation for pacemaker, ICD and bi-ventricular implants. We rarely use anesthesiologists unless it would be an extreme circumstance, for example, an allergy to Fentanyl and Versed. When an anesthesiologist comes, the utilization of Diprivan is used. We rarely utilize reversal agents (Narcan or Romazicon). Our circulating nurse gives meds as needed. We do utilize people™s CPAP machines for people with sleep apnea during procedures. Our each implantation team consist of a cardiologist, 2 registered nurses and 1 radiation technologist, although our team is cross-trained for RNs to scrub as a compliment of 3 RNs. Our radiation technologists do not at this time administer meds or circulate. This ratio of RNs and RTs is standard for heart catheterizations as well as peripheral cases and carotids: a combination of 3 people and only 1 RT per room.
Peggy Thomas RN, Parkview Hospital, Fort Wayne Indiana
pthomas226@comcast.net

BONUS!
The Cath Lab Digest IABP Discussion continues...

I am trying to find information about the practice of removing IABP by registered nurses. Do you have any information about this practice within the cath lab or ICU areas?
Luz Kuilan, RN, MSN, CCRN

We had a case last year regarding IABP removal. As a nurse, I assisted my supervisor who was asked by the MD to remove the IABP balloon. But after that, I realized that we do not have a protocol on how to remove IABP balloon nor competency.
G. Reyes, RN
St. Rose Hospital, Hayward, CA

Cardiac cath lab RTs and RNs pull, after an extensive preceptorship.
Candace Cymerman, RN Manager, CCL

In our ICU, only the MD is allowed to DC the IABP. Some MDs will DC the line in the patients™ room; others will take the patient to the OR.
Anonymous

In my cath lab, we don™t remove any balloon pump catheter this falls upon the unit. Qualified personnel to remove balloon pump catheters are RNs, RT(R)s, cardiac surgeons, and the cardiologist.
Wanda Jones, MS
Henrico Doctors Hospital
Richmond, VA
wlj4uva@aol.com

I am from a cath lab with 4 labs. We only place balloon pumps approximately 2-3x in a month. Coronary care and the perfusionist remove these when patient has been stablized or gone to surgery.
Peggy Thomas RN
Parkview Hospital
Fort Wayne Indiana
pthomas226@comcast.net