Discussion group members responded to the questions below, and emails are included for any questions readers may have regarding a particular lab™s policies.
If you™d like to join our group, please send an email to: cathlabdigest@hotmail.com

Current question: Utilizing Manual Compression
Does your hospital use manual compression as a closure technique in their cath lab, and if so, would you be willing to share your protocol?      
Rebecca J Garry, MSN, RN
rjgarry@hotmail.com

Upcoming questions
The following two questions are still under discussion and results will be featured in an upcoming issue of Cath Lab Digest. If you would like to participate, send your answer to the questioner and copy cathlabDigest@hotmail.com. You are welcome to be published as anonymous; simply specify your wish to do so in the email itself.

Upcoming...replies welcomed
Please cc: cathlabdigest@hotmail.com

I. Protocols for Fem Sheath Removal
We are currently revising our protocols for femoral sheath removal: 4F, 5F, 6F, with GP2b3a inhibitors and without.

I am looking for what you are doing as far as length of time of hold, time to ambulation, and time to discharge.

If you use SyvekPatch, what is the length of time of hold, time to ambulation, and time to discharge? I would appreciate any input, or actual protocols. Thank you!
Mary,
mmaliszewski@notes.cc.sunysb.edu

II. DES: Broadening Patient Selection
Anyone have evidence-based reports to support the need to broaden the patient selection criteria for DES? The IFU says de novo lesions, single vessel and no acute MIs. We are currently adhering to the IFU until we can come up with defined evidence that it is OK to broaden our selection criteria.
Patti Coblentz
PatriciaACoblentz@ProvenaHealth.com

Do you have a question you™d like to ask the Email Discussion Group? Send it to: cathlabdigest@hotmail.com

Group Members Respond to: Utilizing Manual Compression
At both hospitals that I work at, manual compression is utilized. Sheaths are pulled at one hospital with an ACT of <170 and the <150. One hospital uses the Clo-Sur pad, (Medtronic) and the other does not use a closing device. All employees who pull have to be checked off; they must attend an education class that covers anatomy and physiology and have a minimum of 5 pulls.
Kevin BS,RN,RCIS,
ldrich3@comcast.net

Currently we provide Angio-Seal and the SyvekPatch. The only time we hold manual pressure is for venous sheaths. The advantage with closure devices is an increased turnaround time.
Thomas Gaylets,
t9261@epix.net

Manual compression is still our most-used device.
Carletta Williams,
carletta@weirtonmedical.com

We often use 4F catheters for diagnostic work, and, as such, use manual compression for hemostasis, with or without a patch. If time is short, we will use a CompressAR device in PACU. Otherwise, it is HHP for us. We have no written policy regarding delineations re: different closure procedures. It is physicians™ choice when
choosing closure devices, but OUR choice regarding manual options.
Alex Holmes,
Alex.Holmes@tenethealth.com

Only if the D-Stat patch or Angio-Seal does not work. But not as a 1st line.
Patti Coblentz
PatriciaACoblentz@ProvenaHealth.com

We do manual pressure on almost all of our dx cases and also about 75% of interventional cases.
Annie Ruppert,
Annie.Ruppert@sharp.com

Below is the policy we implemented in our post cath recovery area. We do not pull the sheaths in the lab because we do not have a holding area. If the sheath is a 4Fr the patient may ambulate after 3 hours. We do use Angio-Seal, but only on a small percentage of our patients.
Courtesy of Tracijo Capua, CCL Coordinator, Flagler Hospital,
St. Augustine, Florida, Tracy.Capua@flaglerhospital.org

We do about 1/2 closure devices and 1/2 manual compression. Above is our policy for manual compression.
Courtesy of Larry Sneed, BS,RCP, Manager, Cath Lab
Alamance Regional Medical Center
sneelarr@armc.com

The policy below is courtesy of Carletta Williams
carletta@weirtonmedical.com

More upcoming questions for the Cath Lab Digest Email Discussion Group (and readers!)

Would you be able to help your fellow professionals with the following questions?

Monitoring of vital signs
I am looking for any information or standards with regard to monitoring of vital signs with femoral sheath removal. Currently we do q5" signs till hemostasis is achieved, i.e., blood pressure and pulse ox with wave form should we also be monitoring the ECG?
Ellen Ciccarillo-Clarke
Email: Eciccar@harthosp.org
cc: cathlabdigest@hotmail.com

Ok to hire surgical/scrub techs?
I am opening a new cath lab in Wisconsin and am wondering if there are any legal guidelines we need to follow in hiring Surgical/Scrub techs (STs) in the cath lab. Where I came from, we had a couple STs that were not certified because they had been in the field before the ST programs were around. I wanted all RTRs and RNs, but we are having trouble finding those people. Can we hire staff that does not have the ST certification (EMTs, GI Techs, LPNs etc) to fill a surgical tech role if our job description is clear on what they can and can not do? And what roles should these people be limited to in your opinion, can they cover the CV role if they get on the job training? Please let me know your thoughts. Thank you!
Shelly Gluege, RTR
Supervisor of Cardiac Cath/Interventional Vascular Labs
Diagnostic and Treatment Center, Schofield, WI
Email: gluegema@dxandtx.com
cc: cathlabdigest@hotmail.com

Share your door-to-balloon timing?
We are looking at our door-to-balloon time, so I thought I would try to see what other labs are doing.
1. What is your door to balloon time?
2. Do you track all AMI's?
3. Do you still have an in-house RN for sheath pulling and acutes?
4. How many are on the call team?
5. What is their expected response time?
Thank you!
Julie Baran, RN, BSN, Clinical Manager
Adult and Pediatric Invasive Cardiology
Memorial Hermann Hospital
Email: julie_baran@mhhs.org
Cc: cathlabdigest@hotmail.com

Cath Laughs
Below is an anecdote for cath lab issues when team efforts result in misgivings. An old-timer gave this to me 20 years ago. Since then I have witnessed how someone else has always accomplished tasks and very seldom complained. Yet after 30 years, someone else still travels the hallways in cath labs today.

Obituary Notice
We are saddened to learn this week of the passing of one of the cath lab's most valuable employees someone else. Someone's passing has created a vacancy that will be difficult to fill. Else has been with us for many years, and did more than a normal person's work. Whenever leadership was needed, this wonderful person was looked to for inspiration as well as results. If there was a job to do, a position to be filled, or a meeting to attend, one name was always on everyone's lips: Let someone else do it! Whenever you have a chance to participate in one of the top twenty cardiac cath labs in the United States, remember we can™t depend on someone else anymore. He is survived by all members of our cardiac cath lab team. We should be active and keep someone else™s memory alive.
Chuck Williams, BS, RPA, RT(R)(CV)(CI), RCIS, CPFT, CCT
Emory University Hospital, Atlanta, GA, RPAinGA@yahoo.com