Cath Lab Digest

What is the size of your cath lab facility and number of staff members?

Baylor Hamilton Heart and Vascular Hospital is comprised of five cardiac suites, one cardiac/peripheral suite, and one endovascular suite. We are in the process of renovating one of the cath lab suites, which will function as a combo cardiac/peripheral suite.

Baylor Hamilton Heart and Vascular Hospital’s cath lab has a combination of registered nurses (RNs), registered cardiac invasive specialists (RCISs), and radiologic technologists (RTs).

We have a total of 38 staff: 21 RNs (12 full-time, 2 part-time and 1 PRN), 7 RCISs (5 full-time, 1 part-time and 1 PRN), and 10 RTs (8 full-time, 1 PRN and 1 team leader).

Our team members have an array of length of experience, ranging from one to thirty years. Our electrophysiology (EP) department has a dedicated staff that operates independently from the cath lab.

Our hospital consists of cardiologists and vascular surgeons. Each physician group has their own patient mix. They do consult with one another if assistance is needed from the other specialty.

Baylor Hamilton Heart and Vascular Hospital is a teaching hospital with cardiac and vascular fellows participating in procedures. The cardiology fellowship duration is three years with two fellows accepted into the program each year. We do have a cardiology interventional fellowship, which consists of one fellow for an additional year. Our vascular surgical fellowship is two years, with two fellows accepted per year.

What type of procedures are performed at your facility?

Cardiac: Right and left diagnostic cardiac procedures, percutaneous coronary intervention (PCI) procedures (balloon/stent), rotational atherectomy, intravascular ultrasound (IVUS), endomyocardial biopsies, atrial septal defect (ASD) and patent foramen ovale (PFO) closures, septal ablations, valvuloplasty and intracardiac echocardiography (ICE).

Peripheral: Diagnostic procedures, percutaneous transluminal angioplasty (PTA), stenting (including carotid stenting), atherectomy, endograft repair — both abdominal and thoracic, and inferior vena cava (IVC) filters, both bedside and in the department.

During the 2008 fiscal year, we performed 5,749 cases, broken down as follows:

• Cardiac diagnostic cases: 2,421
• Cardiac interventional cases: 1,450
• Diagnostic peripheral cases: 351
• Peripheral interventional cases: 610
• Peripheral diagnostic w/ cardiac procedures: 917

Does your cath lab perform primary angioplasty with surgical back up on site?

Yes, we are connected to the main Baylor University Medical Center at Dallas campus. A room and team are available 24 hours a day, 7 days a week.

What procedures do you perform on an outpatient basis?

The majority of our scheduled procedures are on an outpatient basis. Endograft repair and carotid stenting remain on an in-patient basis.

What percentage of your patients is female?

Forty-two percent of our patients are female.

What percentage of your diagnostic cath patients go on to have an interventional procedure?

The total number of diagnostic coronary angiography cases having interventions in same visit to the lab was 39.1%.

Who manages your cath lab?

Andres Sisneros, RT(R), manages our lab. He has been the cath lab and imaging manager/team leader since October 2005. Prior to becoming our team leader, Andres was part of our staff, starting his career at Baylor in 2000. Andres has been in the cardiology field since 1993. He reports to Nancy Vish BSN, MSN, PhD, President and Chief Nursing Officer of Baylor Jack and Jane Hamilton Heart and Vascular Hospital.

Do you have cross-training? Who scrubs, who circulates and who monitors?

We operate with a three-person team per room. The RN circulates while the other two team members scrub and monitor. All RCISs and RTs will scrub and monitor.

The RNs do have an opportunity to learn all three roles in the lab.

Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab?

Not necessarily in the room, but we have 9 full-time RTs in the cath lab. Texas does require an MD or an RT to administer ionizing radiation. The majority of our MDs prefer to operate the fluoro and panning of their images. We do have a couple of physicians that prefer the staff to pan.

All of our personnel can operate the table (panning) and monitoring equipment.

What are some of the new equipment, devices and products introduced at your lab lately?

We upgraded both of our Volcano IVUS units (Rancho Cordova, CA) with Virtual Histology and fractional flow reserve. Our FoxHollow atherectomy devices (Redwood City, CA) now have new and improved sizes for distal vessels. We have the Diamondback, which is another type of atherectomy device used for distal vessels (Cardiovascular Systems, Inc., St. Paul, MN). We also began performing the TandemHeart (CardiacAssist, Inc., Pittsburgh, PA) procedure in 2008. This is a percutaneous ventricular assist device, which is an adjunct for patients needing heart transplants. Impella Proforma is a new product from Abiomed (Danvers, MA), which is a percutaneous cardiac assist device.

Can you describe the system(s) you utilize and how they work in cath lab daily life?