Cath Lab Digest

What type of procedures are performed at your facility?

A variety of procedures are performed on approximately 125 adult patients per week. Procedures include angioplasty, stenting, AngioJet® thrombectomy (Possis Medical, Inc., Minneapolis, MN) and Export Aspiration Catheter (Medtronic, Minneapolis, MN), iLab Intravascular Ultrasound (IVUS) (Boston Scientific, Maple Grove, MN), FilterWire (Boston Scientific, Natick, MA), PolarCath (CryoVascular Systems, Inc./Boston Scientific), SmartWire Pressure System (Volcano Therapeutics, Inc., Rancho Cordova, CA), directional coronary atherectomy (DCA), Rotablator (Boston Scientific), temporary pacemaker insertion (TPM), permanent pacemaker (PPM), intra-cardiac defibrillator (ICD), pericardiocentesis and intra-aortic balloon pump (IABP) insertion. Routinely, renal and iliac stenting, with occasional stenting of the superficial femoral artery (SFA) and subclavian arteries is performed. A carotid angiography and stenting program was recently launched in our lab.

Does your cath lab perform primary angioplasty with surgical backup?

Surgical backup is available at all times. The on-call cardiovascular (CV) physician and surgical team are readily available on nights and weekends.

What procedures do you perform on an outpatient basis?

All cath lab procedures, as needed, are performed on an outpatient basis; however, inpatients who require our services are also treated.

What percentage of your patients are female?

Women comprise 38% of our patient population.

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

Thirty-one percent of our diagnostic left heart caths will have an intervention.

Who manages your cath lab?

Patricia Bailey, RN, BSN, manages the cath lab. She has 15 years of experience in our lab. Our clinical coordinator is Sandy Tigue, RN, BSN. Dr. Warren L. Strickland, III, MD, FACC serves as medical diretor.

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

RNs scrub, monitor, and circulate. RTs scrub (pan the camera and table) and circulate. When using a three-person team consisting of two RNs and one RT, the two RNs trade between the scrub and monitor/circulate position; when we have one RN and two RTs, the RN monitors, one RT scrubs and the other RT pans.

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

Yes, the RNs are not trained to operate the fluoroscopy equipment, thus an RT must be present.

Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the fluoro pedal) in your cath lab?

The RT operates the equipment and pans the table. The physician, or at his designation, the scrub person, uses the fluoro/cine pedal from the scrub side of the table.

Does your lab have a clinical ladder?

All new employees start out as a Cardiac Cath Technologist I. With documented competencies and experience, they can advance to a Tech II. To become a Tech III, there are additional requirements, such as teaching a class.

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

We are using the Polar Cath (CryoVascular Systems/Boston Scientific) cryoplasty system. For carotid stenting procedures, we are using the Rapid Exchange Carotid Stent System and Embolic Protection System (Abbott Vascular Devices, Redwood City, CA).

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

Three of our cardiac labs are equipped with Medical Imaging Solutions (New Orleans, LA), provided through Southeast Imaging (North Little Rock, AR). Our other two labs are scheduled to be updated in 2006. Out of the five labs, the first lab was upgraded to the Axiom Artis dTC (Siemens Medical Solutions, Malvern, PA) large flat detector. The second lab is currently being installed with an Axiom Artis dTC dedicated cardiac flat detector. The remaining three labs are scheduled for upgrades to flat detector technology (also Axiom Artis dTC) at the rate of one per year for the next three years. We use the PICOM archival system by ScImage (ScImage, Inc. Los Altos, CA). Hemodynamic and event log recording are done with the Witt Calysto Series IV System (Melbourne, FL). Our scheduling is done under the OR framework in the Eclipsys 7000 Series System (Eclipsys Corp., Boca Raton, FL). To further modernize our department, we are considering the addition of the dual-source Siemens CT scanner.

How is coding and coding education handled in your lab?

Currently at Huntsville Hospital, our materials management staff enters procedural codes through the SIS by utilizing a patient charge sheet completed by clinical staff and the physician at the time of procedure. This information is communicated with the appropriate personnel in patient accounting and medical records to insure that coding and billing are accurate. However, we are currently awaiting a Witt Transcription Interface upgrade that will allow the physician to transcribe the procedure at the end of the case, and this will communicate with the proper departments to generate patient procedure charges.

How does your lab handle hemostasis?