Cath Lab Digest

Can you tell us about your cath lab?

Maury Regional Medical Center (MRMC) is a 250-bed facility serving an eight-county region in middle Tennessee. Maury Regional Medical Center Outpatient Cardiology includes two cardiac cath labs, both of which are capable of performing radiologic procedures and implantable rhythm management devices. The lab also includes a 5-bed holding area located within the department.

Staff consists of:

• Six full-time registered nurses (RNs)
• One cardiovascular radiologic technologists (CVRT)
• One registered cardiovascular technologist/registered cardiovascular invasive specialist (RCVT*/RCIS)
• One licensed practical nurse (LPN)/paramedic/ scrub tech

We have two employees who have been in the lab less than two years and the remaining staff has experience ranging from five to twenty-seven years.

We provide services for five cardiologists, including four interventional cardiologists, 1 electrophysiologist and 1 physician assistant. All physicians are board-certified in cardiovascular medicine and most are fellowship-trained in interventional cardiology. We have one pulmonologist specializing in pulmonary hypertension.

What procedures are done at your lab?

We perform cardiac and peripheral diagnostic and interventional procedures, implantation of cardiac rhythm management devices (CRMs), transesophageal echocardiograms (TEEs), and cardioversions.

On average, we perform 40 cardiac catheterizations per week and 15 interventional procedures. We perform around two peripheral procedures and approximately three pacemaker(PM)/implantable cardioverter defibrillator (ICD) insertions per week.

Do any of your physicians routinely utilize transradial access?

Yes. We started our radial program late 2009. Currently 80% of our cases are being performed via the radial approach.

What percentage of your patients is female?

The female patient population in the lab is approximately 45%.

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

Twenty-two percent (22%) are interventional and 52% are normal or treated medically.

Who manages your cath lab?

Valerie Yeiser, RN, BSN, CCRN is the manager of outpatient cardiology, which includes the cardiac cath lab, cardiac diagnostic testing and cardiopulmonary rehab. Kevin Maquiling, MD, is the medical director of the cardiac cath lab.

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

Yes. RNs cross-train to scrub, monitor and circulate, and RTs cross-train to scrub and monitor.

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

No, we do not always have RT present in lab for procedures.

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?

Staff members who have been trained to scrub can position the image intensifier (II)/ flat detectors, pan the table and change the angles under the cardiologists’ direction. The cardiologists operate the fluoro and cine pedals.

How does your cath lab handle radiation protection for the physicians and staff that are in the lab day after day?

All staff and physicians wear a film badge. These are monitored thru Landauer (Glenwood, Ill.). We have a radioisotopes committee meeting regularly to review overexposures. Lead aprons, glasses, and shields are checked on a routine basis.

How does your lab communicate information to staff and physicians to stay organized and on top of change?

Staff meetings are held within each department on a monthly basis. Any procedural changes, concerns, and/or case reviews are done at this time. The cath lab medical director meets quarterly with the staff to discuss upcoming changes, voice concerns and educate the staff on new technology or procedures as the need arises. The cath lab manager meets with the cardiovascular advisory group, which consists of the cardiovascular service line director, cardiologist, emergency department medical director, chest pain center coordinator, and quality assurance managers, every other month to facilitate opportunities for improvement between departments.

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

Intravascular ultrasound (IVUS) is available in our lab (iLab, Boston Scientific, Natick, Mass.). The Diamondback (CSI, Inc., St. Paul, Minn.) atherectomy system is used for peripheral cases. Fractional flow reserve (FFR) (PressureWire, St. Jude Medical, Minnetonka, Minn.), and the Xience V everolimus-eluting stent (Abbott Vascular, Redwood City, Calif.) are being successfully used in our lab. For our radial cases, we use the Terumo radial access kit, as well as the TR Band (Terumo Corp., Somerset, New Jersey) for the sheath pull. We currently use 90% Medtronic PM/ICD devices (Minneapolis, Minn.).

How is coding and coding education handled in your lab?