Cath Lab Digest

Tell us about your cath lab.

Crouse Hospital is a 563-bed not-for-profit hospital located in Syracuse, New York.  Within the Cardiac Care Center, there are three cath labs and a nine-bed admission/recovery area. Crouse is an Accredited Chest Pain Center and Heart Failure Center by the Society of Chest Pain Centers and is the site of the region’s only pediatric cath lab. We have twelve registered nurses (RNs), one licensed practical nurse (LPN) and one interventional radiologic technologist. Several nurses working in the cath lab are currently working on either a bachelor’s or master’s degree in nursing. Together, our staff has an average of 15+ years experience in cardiovascular nursing.

What procedures are performed in your cath lab? 

We perform diagnostic and interventional cardiac catheterizations, patent foramen ovale (PFO) closures, temporary and permanent pacemaker insertions, implantable cardioverter-defibrillator (ICD) insertions, pediatric catheterizations and ablations, emergency balloon septostomies on newborns, and diagnostic and interventional peripheral vascular studies. We also have the capability for intra-aortic balloon pumps, pericardiocentesis and thrombectomies. We perform approximately 35 scheduled procedures a week, and provide 24/7 emergency call for adult and pediatric emergencies.

Does your cath lab perform primary angioplasty without surgical backup on site?

Yes. We have an agreement with SUNY University Hospital, which is adjacent to Crouse Hospital. In the event of an emergency surgical intervention, patients are transported via a connecting tunnel directly to the University Hospital OR. 

What percentage of your patients is female?

Forty-five percent of the patients we see are female. 

What percentage of your diagnostic caths is normal?

On average, 74.16% of our patients need an intervention at the time of their catheterization. Only 25.82% are normal.

Do any of your physicians regularly gain access via the radial artery?

Yes, almost exclusively. We have been using the radial approach since 1997. We only utilize a femoral artery or a brachial cut-down approach when absolutely clinically necessary. The radial artery is even the site used with emergency ST-elevation myocardial infarction (STEMI) patients. Femoral arteries are reserved for right heart caths and for patients who absolutely cannot be accessed through the radial artery. 

Who manages your cath lab? 

Lorissa Plis DNP, RN, CNS, CCNS, CCPC, is the Cardiac Care Center manager and Chest Pain Center coordinator, Robert Pikarsky is the administrative director and Joseph Battaglia, MD, FACC, FSCAI, is the medical director.

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

All RNs in the department rotate scrub, circulator and monitor roles. The LPN and the RT cannot push intravenous medications, so they only scrub and monitor cases. The RT is responsible for the radiology equipment and radiation safety.

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

No, but we have a RT on staff in the cath lab. She is present and available for all cases, but is not assigned to each case. The physicians initiate and operate fluoro in all the cases. 

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?

Only trained physicians and the interventional radiological technologist can operate the x-ray equipment. The physicians in our lab typically operate the fluoro pedal and pan the table during cases; however, the RT can assist with positioning the II, panning the table, and changing the angles or operating the fluoro pedal as needed. Nurses have no involvement in any of these duties.

How does your cath lab handle radiation protection for the physicians and staff?

Radiation safety is very important to us. Our RT and the inventory and equipment support specialist sit on the Radiation Safety Committee. We monitor and disclose radiation levels monthly to staff and are always looking for strategies to reduce radiation exposure. 

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

Because safety is our priority, we have instituted the use of the RadPad for our fluoro cases (Worldwide Innovations & Technologies, Inc.). The RadPad is a disposable, lead-free pad that reduces scatter radiation exposure to medical personnel during fluoroscopy procedures by 95%. We are also implementing the LUMEDX Cardiovascular Information System for real-time scheduling, and cardiac catheterization and echocardiography physician documentation. We have a dedicated cardiovascular information system (CVIS)/picture archiving and communications system (PACS) manager, Justin Pratt, AEMT-P.

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