Cath Lab Digest

Tell us about your cath labs.

Medical Center of the Rockies (MCR) of Loveland, Colorado, a Level II trauma center, and Poudre Valley Hospital (PVH) of Fort Collins, a Level III trauma center, comprise two hospitals in the Poudre Valley Health System. Both hospitals are magnet facilities and have received numerous additional commendations and awards for management and outstanding level of care, such as the 2008 Malcolm Baldrige National Quality Award and Thomson Reuters 15 Top Health Systems in 2012. Our cardiac cath labs service northern Colorado, western Nebraska, and southern Wyoming, a service area of about 50,000 square miles.

The two hospitals have a total of 417 beds with four cardiac/peripheral cath labs and one biplane electrophysiology room. We also have another room available for future expansion. Our cath lab primarily staffs MCR, but we provide 50 regular hours of staffing for PVH during the week. The call team covers both hospitals. The cath lab is made up of 26 registered nurses (RNs), 3 registered cardiovascular invasive specialists (RCISs), 5 dedicated electrophysiology (EP) staff and 24 non-invasive/pre/post RNs. Currently, 80% of our department has certification in our field. Everyone in the cath lab has certification with the exception of our newest members. Our department has very low staff turnover. We have staff members who have worked here as long as 29 years and as little as 18 months.

What procedures does your lab perform?

Our lab performs left and right heart caths, peripheral angiograms, and carotid angiograms, and we utilize both fractional flow reserve (FFR) and intravascular ultrasound (IVUS) in our diagnostics. We perform percutaneous coronary interventions (PCIs), rotablations, atrial septal defect (ASD) and patent foramen ovale (PFO) closures, chronic total occlusions (CTOs), valvuloplasty, trancatheter aortic valve replacement (TAVR), intra-aortic balloon pumps (IABPs), pericardiocentesis, temporary pacing, and high-risk PCI involving Impella (Abiomed) left ventricular device support.

Our EP lab performs rhythm studies and ablations, including supraventricular tachycardia (SVT) ablations, ventricular tachycardia (v-tach) ablations, atrial fibrillation (a-fib) ablations and high-risk EP procedures involving Impella support. They also implant pacemakers, implantable cardiac defibrillators (ICDs), and bi-ventricular devices. 

Our Pre/Post nurses assist our cardiologists in performing treadmill testing, Lexiscans, transesophageal echocardiograms, dobutamine stress echocardiogram/dobutamine stress nuclear tests, tilt table testing, cardioversions and infusions.

Our procedural volume is:

• Coronary procedures: 28/week
• Peripheral procedures: 4/week
• Electrical procedures: 12/week
• Carotid procedures: <1/week
• PFO/ASD procedures: <1/week

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

Yes. We have labs in two different hospitals. Patients at PVH who need emergency cardiac surgery are transported with IABP support via ambulance to MCR, a 20- to 30-minute ride, due to the fact that PVH does not have an open-heart operating room.

Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery?

In the last year, we had one complication that has required emergency cardiac surgery. Our facility has remained under the American College of Cardiology (ACC) average of 0.3% in cath lab-related complications requiring emergency cardiac surgery.

What percentage of your patients is female?

Forty-one percent (41%), including cardiovascular procedures, as documented in our charting system.

How many diagnostic cath patients go on to have an interventional procedure and how many diagnostic caths are normal?

Diagnostic-to-interventional procedures are 41%, and normal diagnostic caths are 53%.

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

Yes, three out of seven of our interventional cardiologists primarily use radial access. We have several others who use both femoral and radial access, based on what is best for the patient at that time.

Who manages your cath lab?

Carol Mackes, BSN, NE-BC.

Do you have cross training? 

Our cath lab consists of primarily RNs and RCIS-certified techs. RNs are responsible for performing in the scrub, circulator and monitor roles, while our techs are responsible for the scrub and monitor roles. The cath lab staff is able to assist our Pre/Post unit and EP Lab as needed when staffing issues arise.

Who documents medication administration during the case?

The staff member in the monitoring role documents all of the medications administered during the case. If it happens to be a “Code Blue” situation, the monitor person documents all medications that would normally be given during a cath, and the Code Blue recorder documents all of the medication that is normally given during a code.

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