Cath Lab Digest

Can you give us an overview of your cath lab?

The Metro Health Hospital Cardiovascular Laboratory consists of two cardiovascular labs and one interventional lab, with a 12-bed pre/post care area. The staffing matrix consists of thirteen registered nurses (RNs) and seven registered radiology technologists (RT[R]s) in both full and part-time roles. Staff longevity ranges from one to twenty-plus years, with almost 50% of staff serving five years or more.

What procedures are performed in your cath lab? 

We perform:

• Left and right heart catheterization
• Emergent coronary angioplasty
• Peripheral vascular angiography and interventions
• Devices including loop recorders, pacemakers, implantable cardioverter-defibrillator (ICD)s, and bi-ventricular ICDs
• Myocardial biopsy and pericardiocentesis

We average from twelve to fifteen procedures a day.

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

Yes, we perform primary coronary angioplasty without surgical backup. We were the first hospital in the state of Michigan to go live with this program seven years ago.

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

No. In fact, in the seven years that we have been doing primary percutaneous coronary intervention for ST-elevation myocardial infarctions (STEMIs), we have never needed emergent cardiac surgery due to complications from an intervention.

What percentage of your patients is female? 

Forty-three percent (43%) of our patients are female.

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

The approximate percentage of diagnostic catheterizations that evolve into an intervention is between 27 and 30%. The percentage of diagnostic catheterizations that are normal is between 10 and 15%.

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

We have 6 physicians (out of 10) that perform radial access on a consistent basis.

Who manages your cath lab?

Philip Pascucci, RN, our cardiovascular lab manager, has 8 years of cardiovascular experience and 12 years of emergency room experience.

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

The staff is cross-trained to the fullest extent by licensure. RNs perform in all roles in the cardiovascular lab and pre/post care area. The RT(R)s perform in all roles except the nursing role.

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

Yes, though our physicians primarily operate the equipment, an RT is present. In the cardiovascular lab, only the physician pans the table, manipulates the flat detector and controls fluoroscopy. 

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

An RT(R) assists in the handling of radiation protection. This includes annual lead checks, monitoring of radiation badges, and radiation safety education upon orientation.

Our staff rotates positions, so on a weekly basis, staff is in the pre/post care area some days and in the actual labs on other days. We also rotate in the lab itself, so staff is out of the field of radiation while recording the case.

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

We have started an extensive peripheral vascular program, and are very busy with chronic total occlusions and below-the-knee intervention as part of our amputation prevention program. Some of our new equipment includes the excimer laser (Spectranetics), the Crosser total occlusion crossing device, the Diamondback 360˚ atherectomy device (Cardiovascular Systems Inc.), and optical coherence tomography (OCT) along with standard intravascular ultrasound (IVUS). Due to our physicians’ expertise in this field, we have many vendors that bring in new, FDA-approved equipment for our physicians to trial.

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

This is a very challenging area. We are at the size where we are big enough that you can’t just catch people in the hall, but not big enough to keep the labs running while you have staff meetings. We do much of our communication by e-mail.

As a manager, I spend about 30% of my time in the labs working, so I see many of our needs firsthand.

We have monthly lunch meetings; providing dessert assures attendance. I will also round (one-on-one talk with each person on staff) at least quarterly so they can share their views on what is working, what is not, and equipment needs.

Hospital events are posted on a communication board located in our locker room.