Cath Lab Digest

Tell us about your cath lab.

Piedmont Henry Hospital is a 215-bed, not-for-profit, community hospital located in Stockbridge, Georgia. We serve the southeast region of Atlanta. As of January 1, 2012, we officially became the newest member of the Piedmont Healthcare system.

Currently, our facility accommodates two cardiovascular angiography labs, one electrophysiology (EP) lab and 11 admit/recovery rooms.

On February 28th, 2011, our cath lab successfully performed its first coronary angioplasty.  In the year since, we have done 487 cardiac interventions. Prior to this date, we were a diagnostic lab, performing interventional peripheral and radiology procedures.

Our dedicated team consists of 18 registered nurses (RNs), four registered cardiovascular invasive specialists (RCISs), and five registered technologists in radiography (RT[R]s). They have been part of our team over a period ranging from six months to 25 years.

The team operates efficiently next to highly skilled and experienced physicians, including diagnostic and interventional cardiologists, electrophysiologists, vascular surgeons, and interventional radiologists, who all perform procedures in our area.

What procedures are performed at your lab?

The cath lab performs various diagnostic and interventional cardiac and peripheral procedures, as well as interventional radiology and vascular access procedures. These include right and left heart catheterizations, angioplasty, stenting, AngioJet (MEDRAD, Inc.), intravascular ultrasound (IVUS), fractional flow reserve (FFR), intra-aortic balloon pump (IABP) use and temporary pacemaker insertions, as well as peripheral run-offs and atherectomy cases. Percutaneous nephrostomy placements, Infusaport insertions, kyphoplastys, cholangiograms, embolizations, arterial-venous fistula/graft angiography and interventions, Permacath and inferior vena cava filter insertions are also done in the cath lab, in addition to other invasive procedures.

The EP lab performs electrophysiology studies with and without mapping, ablations and device implant, removal and upgrades.

Also, our team in the Admit Recovery Unit (ARU) assists in transesophageal echocardiograms and cardioversions, as well as in pre and post procedure care.

Together, our labs average about 115-120 cases per week.

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

Yes. Our facility does not have surgical backup for angioplasty procedures. In the event that a patient needs a surgical intervention, s/he is referred to a cardiothoracic surgeon at a nearby facility. In emergency cases, an intra-aortic balloon pump catheter is typically inserted to stabilize the patient and the staff expedites a critical care ambulance service to transport the patient to the appropriate hospital.

What percentage of your patients is female?

Females make up about 41 percent of our patient population.

What percentage of your diagnostic caths is normal?

Approximately 14 percent of our procedures are diagnosed as normal.

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

Yes, about 40 percent of our procedures are performed via the radial artery. 

Is your lab involved in clinical research?

Not at this time.

Who manages your cath lab?

Shelly Selby, RN, MSN, CCNS, CCRN, Director of Cardiovascular Services, is head of the leadership team, consisting of: Carrie Clayton RCIS, manager of the Cardiovascular Angiography Lab; Jo Pike, RN, manager of the Admit Recovery Unit; and Mogregory Morgan, RT(R), manager of the Electrophysiology Lab and Noninvasive Cardiology. Our co-medical directors are Rajasekhar Reddy, MD, FACC and Vikram R. Mandadi, MD, FACC.

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

Every team member is expected to cross-train in at least two positions. All disciplines are permitted to scrub, circulate and monitor. However, only registered nurses are allowed to administer medication.

Having multi-skilled team members is encouraged to strengthen our foundation of knowledge.  It creates a more proficient and cohesive environment, and enables all members of the group to appreciate and understand all steps involved in a procedure.

Who documents medication administration during the case?

Medication administration is documented by the monitor for the procedural record, the circulating nurse on a physician order sheet, and on the medication administration record (MAR).

Are you recording fluoroscopy times and doses?

Yes, fluoroscopy times/doses are recorded on every patient as part of the procedure record.

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

No. The physician as well as RT(R)s and RCISs are trained and credentialed to operate the X-ray equipment. The physician, as his practice dictates, determines how the scrub assists in the procedure.