Cath Lab Digest

Can you tell us about the cath lab at Deborah Heart and Lung Center?

Currently, we have three cath labs, with an additional lab under construction. We also have a dedicated endovascular lab for peripheral procedures that is housed within the Radiology department.  The three cath labs are primarily cardiac cath labs; however, we do perform peripheral and structural procedures in those labs as well. The fourth lab, which will hopefully be open and functioning by August of this year, will be a swing lab, outfitted for cardiac, peripheral, and structural procedures.

What are the different types of procedures you do?

We do the entire spectrum of coronary procedures, from diagnostic catheterization and angiography to complex cardiac interventions. We are proficient in all the adjunctive interventional devices and equipment, including fractional flow reserve, intravascular ultrasound, rotational and laser atherectomy, intra-aortic balloon pumps, and percutaneous left ventricular assist devices. With regards to peripheral procedures, we again perform the entire range of peripheral angiography and interventions from head to toe, including carotids, subclavians, renals, mesenterics, iliacs, femoral, and even below the knee for limb salvage. Aortic interventions, including percutaneous coarctation repair and endovascular abdominal aortic aneurysm repair, are also performed by our interventionalists in conjunction with the vascular surgeons.

You also have a congenital and structural heart program.

We have been involved in congenital heart procedures for a long time, but we have recently expanded to include advanced structural heart procedures as well. We perform percutenous closures of atrial septal defects (ASDs), ventricular septal defects (VSDs), patent foramen ovale (PFO), and patent ductus arteriosus (PDAs). We also perform coiling of anomalous coronary pulmonary fistulas and arteriovenous malformations. We have recently begun repairing paravalvular leaks in the aortic and mitral positions, in addition to aortic and mitral balloon valvuloplasties.

Can all your labs accommodate congenital and structural procedures?

Yes, but we tend to do them in our largest lab with biplane imaging, which also has anesthesia lines, allowing immediate access to general anesthesia when needed. We also have a hybrid OR under construction, which will allow the performance of complex cases within that lab.

Are you also doing transcatheter aortic valve replacement (TAVR)?

Not currently, but upon completion of our hybrid OR in 2013, we anticipate having this cutting-edge technology. It will not only be a collaboration between interventional cardiologists and cardiothoracic surgeons, but also between the cath lab staff and the OR staff within the new space of the hybrid OR.

Are all the physicians utilizing your lab interventionalists?

Yes, our cath lab physicians are interventional cardiologists that are employed by the hospital. All of them do coronary, peripheral, and structural cases, allowing our physicians to cross-cover all hospital cases.

Does your program train fellows?

Yes. In fact, Deborah Heart and Lung Center has the largest osteopathic cardiology fellowship program in the country (18 fellows). Moreover, this is also the largest osteopathic interventional cardiology fellowship program (4 fellows) and the only osteopathic endovascular training program in the country. There are one to two fellows (usually 1 general and 1 interventional cardiology fellow) and 1 attending scrubbed into every case in the cath lab.

Tell us about your staff.

At this time, our staff consists of 15 members, with varying credentials. We have registered nurses (RNs), radiologic technologists (RTs), cardiovascular technologists (CVTs), registered cardiovascular invasive specialists (RCISs), and cardiac-interventional radiographers (CIs). We have no licensed practical nurses (LPNs).

How many staff is needed per procedure?

There are usually two staff members in the actual procedure room and one recording, for a total of three staff members assigned to each case. One of the two staff members in the procedure room will be an RN, but the others assigned to the staff can be any mix.

Nurses circulate and technologists scrub in?

Correct. The nurses circulate and administer medications while the tech is either scrubbed in or feeding the table, making sure that the physicians have all the equipment they need. However, nurses are able to and encouraged to scrub in whenever necessary.

Do you encourage your staff to take the registered cardiovascular invasive specialist (RCIS) exam?