Cath Lab Digest

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

Our most recent technology addition is Guidant's Acculink/Accunet Carotid Stent system (Santa Clara, CA). We also have intra-cardiac echocardiography (ICE), which we are using with adult ASD/PFO closures and electrophysiology procedures and the Frontrunner CTO catheter (LuMend, Inc., Redwood City, CA). Additionally, we have IVUS, WaveWire (Volcano Therapeutics, Inc., Rancho Cordova, CA), AngioJet® (Possis Medical, Inc., Minneapolis, MN), and distal protection device capability. In EP, we use Carto (Biosense Webster, a Johnson & Johnson company, Diamond Bar, CA) and Localisa® (Medtronic, Inc., Santa Rosa, CA) for 3-D mapping, and cryoablation technology.

Is your cath lab filmless?

Yes, we have been filmless for 10 years. We were the first cath lab in the Sacramento area to go digital. Our x-ray vendor is Philips and our vendor for digital archiving is Heartlab. We are now placing viewing stations throughout various locations of the hospital, including medical records, CICU, telemetry, and the cardiac operating room.

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

We do not have an RT (radiologic technologist) present during every procedure we perform. All of our physicians maintain their California fluoro license which allows them to operate the equipment. During complex procedures, peripheral procedures, and pediatric procedures, we do have an RT in the room. There is always at least one RT working in the department whenever open per California Department of Health Services Titles 17 & 22. After-hours and weekend on-call teams always include 1 RT in the mix.

Which personnel can operate the x-ray equipment in your cath lab?

All of the options below apply when fluoro is being performed. Per Title 17, with the exception of initiating x-ray when a patient is in the beam, anyone can position the table or change settings.

- Positioning the image intensifier

- Cardiologist, RT

- Panning the table - Cardiologist, RT

- Changing angles - Cardiologist, RT

- Stepping on the fluoro pedal - Cardiologist, RT

How does your lab handle hemostasis (i.e., manual or vascular closure devices, where do patients go, who is responsible?)

We use vascular closure devices in 25% of our patients. Angio-Seal (St. Jude Medical, Minnetonka, MN) is the predominant device in use. We have trained four of our RN staff to deploy Angio-Seal and plan to work with the vendor to train more RNs and CVTs. Outcomes with RN deployment of Angio-Seal have been excellent. We also use the Neptune Disc (TZ Medical, Inc., Portland, OR) and have had good results, although we continue to primarily use the FemoStop (Radi Medical Systems, Inc., Reading, MA) and the CompressAR® (Advanced Vascular Dynamics, Portland, OR) for mechanical compression.

Does your lab have a hematoma management policy?

We have a hospital-wide management protocol for the patient who has undergone cardiac catheterization and/or a coronary/peripheral interventional procedures. These protocols provide guidelines for managing vasovagal episodes, chest pain, and bleeding/hematoma that may develop post-procedure. These concepts are taught on a regular basis by the nurse educators and clinical nurse specialists, and competency for groin management is assessed at least annually.

Additionally, staff members are asked to report hematomas so that rates can be tracked by Integrated Quality Services. Additionally, vascular complication rates are captured in our ACC data, which is reported to our cath lab staff and medical staff committees on a regular basis.

How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies?

We are very fortunate to have a dedicated Materials Management Coordinator in the department who oversees our extensive inventory of supplies, catheters, and devices. Inventory is managed using a GE computerized tracking system and bar code scanning at the point of supply usage, which automatically modifies inventory and alerts the Materials Management Coordinator when the re-order threshold has been reached. The GE Marquette MacLab (Waukesha, WI) interfaces to the GE LMT system in the Materials Coordinator's office and supplies are ordered. A careful verification of all procedures and charges is done daily to eliminate lost charges and verify accuracy of charges.

Has your cath lab recently expanded in size and patient volume, or will it be in the near future?

Currently, we have an average of 18-22 scheduled cases each day, and then the unstable patients and the add-ons come in all day and evening. We opened our 4th room last year, which is predominately used for electrophysiology procedures and device implantation. This has helped our daily schedule tremendously. Sutter Medical Center also does some device implantation in the operating room, depending on physician preference for use of general anesthesia or schedule flexibility. We are also in the planning to move and expand our Holding Area from 10 beds to 16 beds. We anticipate beginning construction in early 2005.

Is your lab involved in clinical research?