Cath Lab Digest

What type of procedures are performed at your facility?

UHS Cath Labs perform about 15,686 procedures annually, approximately 300 procedures per week. We perform various cardiac and peripheral interventions, including adult diagnostic heart studies, electrophysiology (EP) studies, device implantations, percutaneous transluminal coronary angioplasty (PTCA), cardiac stenting, alcohol (ETOH) ablations, chronic total occlusions (CTOs), atrial septal defect (ASD), patent foramen ovale (PFO) and ventricular septal defect (VSD) closures, intravascular ultrasound (IVUS), rheolytic thrombectomy, atherectomy, renovascular stenting, peripheral atherectomy, thrombectomy and peripheral stenting. Our carotid intervention volume has been increasing, according to Stephanie Hyde, CCL Data Systems Coordinator.

Does your cath lab perform primary angioplasty with surgical backup?

UHS Cath Labs have arrangements with our cardiothoracic surgery staff on a 24/7 basis.

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

I can recall we had one right coronary artery (RCA) perforation that required emergent cardiac surgery.

Has your cath lab expanded in size and patient volume?

With the recent addition of peripheral procedures performed in the cath lab, new cardiologists and a new electrophysiologist (Dr. Manoj Panday), we have indeed seen a patient increase. At this pace, we will be experiencing more volume and may have to add another lab suite or a computed tomography angiography (CTA) suite.

How does your cath lab compete for patients?

UHS is the only county facility that has referrals from most of south central Texas due to its trauma Level I status. In addition, from our cardiology group, we receive referred patients with critical needs from nearby communities.

What procedures do you perform on an outpatient basis?

We perform diagnostic heart studies as well as certain peripheral interventions.

What percentage of your patients are female?

Fifty-seven percent of our patients are female.

What percentage of your diagnostic cath patients go on to have an interventional procedure?

Anywhere from 50 to 60 percent of our diagnostic cases become interventions.

Who manages your cath lab?

The cath lab is under Patient Care Services, of which Nancy Ray RN, MA is the Chief Nursing Officer (CNO)/Associate Administrator. The cath lab is managed primarily by a clinical director (Franklin D. Espanto, BSC, RCIS) with a medical director (Marc Feldman, MD). What is unique about this setup is the very close bond between these entities. With the support of the CNO, clinical decisions are made by both the medical and clinical directors. In addition, every staff members is a part of this management process. We collect, review and discuss issues to further raise the bar in delivering patient care.

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

Currently, we do not have cross-trained staff. It has been a focus since I arrived at University Hospital two years ago. We have been working towards this goal through simple educational sessions and protocol reviews. Since University Hospital is affiliated with the University of Texas Health Science Center of San Antonio (UTHSCSA), the staff attending cardiologist scrubs with the fellow. We have a CVT that monitors, an RN that circulates and an RN that charts. On occasion, we have our CVTs or RCISs scrub cardiac and peripheral procedures. We do have our trained technologists assist on all device implantations.

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

Not necessarily, since the cardiac fellow and the staff attending cardiologist operate the x-ray equipment. The physicians primarily control the positioning of the II, table panning and stepping on fluoro.

How did you begin performing peripheral cases?

Initially, the cardiologists were performing simple peripheral renovascular, carotid and lower extremity procedures. After upgrading one of our radiological units to improved imaging technology, vascular surgery joined in to use our lab. We became aggressive in our supply capabilities and have exposed our staff, particularly the CVTs, to scrubbing in on these procedures.

What specific equipment was instituted and/or dedicated towards peripheral cases?

Since most of peripheral supplies are macro compared to the cardiac side, it was important to have a process to introduce these supplies. With our own supply section, we had very close communications with the primary peripheral operators on what was needed. Operations manager David Parks, Jr., arranged with the various peripheral vendors to consign supplies. A peripheral cart with the supplies essential for these procedures was created. Some of the specific equipment requested was the Silverhawk catheter (FoxHollow Technologies, Inc., Redwood City, CA), Frontrunner® XP CTO catheter (Cordis Corporation, Miami, FL) and the Angio-Jet® system (Possis Medical, Inc., Minneapolis, MN).

How is inventory management handled for the peripheral equipment?

With the help of our hemodynamic system, which has a bar code feature, the operations manager can see and forecast peripheral supplies that are routinely used and must be re-ordered before we have no replacements available on the shelves. This process also requires the personal effort of double-checking the cart once in a while, which is done by inventory specialist David Schmid.

What peripheral procedure training was instituted so staff could be competent and skilled?