Cath Lab Digest

Can you tell us about your cath lab?

The Wentworth Douglass Hospital Cardiovascular Lab has 2 interventional Artis Zee suites (Siemens Medical, Malvern, Pennsylvania) that perform both cardiac and peripheral procedures. We have 5 new private patient holding rooms, as well as a nursing charting station. In our lab, we have 14 staff members. There are 8 technologists and 6 nurses. The staff holds an assortment of credentials including registered nurse (RN), respiratory therapist (RRT), radiologic technologist [RT(R)], and registered cardiovascular invasive specialist (RCIS). Two of our nurses currently have their CCRN credentials as well. The staff here has a wide range of employment history at this hospital, ranging from 10 years to 6 months.

What procedures are done at your lab? 

Our cardiovascular suites perform a variety of diagnostic procedures, including cardiac and peripheral interventions. Additionally, we insert permanent pacemakers, abdominal aortic aneurysm (AAA) stent grafts, and dialysis catheters, as well as perform pericardialcentisis, transesophageal echoes (TEEs), and cardioversions. The staff works with both cardiologists and vascular surgeons. Each week, we perform an average of 25 procedures.

Does your cath lab perform primary angioplasty with surgical backup on site?

We do perform primary angioplasty without surgical backup on site. If a patient requires emergent surgical intervention, they are transferred to a local regional hospital where a cardiothoracic team is readily available.

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

Our lab has approximately 39% of patients proceed to percutaneous coronary intervention after a diagnostic cardiac catheterization.

What percentage of your patients is female? 

Our female patient population is close to 43%.

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

We have two interventional cardiologists who regularly gain access via the radial artery. There are also several diagnostic physicians who are beginning to train in radial techniques.

Who manages your cath lab?

Our cardiovascular lab is managed by a collaborative group: Cindy Harris, RN, MBA, Director of Cardiovascular Services, Ann Dupuis, RT(R)(CV), Cardiovascular Manager, Christian Comeau, RT(R)(VI)(CI), RCIS, Invasive Cardiovascular Supervisor, and Brian Smith, RN, CCRN, Nurse Manager. 

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

Specialists scrub all procedures in our lab and nurses circulate, because they administer medications. All staff members are trained to monitor procedures.

Who documents medication administration during the case?

In our lab, we use the McKesson hemodynamic system, which allows us to have a monitor person outside the room documenting hemodynamics and a nurses’ charting station in the room, used for documentation of medications. Both cardiovascular technologists and nurses may document medications during the case. All medication is reviewed and signed by the nurse before the case is finalized.

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

Our hospital does not require a radiologic technologist (RT) to be present in the room.

Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the fluoro pedal) in your cath lab?

Physicians primarily control the fluoro/cine pedal during procedures and the specialist performs the other operations of the x-ray equipment, but the specialist is able to perform all controls.

Are you recording fluoroscopy times/dosages?

We document fluoroscopy times in our hemodynamic system; it then creates a report that is entered into the patient’s medical record.

How does your cath lab handle radiation protection for the physicians and staff?  

The standard for our staff is generally the same as across the country. We do have monthly monitoring of dosimeter badges and staff lead aprons are checked annually by our radiology department. One of our newer measures in radiation safety is the SorbX angiography shield (AngioSystems, Inc., Ducktown, Tennessee). Our labs also have full-height radiation barriers that are used by the circulating staff to protect from extra radiation in the room. The staff has also been provided with leaded eyewear.

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