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A Cath Lab Digest Editorial Board Discussion

Should an IABP be Required in the Cath Lab?

I am the Director of Clinical Engineering at the Chester River Hospital in Chestertown, MD. We have an underutilized cath lab (average less than 3 procedures a week) and our intra-aortic balloon pump is at its “end-of-life.” In the 7 years we have had the cath lab, we have NEVER used the pump. Replacement of this unit would run in the $60,000 range and in these economic times, I am having difficulty justifying the cost, UNLESS IT IS A REQUIREMENT. I understand the safety features of having one at hand, BUT, I also need to reconcile my meager budget. Any direction or information you could give would be greatly appreciated.

Thanks again,
Albert Brotschul CBET
Dir. Clinical Engineering
Chester River Hospital
Chestertown MD
abrotschul@chesterriverhealth.org

I am not sure of the standards for Maryland; each state’s guidelines vary. In Ohio, the Administrative Code does not require an IABP unless the facility performs PCI (elective or emergent).

Ohio Administrative Code: Adult Cardiac Catheterization Services - Facilities, equipment, and supplies 3701-84-32 (E: 1-13, F:1-4)

Kenneth A. Gorski, RN, RCIS, FSICP
Assistant Manager,
Cardiovascular Laboratories
Cleveland Clinic Heart and
Vascular Institute
Cleveland, OH

You need to assess whether you really should have a cath lab. What is your annual number of cases?

Georgann Bruski
Systems Vice President
Cardiovascular and Radiology
Caritas Christi
Boston, MA

I agree with both Ken and Georgann. If procedural volume is that low, competencies for the physician volumes may not be adequate for the diagnostic lab; however, if doing that level of volume, I could state a case for or against having a balloon pump. Maquet will do what they call a “Transit” program, whereby if you agree to purchase a minimum amount of balloons over a 48-month period, they will give you a pump. An option would be to purchase a “refurbished’ pump.

Albert, your title is “Clinical Engineering Director,” which tells me that you are looking at this from a different point of view that those of us who have been in a director or manager position. In most cases, I would not want to be in a diagnostic-only lab without a balloon pump.

Note: My Maquet representative has confirmed that Maryland is a state that requires cath labs have an IABP.

Steve Gressmire RT(R)(CV) ARRT
Senior Technologist,
Cardiovascular Services
Cardiac Cath Lab,
Gateway Medical Center
Clarksville, TN

Hi Albert,

Tough question. I am sure you have also agonized over whether you should keep the cath lab going too. Is your lab interventional or purely diagnostic?

If purely diagnostic, then maybe your answer would be to run the lab almost as a free-standing diagnostic facility. At three cases or so a week, you probably are not using much black ink.

How much does it cost you to keep the inventory and the equipment and staff at the ready mode?

What other vascular cases are you doing in that room, or what vascular cases can you do in that room?

Indeed, the cath lab is a great asset, if fully utilized, but consider skill levels, too.

Are your doctors and staff doing enough cases to maintain finely-tuned skills?

Your answers would probably provide an answer to what your options are.

Bob Basile, Sr., RT(R)
Valley Access Center
Bethlehem, PA

What comes to mind is consideration of the new Impella left ventricular assist device, BUT, given this person’s cath lab load, that device, too, would have a hard time being cost-justified.

Heidi Bonneau
Highlands Consulting, Inc.
San Jose, CA

I would suggest Albert contact Maquet and request:

1. Swap out the old for a new at a minor cost, OR

2. Re-furbish the old.

I would assume that either of the above would be minor compared to $60,000 and the unit has plenty of value since it has never been used.

Kind regards,
Tom Maloney
Memorial Regional Medical Center
Richmond, VA

Albert Brotschul responds:

As a clinical engineer, I am looking at this from a non-clinical point of view. I only see that my Datascope (now Maquet) 98XT is an unused, expensive piece of medical equipment that will no longer be supported by the manufacturer. Each year, besides the upkeep costs, I have staff education and competencies to consider. The staff in my cath lab are exceptional technologists who I’m sure would skin me if they even thought I was removing their equipment. The other side of the coin is that my administration is doing EVERYTHING in their power to save dollars in these tough economic times. Because dollars saved are jobs kept, that was my primary reason for asking the question, “Is an IABP required equipment.” After reading all the responses, I have concluded that whether or not this equipment is required by “law,” staff working in this field believe it to be NECESSARY MEDICAL EQUIPMENT in a cath lab.

Thank you all for your responses!
Albert Brotschul CBET
Dir. Clinical Engineering
Chester River Hospital
Chestertown, MD
abrotschul@chesterriverhealth.org

STEMI Intervention Questions: Emergency Flasher Lights

In the September 2009 issue, in response to a question about flasher lights for STEMI call teams driving in to the hospital, Dr. Mehta wrote:

…In my Textbook of STEMI Interventions, Chapter 19, I refer to the need for legislation to improve door-to-balloon times — emergency flasher lights fall in this category. When will this happen? Only after a few politicians or their loved ones become victim of an acute MI or when media gets behind it.

Regards,
Sameer Mehta, MD, FACC, MBA
Voluntary Associate Professor of Medicine, University of Miami
Miami, FL
Course Director, LUMEN
http://www.lumenami.com

Chuck Williams (iraa.rpa@gmail.com) responds:

I do not believe in sacrificing my life or someone else’s life on the highway to make the hospital look good in the medical community. I have lost a couple of peers who have died enroute to the hospital to save another life.

I lived in Miami in the late 60’s and through the 70’s, when the night drive to the medical center took 20 minutes. As Miami’s population increased, the drive continued to lengthen from 20 minutes to 60 minutes. I was stopped quite often by the police. When I told them I was enroute to the hospital to take care of a patient, they always said, Just be careful, and let me go. (Then there are the hard-nosed police officers, which is a different story.)

Question about the process or procedure of STEMI interventions? Ask the expert. Email Sameer Mehta, MD, at: mehtas@bellsouth.net