Cath Lab Digest

Tell us about your cath lab.

Winter Haven Hospital is a 527-bed facility located in central Florida. We are the only Magnet-accredited hospital in Polk County. We currently have three labs utilized for coronary, peripheral, and electrophysiology (EP) procedures. In addition to serving the local community, we conduct a number of training courses for physicians, including a hands-on radial course, laser atherectomy, rotational atherectomy and orbital atherectomy. We also participate in a number of clinical trials.

Our department consists of 26 total staff members, with an average of six years of experience in cardiac catheterization. Among them are eight registered nurses (RNs); all are eligible to have their critical care registered nurse (CCRN) certification. Four of our RNs have bachelor of science in nursing (BSN)-level educations. We have 12 technologists of varying backgrounds, including radiology, respiratory, and cardiovascular, 100% of whom are registered cardiovascular invasive specialist (RCIS)-certified. The additional six staff members are support staff: our secretary, financial coding analyst, licensed practical nurse (LPN), transporter, and tech assistants. This staff works among three procedure rooms and one three-bay holding area.

What procedures are performed in your cath lab?  

We are a fully invasive cardiac catheterization lab, capable of performing essentially all procedures, with the exception of transcatheter aortic valve replacement (TAVR); however, there are plans to incorporate TAVR in the near future. We perform approximately 80 procedures per week. Since 2008, we have transitioned to a “radial-first” mentality and now perform approximately 75% of our coronary procedures via the radial approach. We perform the following procedures:

• Invasive cardiac procedures:  Left and right heart catheterization, percutaneous coronary intervention (PCI) including Impella (Abiomed)-supported procedures and chronic total occlusions (CTOs), rotational and orbital atherectomy, laser atherectomy, AngioJet thrombectomy, aortic balloon valvuloplasty, pericardiocentesis, and intra-aortic balloon pump.  
• Rhythm therapy procedures:  Bi-ventricular automatic internal cardiac defibrillators (AICDs), pacemaker and loop recorder devices. We also have a budding EP program in which we perform EP studies and atrioventricular  node/atrial flutter ablations.
• Non-invasive cardiac procedures:  Transesophageal echocardiogram, tilt table testing, cardioversions and non-invasive programmed stimulation procedures.
• Peripheral procedures: Abdominal angiography, peripheral digital subtraction angiography, percutaneous transluminal angioplasty of the peripheral vessels utilizing laser, orbital and rotational atherectomy, and including lesions considered to be CTOs, critical limb ischemia, limb salvage procedures, carotid angiography and stenting, and inferior vena cava filter insertions/removals.

Can you share more about your planning for TAVR procedures?

We are currently budgeted for a new hybrid procedure room to facilitate the performance of TAVR as well as other structural heart procedures, aortic endografts, etc. Construction should begin in early 2013.

Does your cath lab perform primary angioplasty without surgical backup on site? 

Winter Haven Hospital has cardiovascular surgeons on call at all times, providing our facility with full surgical backup. We also serve as an emergency backup site for a few nearby facilities without surgical backup.

What percentage of your diagnostic caths is normal?

Over half of our diagnostic procedures yield positive results that may warrant some form of revascularization therapy (PCI or bypass). Our lab practice is largely evidence-based; therefore, we utilize a good deal of intravascular ultrasound (IVUS, Boston Scientific and Volcano) and fractional flow reserve (FFR) (Volcano, Inc.), particularly with intermediate angiographic lesions. We also try to utilize a heart team approach when choosing a revascularization strategy in complex anatomy.