Cath Lab Digest

Tell us about your hospital and cath lab.

Founded in 1826, Yale-New Haven Hospital (YNHH) is a non-profit, 1,008-bed tertiary care hospital that receives national and international referrals. The hospital includes Smilow Cancer Hospital at Yale-New Haven, Yale-New Haven Children’s Hospital and Yale-New Haven Psychiatric Hospital. An article released by U.S. News & World Report, “America’s Best Hospitals”, ranked YNHH among the best hospitals in the United States. The hospital is accredited by The Joint Commission and in May of 2011, the American Nurses Credentialing Center granted YNHH Magnet Recognition, which signifies nursing excellence and recognized collaboration between nurses and members of the healthcare team. Only six percent of American hospitals have received this honor. YNHH prides itself on its mission, which focuses on community service, teaching, research and patient care. In addition to providing quality medical care to patients and families, YNHH is the second largest employer in the New Haven area, relying on the skills of nearly 9,000 employees and a combined medical staff of about 3,600 university and community physicians practicing in more than 100 specialties. 

YNHH’s Heart and Vascular Center offers a wide range of procedures for cardiovascular conditions, and is consistently ranked among the best in the nation by U.S. News & World Report. Services include diagnostic and interventional procedures, cardiothoracic surgery, electrophysiology and interventional radiology. The Heart and Vascular Center (HVC) includes a women’s heart program, a non-invasive cardiovascular imaging department, a cardiac rehabilitation program and five inpatient units:

• A 14-bed cardiac intensive care unit;
• An 18-bed cardiothoracic intensive care unit;
• A 14-bed cardiac surgical step-down unit;
• A 26-bed medical cardiology unit, and;
• A 25-bed progressive care unit.

The Heart and Vascular Center also includes six interventional labs, three state-of-the-art electrophysiology (EP) labs, including two biplane fluoroscopy rooms, and pre-procedure and post-procedure recovery areas. Five operating room suites are designated for cardiac use.
The cardiac cath lab features five procedure rooms, including a Philips pediatric hybrid lab and a Siemens Artis Zeego Multiaxis Robotic System.

HVC procedural area staff, composed of the cath lab, EP lab and interventional radiology (IR) lab, includes:

• Six advanced practice registered nurses (APRNs);
• Two physician assistants (PAs);
• A service line educator;
• A scrub educator;
• 67 registered nurses (RNs);
• 39 radiologic technologists (RT[R]s);
• Three clinical service associates (CSAs), who schedule all out-patient cardiac cath, EP and IR procedures;
• Two patient care associates (PCAs);
• Two operating room aides (ORAs); 
• An inventory control lead – a shared position between the Cath/EP/IR labs.

Staff experience ranges from one to 40 years. There are 24 attending physicians, three interventional fellows and a number of cardiology fellows who rotate monthly in the cath lab. A practice manager, who is an RN, oversees the entire procedural area. One manager is in charge of clinical operations for the cath and EP labs, and another manager heads IR operations. An assistant patient services manager is in charge of nursing for the entire HVC procedural area. As one of the nation’s leading providers of heart and vascular health services, YNHH’s Heart and Vascular Center is a national pioneer in developing new heart treatments and therapies. Our reputation is one of the reasons that we are consistently ranked among the top 100 hospitals for cardiac care in the nation.

What procedures are performed in your cath lab?

The HVC cath lab performs diagnostic and interventional procedures. In 2011, the cath lab performed:

• 3,166 cardiac caths (adult and pediatric) procedures;
• 1,360 angioplasties;
• 268 cardiac biopsies;
• 337 peripheral vascular procedures (diagnostic/therapeutic procedures for iliac, superficial femoral, renal, carotid and subclavian artery disease);
• nine percutaneous valve replacements.

Intra-aortic balloon pumps (IABP), transvenous temporary pacemakers and pericardial taps are also performed. Pressure wires are used in performing fractional flow reserve (FFR), and intravascular ultrasound (IVUS), thrombectomy, and rotational artherectomy are also utilized by the HVC.

What percentage of your patients is female?

Thirty-five percent of the patients are female.

What percentage of your diagnostic caths is normal?

Twenty-four percent of the diagnostic cardiac caths are normal, meaning less than a 10 percent occlusion.

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

Yes, physicians regularly gain radial access. Approximately 40 percent of the cases are performed via radial access.

Who manages your cath lab?