Cath Lab Digest talks with Wissam Gharib, MD, FACC, FSCAI, West Virginia University Heart Institute, West Virginia University Hospitals, Morgantown, West Virginia, about his use of the left ventricular assist Impella device (Abiomed, Danvers, Mass.).

Can you tell us about your cath lab?

The West Virginia University Heart Institute has 3 dedicated cath labs with another lab mainly used for electrophysiology procedures. We do between 1,200 and 1,400 interventions per year, and up to 3,000 caths per year.

“When I was first taught how to do angiograms, I was told that you never want to leave blood in the sidearm of the sheath. I was to aspirate to make sure there was no clot and then flush with sterile heparinized saline. Now, we are composing a protocol in our facility, and we are unsure if we should be aspirating 10 ml of blood prior to removing sheath.

So much research is happening today in cardiology. Who is doing the research, and where are the patients coming from?

There are many hospitals nationwide participating in research as a part of the National Cardiovascular Data Registry (NCDR^®). The NCDR is operated by the American College of Cardiology (ACC), in partnership with leading cardiovascular associations dedicated to compiling data and using it to create and implement protocols that improve care for patients nationwide.

I recently learned that I could see my real-time x-ray dose while doing a case. My x-ray system (Philips, Bothell, Wash.) has a display (see Figures) on the left side of the monitors that shows my table height, source-to-image distance (SID), and flat detector (FD) distance, and below it shows the fluoroscopy settings (low, normal), fluoro time, K mGy/min, patient dose area product (DAP) (I think) and air kerma (AK) in mGy. It was also interesting that by raising and lowering the tube, table, or fluoro setting, the operator can change dosage and know, in real time, in which direction.