Chemical dependence among allied health professionals is a significant problem, with a lifetime prevalence of approximately 10-15%. This percentage is similar to the population at large. Allied health professionals with psychoactive use disorders have long been documented throughout history. In 1958, the Federation of State Medical Boards (FSMB) of the United States identified drug addiction and alcoholism as a disciplinary problem. The most commonly abused substances by allied health professionals are alcohol, opiates, marijuana and benzodiazepines.

This is the first article of short series, which sets the groundwork for investigation into the potential injuries, specifically carpal tunnel syndrome, we as invasive specialists in the field might develop as we care for our patients. The second article will deal with the scientific data that the National Institute for Occupational Safety and Health (NIOSH) scientists and our cath lab personnel at Washington Adventist Hospital will be collecting. That data, and any intervention and protection from injury practices will be developed, collated, and published in the future.

P.B. is a 78-year-old woman with progressive, disabling angina. She has longstanding insulin-dependent diabetes, hypertension, dyslipidemia, and has had one previous myocardial infarction. Her cardiac catheterization reveals a “B1” lesion of the distal left main, a “C” lesion of the proximal left anterior descending (LAD) and a “B1” lesion of the proximal posterior descending artery (PDA). The left ventricular ejection fraction is 35%. She is referred to a cardiac surgeon for multi-vessel coronary artery bypass. Rather than performing a conventional CABG through a sternotomy, the surgeon reviews the catheterization with an interventional cardiologist and they agree that the patient is a good candidate for the hybrid procedure.

Cardiovascular administrators are faced with ever-increasing challenges to maintain and improve revenues in the cath lab. There are many processes utilized by administrators to achieve this task, but every cath lab is uniquely different and a single process that worked for one cath lab may not work for another. Thus, this article will provide a variety of possibilities to assist in reducing costs and increasing revenue. Opportunities to build revenue include supply cost reduction, a supply and procedure charge master, payer agreements for high cost supplies, cath lab procedures, operational efficiencies and lastly, keeping abreast with new technology in your cath lab.

Providence Hospital and Medical Centers (Southfield, MI) is a 459-bed teaching hospital known for the quality of its cardiovascular care. For the fourth year in a row, the Providence Heart Institute has been recognized as one of the Top 100 Cardiovascular Hospitals in the country by Solucient, a provider of strategic healthcare information, and it has been a Blue Cross-Blue Shield Cardiovascular Center of Excellence since 1995. Hospitals receiving this designation must meet criteria which include quality of care, comprehensive services, low incidence of complications and financial accountability.

Successful cath lab design is established during the planning phase. Extensive communication among administrators, facility personnel and design team members helps develop the optimum design. Administrators and facility personnel need to consider the critical issues of circulation, cath lab sizing and control room placement. Assessing the needs of these areas in light of the overall facility design goals results in environments that fulfill patient and staff requirements while also addressing future facility needs.

Discussion group members responded to the questions below, and emails are included for any questions readers may have regarding a particular lab's policies. If you'd like to join our group, please send an email to: **link-1**cathlabdigest@hotmail.com**endlink**

This monthly column in Cath Lab Digest reviews important points of distinction in DES, from characteristics to techniques, so that physicians and professionals have valuable and relevant information about this revolutionary technology.

A new system for the prevention of contrast-induced nephropathy in patients undergoing invasive angiographic procedures is on the horizon. The device uses a bilateral catheter system to perfuse the renal bodies intra-arterially with fenoldopam, which may maximize renal function in patients with renal insufficiency prior to an intervention. Contrast-induced nephropathy (CIN), which often occurs in congestive heart failure, diabetics, and intravascular volume-depleted and renal-compromised patients undergoing diagnostic cardiac and interventional cardiac procedures, is associated with high morbidity and mortality rates. Madyoon, who is currently studying the effects of radio-contrast nephropathy1,2 on patients at St. Joseph’s Medical Center in Stockton, California, has determined mortality rates for patients who developed contrast-induced nephropathy requiring dialysis at 25%, with one-year mortality rates of 55%.

This novel catheter uses electrical impedance to measure luminal cross-sectional area (CSA) prior to or after angioplasty for stent sizing and deployment. It also has potential applications for plaque characterization.

Iam the senior technologist at Sacred Heart Medical Center (SHMC) in Eugene, Oregon. I have worked here for 27 years and have been a part of the growth and continued “maturity” of our invasive cardiovascular program. We have continued to be a combined department with five procedure rooms: (2) dedicated coronary; (2) dedicated specials; and (1) dedicated EP lab. Sacred Heart is the third busiest hospital in Oregon with staff that is knowledgeable and experienced in all vascular procedures.