What is the size of your cath lab facility and the number of staff members? We currently have four Philips Integris labs (Bothell, WA). One is designated for electrophysiology procedures (EP). Our newest lab, a Philips FD20 with flat detector, was installed last year and is being used for both cardiac and peripheral procedures.

On March 17, 2005, the Centers for Medicare and Medicaid Services (CMS) issued a decision memorandum supporting the use of carotid artery stenting (CAS) with embolic protection as a reasonable and necessary treatment for symptomatic patients having a carotid artery stenosis ≥ 70%, and symptomatic or asymptomatic patients enrolled in a clinical trial or a post market surveillance study who have a 50–70% stenosis or ≥ 80% stenosis, respectively. Patients within each of the three categories must be considered at high risk of complications from carotid endarterectomy (CEA). The CMS decision was based on supportive safety and efficacy data of a randomized clinical trial that compared CEA to CAS (SAPPHIRE by Cordis Corporation) and a CAS registry (ARCHeR by Guidant Corporation) that compared results to historical controls. Several low-risk CAS clinical trials or registries are in progress; the objective of these being a comparison of major adverse cardiac and cerebrovascular eve

Dr. Mario J. Garcia and colleagues investigated the diagnostic accuracy of 16-row multidetector computed tomography (MDCT) for the detection of obstructive coronary disease in a multi-center study, Coronary Assessment by Computed Tomographic Scanning and Catheter Angiography (CATSCAN).

Technology advances in the field of percutaneous coronary intervention (PCI) have significantly decreased the time it takes to perform individual tasks. Yet despite these advances in technology and the resulting time savings, cardiac catheterization labs often continue to struggle within the constraints of old systems and processes. This mindset and lack of action may be due to unrealized time savings or an unwillingness to change, in keeping with the fallacy “If it isn’t broken, don’t fix it.” As technology continues to advance, healthcare providers are caring for a more informed and technology-driven patient. It will become increasingly difficult to rely on the cliché that “we have always done it this way.” It is imperative to maximize time-saving, while also improving the safety and quality of care that is delivered to patients. This has become more evident with the recent Medicare proposal of a five percent decrease in physician reimbursement and a three percent increase in outpati

Advances in interventional cardiology have enabled operators to increase proficiency, while minimizing patient injury and risk. Other technological advancements, seen in areas of minimally invasive medicine, such as robotic-assisted surgery, have inspired engineers to explore approaches for improving outcomes and decreasing technical failure rates for percutaneous coronary interventions (PCI). Furthermore, the volume of patients that are now being referred to PCI and the time demands placed on interventional cardiologists, put operators at increased risk of occupational hazards. The ability to improve safety and the personal health of operators while maintaining the outcome of these procedures has lead to the development of beneficial technologies, such as Corindus’ CorPath™ (Auburndale, MA), a remote control catheterization system that allows operators to mechanically maneuver devices as specified by the physician using a remote workstation. CorPath is designed to use conventional gui

New interventional procedures combining magnetic technology with cardiac catheterization require close collaboration and creative thinking.

The introduction of drug-eluting stents (DES) has dramatically reduced restenosis, enabling percutaneous coronary intervention (PCI) to emerge as the cornerstone revascularization therapy for patients with atherosclerotic coronary artery disease (CAD). Available DES address many routinely encountered lesions. Despite these advances, the treatment of bifurcation lesions continue to be problematic, with high rates of thrombosis and restenosis. Many strategies for treating bifurcation lesions using currently available stents have been tested with variable levels of success.1 The purpose of this article is to 1) characterize the problem of vascular bifurcation disease, 2) review current approaches used to treat bifurcation lesions with standard ‘workhorse’ stents, and 3) introduce the Tryton Side-Branch Stent™, which is in early clinical trials and shows promise in being a solution to this problem.

In 1988, Alton Memorial Hospital, a 222-bed non-profit community hospital, opened a diagnostic cardiac catheterization lab to supplement non-invasive testing, which included holter monitoring, echocardiography, and nuclear and pharmacologic stress testing. In December 2000, Alton Memorial Hospital began a primary angioplasty program that subsequently evolved into an elective program in 2002. Since that time, the Alton cardiac program has expanded to include a variety of other cardiovascular services, including enhanced external counterpulsation (EECP), cardioversions, pacemaker and ICD implants, peripheral vascular interventions, and a cardiopulmonary rehabilitation program.

There is a lot of buzz circulating about “RFID” right now. What is RFID and how does it help hospitals and, specifically, cath labs? Radio Frequency Identification, or RFID, is a means of identifying a specific object through the use of a unique identifier. Identifying information resides on a freckle-sized computer chip that is generally contained on a tag or label. Soon, label makers will begin to incorporate this technology into printed labels themselves. The two primary types of RFID tags currently available are “active” tags and “passive” tags. Active tags are designed to track movement and location for high-value, permanent items, and are frequently used for asset tracking (e.g., medical equipment, furniture, and computers). Passive tags are more often used for consumable items (e.g., balloons, stents, and pacemakers). The low cost of the tags (about 40 cents each) makes this an ideal application for consumables because they can be thrown away with the packaging. There are two

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

I currently live in upstate New York with my wife, Melissa and our four children: Kaitlyn, Zachary, Andrew and Teaghan. I started my healthcare career as an EMT, then went to Hudson Valley Community College’s CVT program. I am currently an adjunct instructor in the same program. I work in the cardiac cath lab at Ellis Hospital, located in Schenectady, New York.

Selected abstracts from June 2006 – September 2006.

Multiple new and ongoing questions from readers. Your responses are welcome! Answer or pose a question at cathlabdigest at aol. com.

I work in a cath lab in California. One of our physicians has asked if the staff could access the femoral artery and insert the sheath for him. We have two respiratory therapists that are working as CVTs. I know that the scope of practice for RTs includes arterial sticks. What about the RNs and techs? Can they be certified to access the arteries? I am having trouble finding out if this is okay. Do you have any info on this subject? – Arlene

I have received several inquiries regarding the limits of what a cath lab nurse or tech should be able to do in the lab. One staff member commented, “At my hospital we get diagnostic (cardiology) fellows and an occasional interventional fellow from a nearby city. At that [presumably university] hospital, the tech just stands at the foot of the table and pans for the whole procedure. A scrub tech is also present whose sole function is to pass the physician his wires and catheters. The physician does it all. The scrub tech is not even allowed to suture the sheath into the skin.”