What is the size of your cath lab facility and number of staff members? We currently have one cath lab and have a nurse manager, unit assistant, 5 registered nurses (RNs), 3 cardiovascular technologists (CVTs) and 2 radiologic technologists (RTs). The newest member has been here 3 months and our longest has worked here 4 years. We had a staff turnover when the lab went from diagnostic-only to interventional in 2004. Staff experience ranges from 1.5 years to 24 years.

Introduction. FMD is a non-atherosclerotic, non-inflammatory disease that predominately affects the renal and carotid arteries, although it has been described in all vascular beds.1 Approximately 60–75% of all FMD cases involve the renal rather then the carotid vessels; the renal predilection, however, may be greater in children. FMD more commonly affects women and younger individuals, though the sex distinction has not been proven in children. While its pathogenesis is not completely understood, hormonal, mechanical, and genetic factors, as well as mural ischemia, are thought to play a role. The natural history may be relatively benign, with progression occurring in only a minority of the patients. Depending on the arterial layer that is affected, the disease may be characterized by multifocal, tubular, or focal stenosis, which is a narrowing of the arterial vessel caused by a deposition of collagen that extends into the lumen. In addition to stenosis, vessels with FMD may dev

Introduction. We present a case of an 83-year-old man who developed a pulmonary embolism (PE) and then suffered a cerebral vascular accident (CVA) three days later as a result of an unsuspected patent foramen ovale (PFO). This example emphasizes the importance of considering and identifying a PFO as an unsuspected cause of CVA, especially in the setting of proven venous thromboembolic disease.

Patient safety is always a primary goal in any hospital and radiation safety ranks high on the list of safety items for a catheterization laboratory. The U.S. Nuclear Regulatory Commission (NCR) and the Food and Drug Association (FDA) regulate the use of radioactive materials in medicine and the manufacture of devices that emit radiation, respectively. The Joint Commission (TJC), more commonly referred to as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), also regulates safety through its accreditation process. JCAHO has made the statement that “prolonged fluoroscopy with cumulative dose >1500 rads to a single field or any delivery of radiotherapy to the wrong region or >25% above the planned dose”1 constitutes a reviewable sentinel event. Since that recommendation, medical facilities have been under intense pressure to provide the safest possible environment for radiation safety for their patients.

I read with great interest and considerable consternation two recent editorials by Dr. Morton Kern in Cath Lab Digest. His observations that left ventriculography (August 2007) and crossing the aortic valve (September 2007) are today often considered obsolete by the cardiology community deserves serious discussion.

Cath Lab Digest talks with Rajesh M. Dave, MD, FACC, FSCAI, Chairman, Endovascular Medicine, Pinnacle Health Heart and Vascular Institute Harrisburg Hospital, Harrisburg, Pennsylvania about his thoughts on the challenges and research behind this procedure.

This monthly column in Cath Lab Digest reviews important points of distinction in drug-eluting stents, from characteristics to techniques, to provide valuable and relevant information about this technology.

Introduction. We hereby present a case of distal right coronary stent deployment across a previously undetected ostial occlusion of the posterolateral branch during an acute myocardial infarction. Repeat catheterization at 18 months subsequently revealed an open stent with a newly patent side branch. While many techniques have been proposed to avoid side-branch occlusion with “stent-jail,” our case illustrates the rare opposite occurrence of incidental and spontaneous side branch “jail-break.”

At Corazon, we receive hundreds of resumes every year for cardiologists, surgeons, cath lab directors or managers, cardiovascular administrators, clinical/business consultants, and other heart and vascular-related positions. But, only a small percentage of these are ever taken into consideration by us and/or our clients.

On August 1, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule that updates the Hospital Inpatient Prospective Payment System (IPPS) for Fiscal Year (FY) 2008. This Final Rule will be effective October 1, 2007, and according to CMS, reimbursement for hospitals that report quality data is expected to increase by an average of 3.5%. Overall, the estimated payment to 3,500 acute care hospitals increases by approximately $3.8 billion.

Voltaire said, “Appreciation is a wonderful thing: It makes what is excellent in others belong to us as well.”

Cath Lab Digest talks to both a physician and a technologist about their experience with the Runthrough NS (Terumo Interventional Systems, Somerset, New Jersey).

“There seems to be some confusion about how respirations affect intracardiac pressures and how to properly read them.” — Anonymous email to tginapp@rcisreview.com

The outside of the big blue bus catches your eye, but what’s inside blows you away. Even for an old-timer, the look and feel of the cath lab is uncanny. For new students, the thrill is electric! The mannequin speaks. The flouro virtually pulls you into the case. The touch of the catheter is realistic. All of this is a world away from the lecture room. If an instructor could wish for an ideal tool for combining classroom theory with real-world practice, it would be a clinical simulation lab.

Three years ago, a group of employees at the Washington Hospital Center’s cardiac catheterization laboratory came up with an idea for furthering the knowledge and skills within the lab by hosting an educational fair on the weekend. The goals of this “fair” were to provide a fun and exciting atmosphere so that nurses and technologists could deepen their knowledge of anatomy, new devices, modalities, pharmacology, etc., as well as learn new, relevant skills.

Selected abstracts from March 2007 through August 2007 Full article text can be obtained at www.invasivecardiology.com. All abstracts are reprinted with permission.

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

ABSTRACT: Background. The radial approach to cardiac catheterization is increasingly popular due to shorter procedural and recovery times, and greater patient comfort. Methods. Comparative cost analysis between radial or femoral (with/without closure device) approaches were performed. Results. Radial (R), femoral (F), and femoral with a closure device (F ± C) approaches were used in 70, 62 and 49 consecutive cases, respectively. Group R had higher access equipment cost ($93.0 ± 9.5 vs. $40.5) than Group F (p < 0.001), but lower catheter cost ($19.7 ± 12.7 vs. $31.1 ± 9.3; p < 0.001) than Group F, and lower contrast cost ($26.9 ± 17.0 vs. $42.9 ± 25.0) than Group F ± C (p < 0.001). There was a lower post-procedure recovery cost ($185.2 ± 52.7) in Group R compared to $337.5 ± 59.0 in Group F (p < 0.001) and $208 ± 70.4 in Group F ± C (p < 0.001), with a median recovery time of 126.0 ± 36.0 minutes in Group R vs. 240.0 ± 42.0 minutes, and 150.0 ± 48.0 minutes i

Your patient is on the way to the cath lab. Your routine pre-cath check shows the chemistry and blood counts to be abnormal:

Introduction. Fluoroscopic procedures may involve high radiation doses to both patients and staff. Quick and accurate positioning of the patient and image intensifier, combined with good radiological/surface anatomical awareness generally comes with experience, and is learnt by performing procedures in real life.

I have been a Registered Nurse (RN) for more than half my life. After entering critical care in 1981, I obtained my ACLS certification. In 1984, I achieved my CCRN and received my BSN from the University of South Alabama in 1986. In 1990, I moved from the CCU to the cath lab, and have remained there ever since.