What is the size of your cath lab facility and number of staff members? Jewish Hospital has nine cath labs, including seven interventional labs and two electrophysiology (EP) lab/implant rooms. We have 85 full-time employees (FTEs) within our department. Our FTEs are comprised of registered nurses (RNs), registered radiology technologists (RT[R]s), cardiovascular technologists (CVTs), patient service associates (PSAs), a transporter, supply associate, scheduler, department secretary, and two unit secretaries. The Louisville General Hospital (now closed) supervised the cath lab at Jewish Hospital from 1971 to 1983. The staff consisted of General Hospital employees until 1983. At that time, Jewish Hospital hired its own employees to work in the cath lab. There were no CVTs employed in the lab prior to 1987.

Can you discuss how laser atherectomy has evolved and overcome some of its initial challenges? Laser technology, as well as the catheter design, has evolved over a period of years to make the device safer and more effective. Early laser systems actually utilized a hot tip laser, which heated the tip of the catheter and also used a variety of wavelengths. Initial laser systems were not very successful. They caused damage to the arterial wall and were unable to penetrate especially difficult tissue. The early use of excimer laser was in late 1980s, when the catheter design was stiff and caused more perforation.

Percutaneous coronary intervention (PCI) of aorto-ostial lesions (AOL) represents a complex anatomic subset and can be associated with lower success as well as higher complication and restenosis rates.^1-3 Technically, precise guide catheter and stent placements are crucial. Inadvertent catheter tip engagement, even to a moderate degree, can result in dissection of friable ostial lesions. A disengaged catheter, however, may provide insufficient back-up support for device delivery. We propose a simple technique for maintaining catheter tip alignment proximal and adjacent to the coronary ostium, while allowing constant forward tension to facilitate stent advancement. We have repeatedly utilized this method with success. The following report illustrates a representative case as well as a review of other techniques for PCI of AOL.

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. This article, the last of a three-part series on drug-eluting stent education, focuses on misconceptions about drug-eluting stents. Part two, in last month’s issue, discussed communicating the benefits of this technology to patients.

Abstract. Studies comparing stents and optimizing post-procedural anti-platelet regimens abound. We should re-focus on optimizing stent deployment and maintaining a registry of how we are using and deploying drug-eluting stents.

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

Abstract. Background: The purpose of this study was to determine the effectiveness of a side shield radiation protection method designed to decrease the scatter radiation exposure experienced by operators during cardiac catheterization procedures. Methods and Results: The study included 50 patients undergoing diagnostic cardiac catheterization. Scatter radiation exposure was measured directly with silicone diode dosimeters. Radiation doses were measured outside of protective lead draping worn by the operators at the abdominal and thyroid levels. The mean fluoroscopy times were similar between the control group, 1.86 (± 1.27) minutes and the protected group, 2.47 (± 1.90) minutes. The number of recorded cine angiographic runs was also the same at 10.36 (± 2.86) and 10.29 (± 2.35), respectively. The mean waist exposures utilizing the radiation protection method were reduced by 54%, p < .007 and the mean thyroid exposure were reduced by 8%, p = non significant.

The American College of Cardiology (www.acc.org) represents the majority of board-certified cardiovascular physicians in the United States. Its mission is to advocate for quality cardiovascular care through education, research, promotion, development and application of standards and guidelines, and to influence health care policy.

The Society of Cardiovascular Angiography & Interventions (SCAI) was co-founded by the late Melvin P. Judkins, MD, with his colleague across the country, the late Dr. Mason Sones, both pioneers in coronary angiography. Today, neither would be surprised to learn that their tradition of educating colleagues working in the field continues at an even higher level than ever before through the annual SCAI symposium, named in Dr. Judkins’ honor. Dr. Warren Laskey, a former President of the SCAI who chaired the event for 10 of its 20 years in existence, said something I believe applies to those of us working in the field of coronary imaging and intervention: “The Judkins Cardiac Imaging Symposium anchors us to our past.” This unique educational symposium, dedicated to the cath lab and cardiac imaging, has evolved from a focus on simple and complex x-ray angiography to the newest imaging technologies available.

I am currently the Director of the Cardiac Cath Lab at North Cypress Medical Center in Cypress, Texas. I am an RN, BSN and I graduated from Northern Illinois University. I have also passed the Registered Cardiovascular Invasive Specialist (RCIS) exam and attained fellowship in the SICP.

Training and educating cath lab staff is an ongoing challenge in today’s rapidly changing and expanding interventional world. Many approaches exist to provide the information needed for nurses and technologists who work in this setting. One approach that has been successfully implemented in the Sacramento, California area is a program entitled Cath Lab & Beyond. Going strong since early 2001, Cath Lab & Beyond will be presented again May 8–11, 2007. It’s not too late to enroll!

I am studying for the RCIS exam, and I am overwhelmed by all the different catheters that different vendors offer and all the different names. Each vendor states that their catheter does something that no other catheter does. What do I really need to know for the exam? —RCIS Review Course Student

February 27, 2007 – Washington, D.C.

SICP Editor’s note: The SICP is proud to introduce Shirly Dawson. Shirly is a CVT in the cath lab at the Oregon Heart and Vascular Institute in Eugene, Oregon. She is an active member of the Oregon Chapter of the SICP (Society of Invasive Cardiovascular Professionals). Shirly will be writing a series of articles about teamwork. We hope you enjoy her work.