A patient who has renal insufficiency before the administration of contrast material is five to 10 times more likely to develop contrast-induced renal failure, (also known as contrast-induced nephropathy, CIN) than patients in the general population. Contrast-induced renal failure is related to the dose of contrast material used. Intravenous (and likely intra-arterial) administration of contrast material is responsible for more than 10% of cases of hospital-acquired renal failure. The incidence of renal failure following contrast administration is relatively uncommon, occurring in 0.1 to 13 pe

What is the size of your cath lab facility and number of staff members?

We have six invasive suites:

3 cardiac catheterization,

diagnostic/interventional

1 multi-purpose

1 electrophysiology (EP) lab

1 peripheral angiography lab

All labs are single-plane.

A 24-bed prep & recovery unit is immediately adjacent to the labs. Eight of the 24 beds are staffed on all three shifts from Monday to Saturday noon. The labs are scheduled Monday through Friday from 0700 to 1700. The remaining hours are covered by an on call team.

The staff consists of ap

The cardiac alert system at Memorial Hospital activates several in-house groups, the cath lab team, and a cardiologist to respond to the emergency department.

As the ambulance transported the patient to the hospital, the cardiologist and cath lab teams were also responding. By the time Mr. Jones arrived in the emergency department, the cath lab crew had readied the procedure room and the cardiologist was with the ED physician, ready to receive the patient. Minutes later, Mr. Jones was taken to the cath lab, where his blocked artery was opened with primary angioplasty by the interventional cardiologist. Time from door to open artery: less than 60 minutes. Reality or fantasy?

Setting the Scene: Inova Heart and Vascular Institute

Inova Heart and Vascular Institute is part of Inova Health System, a not-for-profit health care system based in Northern Virginia that consists of six hospitals and other health services including emergency, urgent care centers, home care, nursing homes, mental health, blood donor services, and wellness classes. Inova is governed by a voluntary board of community members. Our mission is to improve the health of the diverse community we serve through excellence in patient care, education and research.

Established in 1961, Inov

Retrofitting a cath lab as part of a major facility project requires multiple approaches to meet often-complex phasing issues. Cath labs must remain operational throughout any project and construction must impact the staff as little as possible. The following four steps are key to achieving success:

Gather extensive data

Evaluate design approaches

Openly communicate with all parties throughout the design phase

Phase construction to maximize the hospital’s investment while minimizing disruptions for patients, their families and staff.

One Facility’s Experience

What were some of the issues in treating certain vessel sizes in the past?

Five years ago, any vessel less than 3.0 mm in diameter was considered a small vessel. Now, small vessels are those that are less than 2.5 to 2.75 mm. Treating disease in these vessels is becoming more critically important, both in terms of women with heart disease and in diabetic patients who may have long diffuse disease. Furthermore, if you perform an angioplasty or stenting in a proximal vessel, it is still imperative to maximize blood flow to the muscle itself by ensuring smaller run-off vessels are open.

Can you help your fellow professionals with the following NEW question?

Nitric oxide for RH Caths

Does anyone have a written procedure for right heart cath studies using nitric oxide inhalation to determine pulmonary artery reactivity for treatment for pulmonary hypertension?

Debbie Herndon
Email: debohern@msn.com
cc: cathlabdigest@aol.com

Ongoing Questions

CMS Website & CAS

We have a question to pose to hospitals that are CMS-certified for carotid stent placement. We have recently been told that we are not a certified hospital whe

I want to start studying for my registry. Can you suggest any resources I could use to study?

Sure. I went a couple of routes. First, I used Wes Todd’s review books. They were a great help and I would recommend them to anyone who is taking the registry seriously. There is a lot of great information and critical thinking questions in his review book. I can honestly say that if I didn't use his book, I would not have been as prepared as I was for the test. Second, get a group of people together and study in a group. I always find that if I have to teach someone something, I retain t

These were older labs with older equipment and they were definitely in need of eventual replacement. We decided to get a modular lab because we saw a major shift in our market. Our volumes underwent an incredible increase as a result of a cardiology group coming over to our facility. In 2002, prior to the increase in volume, we performed 800 cath procedures and 245 electrophysiology procedures. After the cardiologists moved a significant portion of their business to our facility, we were performing approximately 1,500 cath and 750 electrophysiology procedures annually.

Our labs were bein

At the Crossroads offers a change of pace from our usual clinical fare. Here we can read about the life endeavors of our patients. It may help us remember that this patient in front of us on the cath table is not #5 for the day in this room with Dr. Whatever, but rather a fellow human being with an interesting story or two to share.