Tell us about bleeding complications and safety with the radial approach.

Tell us about your cath lab.
There are a total of 6 cath rooms in our cath lab, with one room dedicated to pediatric cardiology. We have 2 separate electrophysiology (EP) rooms, and a total of 10 intake beds and 10 post procedure beds in the cath lab facility.

Also, in our facility, there is a separate large room for patient registration and another area (with 10 beds) for patient preparation prior to procedure on the same floor as the cath lab location.

Introduction
Patients with compromised left ventricular (LV) function benefit from LV unloading during high-risk percutaneous coronary intervention (PCI). The Impella 2.5 (Impella, Figure 1) is a minimally invasive, catheter-based cardiac assist device designed to directly unload the LV and thereby reduce myocardial work and oxygen consumption. The device augments cardiac output and improves coronary and systemic end-organ perfusion. We report on a patient with severe LV impairment who underwent a complex PCI while supported with the Impella, and had an uneventful recovery and hospital discharge.

Case presentation

As more and more hospitals transition from paper medical records to digital medical records, there is a need for a new role within the cath lab service area to support this transition and the accompanying tasks. One might be tempted to call this person something like “database clerk” or “CV information clerk,” but giving this person a minimal role and title would be a mistake. There are sufficient responsibilities to warrant a major role and title. One possible title might be “CVIS coordinator.” In this article, we will discuss how a CVIS (cardiovascular information systems) coordinator can work alongside the cath lab manager/director, clinical educator and other clinicians to improve the quality of the cardiovascular medical service.

CVIS coordinator responsibilities might include the following roles:
• Vendor product development
liaison
• Data standards committee member
• Outcomes database coordinator
• Process database coordinator

There is no doubt that the national initiative to save lives by reducing the time to reperfusion in the acute myocardial infarction patient is working and in full swing for STEMI receiving center cath labs. Reducing the door-to-balloon time (D2B) has been discussed in Cath Lab Digest almost every other month for many years. CLD strives to inform, train, demonstrate, and encourage all parties involved to shorten D2B times. Multi-center studies and even some single-center studies reinforce the benefit of streamlining the process of moving the patient from his home through the emergency department (ED) to the cath lab for angioplasty. The American Heart Association has educated the community in an effort to shorten the time it takes for the patient to recognize symptoms and call EMS. The evaluation of the patient by EMS has been shortened in some centers with transmission of the ECG by fax, phone or email, and activation of the cath lab from the field.

Reprinted with permission from Vascular Disease Management February 2010.

To read this article, please visit http://vasculardiseasemanagement.com/content/the-moma%C2%AE-ultra-proxim...

Reprinted with permission from The Journal of Invasive Cardiology 2009;21:575–582.

Please read the article in full at:
http://invasivecardiology.com/articles/Impact-Multislice-Computed-Tomogr...

Reprinted with permission from The Journal of Invasive Cardiology 2009;21:583.

Read the article online at http://invasivecardiology.com/articles/CT-Angiography-A-New-Crossroad

“I am new to the cath lab and have been sitting in on some vendor in-services. I’ve heard ‘Frank Starling’ a few times already, and I think it has something to do with heart failure. Can you explain what that is?”
– Received at http://www.facebook.com/RCISReview

We’ve used that term a few times in previous articles, and you will likely see it in future articles as well.

‘Frank Starling’ comes from 1914 when Otto Frank and Ernest Starling theorized that the length of the sarcomere [cardiac cell] is the driving force behind effective systole.1 Over the years, this has been abbreviated to be called the Frank-Starling Rule of the Heart. You might also see this as “law,” “mechanism” or “principle” (which I will use in this article). It’s all the same.

Hahnemann University Hospital’s cardiac catheterization laboratory, based in an urban teaching hospital, is one of the busiest in the region, performing thousands of procedures each year. The cath lab consists of four laboratories and a 13-bed holding area. It is staffed by six technologists, 10 nurses and three nurse aides with other ancillary assistance for inventory and administrative functions.

Through improving lab efficiencies, we can achieve operational excellence — a goal we all share. In sharing our story, we hope to share how inefficiencies can be minimized.

Problem/Opportunity
The cardiac catheterization lab was identified as having both remarkable strengths and significant weaknesses as a hospital department. The most substantial weakness of the lab was identified as inefficiency. This is a multi-factorial problem, due to staffing, staff culture, physician behavior, lack of patient readiness for procedure, patient transport and nursing units.