Cath Lab Spotlight

Community Medical Center

Thomas Gayles, RN, BSN
Thomas Gayles, RN, BSN
We have 17 staff members, comprised of RNs and RTs. We also have one medical secretary and a scheduling coordinator. Our staff experience ranges from 20 years to two months. Our Cardiac Cath Lab Director is Dr. Kevin Olsen. We established our heart program seven years ago and are currently in the process of expanding into another cardiac room, will be finished in early August. What type of procedures are performed at your facility? We perform PCIs, diagnostic caths, EP procedures (pacers and defibs), and also peripheral procedures. Peripheral procedures include renal, iliac, subclavian, dialysis grafts, and SFA angioplasty and stenting. We have been performing these procedures for 7 years, with staff being trained on-the-job with an experienced radiological technologist. Shortly, we will be utilizing SimSuite (Medical Simulation Corporation, Englewood, Colorado) for cardiac and peripheral training. We also perform AngioJet® (Possis Medical, Inc., Minneapolis, MN) procedures, intravascular ultrasound and brachytherapy (Beta-Cath System, Novoste Corporation, Norcross, GA). Currently, our weekly totals are: 20 peripheral procedures 15 EP 40 cardiac catheterizations 15 PCIs (A total of 4,680 procedures annually). Does your cath lab perform primary angioplasty with surgical backup? The surgeons are made aware that we are doing primary angioplasty, but are not always in the hospital. In the case of needing direct standby, the surgeons will maintain an open room in the cardiac suite. If direct standby is necessary, we schedule it with the OR secretary and they dedicate a room for us. What procedures do you perform on an outpatient basis? All of our procedures are available as outpatient. The majority of our patients are outpatients and most are discharged the same day. What percentage of your patients are female, and what percentage are obese? In our geographic area, 40 percent of our patients are female and 65 percent are obese. Who manages your cath lab? Currently, an RN, BSN, manages us and he reports to the Director of Ancillary Services, Robert Bonczek. Do you have cross-training? Who scrubs, who circulates and who monitors? Yes. We strongly believe in cross-training and the only function that is not cross-trained is medication administration. Otherwise, all personnel are trained in scrubbing, circulating, monitor, and pacer insertion. Due to the fact that we are all cross-trained (including the manager), the lab flow-through is very efficient and it makes for minimal delays, if any, in the daily schedule. Does your lab have a clinical ladder? We don’t have a clinical ladder yet, but there is a lot of talk in that direction. This is being pursued in order to develop fairness in pay scales amongst the staff. We are also pursuing magnet status at our hospital and hope to complete this in 3 years. What are some of the new equipment, devices and products introduced at your lab lately? Recently, we have purchased AngioJet and the Galaxy IVUS system (Boston Scientific, Maple Grove, MN). We have looked at these items due to physician request in treating cardiac emergencies with clot burden and also to use AngioJet for our peripheral patients. Is your cath lab filmless? Yes, we have been filmless for 5 years now and also have a central archive by Heartlab (Westerly, RI). Utilizing this archive system has increased efficiency for film processing. The physicians can review images at their offices or throughout our hospital. How does your lab handle hemostasis? We use approximately 85% closure devices and if not, we do manual compression. Currently, we are using: Angio-Seal (St. Jude Medical, Minnetonka, MN), SyvekPatch (Marine Polymer Technologies, Danvers, MA) and Perclose (Abbott Vascular Devices, Redwood City, CA). We also use Safeguard (Datascope Interventional Products, Mahwah, NJ) when appropriate to manage any bleeding. Since we can establish an earlier discharge time, we have found the benefit outweighs the cost of closure devices. Due to the lack of beds in our organization, closure devices have allowed us to increase our caseload without increasing demand on the hospital. Does your lab have a hematoma management policy? Yes. Currently, the physician will decide how to handle hematomas, either by manual pressure or with the FemoStop® device (RADI Medical Systems, Reading, MA). How is inventory managed at your cath lab? At this point, we do all inventory by hand and the cath lab manager handles purchasing and ordering. We utilize two technologists, who on a daily basis, oversee the stock and order when needed. Very shortly, we will be looking at a bar code system to replace this method. We are in the process of obtaining quotes for various systems and then having them reviewed by the person in charge of capital equipment. Has your cath lab recently expanded in size and patient volume, or will it be in the near future? By early August, our EP program will be relocated to our Operating Room area and we will have converted the EP room into a 9-inch GE Innova room (Waukesha, WI). This will allow us to expand our current cardiac program. Is your lab involved in clinical research? Not at this time. Does your lab perform elective cardiac interventions? Yes, the majority of our interventions are elective and we have a call team available 24/7 for emergencies. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? Yes, we have had a coronary perforation. After the perforation, we attempted to use a perfusion balloon and long inflation. This was unsuccessful and we were unable to cross the lesion with a stent, so a discussion was held between the cardiologist and CT surgeon. It was then decided to proceed to surgery. What measures has your cath lab implemented in order to cut or contain costs? Every year we have a contest in our lab, with the staff breaking off into teams of three or four and presenting cost-savings ideas. The top savers receive a prize. This year, some of our ideas included dye savers, the SyvekPatch, purchasing our own scrubs, and Acist device usage (Bracco Diagnostics Inc., Princeton, NJ). We are also hoping to turn this tradition into a hospital-wide project with every department looking at areas of cost savings. What type of quality control/quality assurance measures are practiced in your cath lab? We are studying hematomas, patient education and physician timeliness. At present, we have developed patient education bags, which include various information on dieting, medications, etc. These bags are given to patients at discharge and have become quite popular. How does your cath lab compete for patients? Has your institution formed an alliance with others in the area? We try to provide the cardiologists with a majority of the current products available in order to give them a bigger breadth of product. We are also available to perform cardiac procedures with peripheral to follow due to our peripheral capabilities. From an educational standpoint, we provide a cardiac/ peripheral symposium in our area on a yearly basis, called the CMC Cardiovascular/Peripheral Interventional Symposium. We perform live cases which are televised to the conference. Through our strong line of products and live symposiums, we have established a State of the Art campaign. How are new employees oriented and trained at your facility? We have a strong orientation process with a preceptor program and educational material throughout the process. Training is on-the-job, and we also have the SimSuite available only one hour away in Danville, PA. We have been given a specific number of hours to utilize. What type of continuing educational opportunities are provided to staff members? In addition to the CMC Cardiovascular/Peripheral Interven-tional Symposium, we are developing a cath lab library in our area of the hospital. It will be complete with journals, CDs and a laptop computer. The library will hopefully be done by the end of August. How do you handle vendor visits to your lab? Our scheduling coordinator assigns days to our various sales representatives and we allow one sales representative per day. They are allowed in our control room area only. They must first report to purchasing and it is mandatory that they wear a badge. How is staff competency evaluated? We have yearly evaluations and quarterly validations on certain procedures. Quarterly validations are for high-tech equipment such as the AngioJet, rotational atherectomy, the Polarcath system (CryoVascular Systems, Los Gatos, CA), and brachytherapy. Does your lab utilize any alternative therapies, such as guided imagery, etc.? No. How does your lab handle call time for staff members? Presently we have one call team which rotates daily, with 1 RT and 2 RNs, or vice versa. We also have three different start times in order to decrease overtime and accommodate later scheduling of procedures. Our start times are from 7 am, 7:30 am and 8:30 am for the call team. What trends do you see emerging in the practice of invasive cardiology? I feel that brachytherapy and the new Polarcath system will be a new treatment advantage in our peripheral area. Our Taxus (Boston Scientific Corporation, Maple Grove, MN) usage is 85%, Polarcath has been very successful on 90% of our SFA angioplasties, and we have a 0% restenosis rate at this point. Has your lab undergone a JCAHO inspection recently? Yes, we have gone through two surveys thus far. We have held bimonthly hospital meetings to review updates for specific departments and have done dry runs monthly. At this point, we are specifically looking at H&Ps and HIPAA regulations. Where is your cath lab located in relation to the OR department, ER, and radiology department? Our lab is located on the second floor, along with the OR. The radiology department and ER are on the first floor. Please tell readers what you consider unique or innovative about your cath lab and its staff. Unique to our staff is a strong teamwork emphasis, and we have numerous exercises in order to maintain it. On a yearly basis, we have our Christmas and summer parties, along with several breakfasts that the staff makes together in the cath lab lounge. We also have theme parties every month (such as October’s Halloween party) where we dress up appropriately and have lunch provided. Is there a problem or challenge your lab has faced? How was it addressed? Our biggest dilemma is a lack of recovery space within our department to accommodate patients awaiting discharge or an inpatient bed. Some things we have initiated to improve patient flow are: Utilized ancillary recovery area with our own staff to increase our recovery bed capacity. Began doing complete nursing assessments and Kardex’s on patients waiting for a bed, to decrease workload of receiving unit. Attend bed management meetings twice a day to discuss our needs in conjunction with bed availability. By the end of August, construction will be complete, giving us 9 recovery beds. This should alleviate most issues. What’s special about your city or general regional area in comparison to the rest of the U.S.? We live in an older population and heavy retirement area, which keeps us in great demand for procedures. We are emphasizing women’s health awareness and PVD screening programs this year. Author Thomas Gaylets can be reached at