What Do You Think?

Pre/Post Procedure Units I am in the process of researching articles about pre/post procedure units for the cardiac cath lab. We are looking at setting one up at the institution where I work. I am working on my Masters degree and looking at finding research-based evidence. From what I have heard and common sense, these units would appear to be a great idea for cath lab throughput, groin care and decreased complications, nursing/ physician collaboration, and overall quality of care for the patient. Does anyone know of any sources that specifically address any of these issues? Heather Email: hkalin@cox.net Cc: CathLabDigest@aol.com Editor’s note: Cath Lab Digest published an Email Discussion Group feature on the topic of pre and post procedure units in the April 2003 issue. The article can be found online in the archives section of www.cathlabdigest.com. Heparinized Contrast? Our cath lab currently heparinizes our contrast. Is this an institution-based concept or do other facilities do this as well? We are looking for information to address this issue. We originally started heparinizing the contrast when we stopped giving the patient routine heparin at the start of a diagnostic procedure. Currently we put 2,000 units per 200 cc bag of contrast. Any thoughts? Connie, Meriter Hospital, WI Email: csgehin@yahoo.com Cc: CathLabDigest@aol.com Cath Lab Inventory Managers Does anyone have any information on cath lab buyers? I have a great inventory manager/buyer, but feel that he is worth a lot more than we are paying him. I need some comparative salaries and job duties/descriptions. Any help would be appreciated. Thanks! (Anonymous) Email: CathLabDigest@aol.com Usage of FemoStop I am looking for information on usage of the FemoStop device either post diagnostic or interventional procedures. When a FemoStop is utilized post either procedure where do your patients recover? Do they ever go to a telemetry unit? Lastly, what is the usual duration that the device is placed for? Thanks! Email: t9261@epix.net Cc: CathLabDigest@aol.com H&Ps on Inpatients How are you handling having H&Ps on the charts of inpatients prior to their procedure? My issues are with the patients who are direct admits in the evening, and then are scheduled for a 0530, 0630, 0730, 0830 or 0930 cath. Are you refusing to allow patients who do not have an H&P on their chart to have their procedure? Thanks for any help/discussion on this issue. Email: carletta@weirtonmedical.com Cc: CathLabDigest@aol.com Cath Lab Staffing Models I am the Cardiovascular Laboratory Clinical Educator for the Mid-America Heart Institute, St. Luke’s Hospital, Kansas City, MO. I am researching cath lab staffing models to provide feedback to my vice president on this topic. Let me start with the fact that Mid-America Heart Institute is managed through a shared governance (a Physician’s Group and St. Luke’s Hospital, Vice President, who is a RN). The question that was asked was, How many cath labs use the multi-discipline staffing model, whereby all team members (this includes RNs) rotate through the different roles? The real issue centers around RNs being the only health care worker that can assess patients of the group, thereby, should be used in that capacity on each case. Has there been any research on staffing models used in the CCL and how many labs use each type? I ran a search but did not come up with much. Any assistance you can provide or any labs out there sharing their experience would be of great help. Sincerely, David Warren, RCIS, CVL Education Coordinator Mid America Heart Institute, Saint Luke's Hospital, Kansas City, Missouri Email: dwarren@saint-lukes.org Cc: CathLabDigest@aol.com DES and Liability With the current limitation of sizes, patients are waiting for DES to be come available before they undergo PCI. This has raised some liability concerns for us. We are looking at developing a release/waiver that patients would have to sign if they choose to wait for a DES to become available. Has anyone already addressed this and would they be willing to share their approach to the problem? Thanks, Karen Stair Email: KStair@wmhs.com Cc: CathLabDigest@aol.com A reader answers a question from our May issue: The Question: Multiple procedures, same room? I’m looking for any other facility that does cardiac cath, peripheral angio, and radiology/specials in the same room. We are currently doing cath and angio in the lab. The radiologists do a rare nephrostomy but also want to do biliary drainage/ERCPs. Looking for some thoughts on that subject. Any thoughts or help would be much appreciated. Pamela Ofman, RN, Cardiac Services Supervisor Indiana Regional Medical Center Indiana, PA Email: Pofman@indianarmc.org Re: Multiple procedures, same room I work at a smaller 250-bed hospital. Our cath lab has 2 Philips rooms. One of the rooms is a standard 6-, 7-, and 9-inch Image Intensifier that we do all of the cardiac cases in. We are cineless and both rooms are able to print hard copy films for all peripheral work. The other room has a larger Image Intensifier that has a 7-, 9-, and 12-inch field of view. We use that room for all of our interventional radiology cases. We have a group of radiologists who use that room. We will use the vascular room for overflow cardiology cases. However, the image quality is not as good with the larger II and with larger patients, we have a lot of white out. The vascular room is nice, as the tube is able to image from the cerebrals to the toes. The cardiac room has a fixed system and the tabletop floats, so you can basically get from the cerebrals to the iliacs. In our lab, we tend to run close to schedule in the cardiac room, which is scheduled on the hour. However, since we share the interventional radiologists with another hospital, they tend to run behind. That room is scheduled on the half hour. The IR also usually have not met the patients prior to the case, so they take some time talking to the patients in the holding area before we can even put them on the table. With the cardiac cases, we are able to get the patient on the table, prepped and draped before the cardiologist arrives. We are a lab of 2 RNs who give sedation and assess the patient. The 6 RTs rotate between scrubbing, circulating, monitoring, obtaining hemostasis, and putting in the charges. We do all kinds of IR procedures from runoffs, PTAs, embolizations, biliary drainage, perc. neph, IVC filters, pulmonary studies, renal art…ERCPs are done up in Radiology in the Diagnostic area. We also use the vascular room for most of the pacemaker and AICD implantations. This opens more time slots to schedule for cardiac cases. Good luck, and may your IR doctors have a better time table. Jodie Please send your questions or responses to Rebecca Yospyn at: cathlabdigest@aol.com