Cath Lab Digest - January 2008 - (Page 16)

16 SPOTLIGHT continued from page 1 JANUARY 2008 Central Baptist Hospital Our cardiac observation unit, prepost procedure area staffing consists of 16 RNs, 3 patient care techs, 2 health unit coordinators, 1 clinical nurse manager, and 1 administrative assistant. Staffing longevity ranges from one year to over 20 years. For the third year in a row, Central Baptist Hospital has been recognized among the top 10 Best Places to Work among large companies in Kentucky. What type of procedures is performed at your facility? Routine procedures include diagnostic catheterizations, cardiac interventions and stents (drug-eluting and bare metal), Rotoblator (Boston Scientific, Natick, MA), intra-cardiac ultrasounds and AngioJet (Possis Medical, Inc., Minneapolis, MN). We perform an average of 400 cardiac cath procedures including stents, thrombectomies and permanent pacemakers, per month. Our facility has seen a significant increase in vascular procedure volume. Two of our five cardiac cath labs are equipped for peripheral use. One lab has anesthesia setup available as well. We have been performing carotid stent procedures for over 3 years, and had the second-highest patient enrollment in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) trial. Does your cath lab perform primary angioplasty with surgical backup? Our facility performs primary percutaneous coronary intervention (PCI) with surgical backup 24/7. The cath labs and operating rooms are located on the same floor of the heart institute. What procedures do you perform on an outpatient basis? We perform pacemaker generator changes and left heart catheterizations as outpatients. What percentage of your patients is female? 46% What percentage of your diagnostic cath patients go on to have an interventional procedure? Approximately 37% of diagnostic cath patients have an intervention. Who manages your cath lab? Nanette Jackson, RT(R), is the Director, Cardiovascular Services. Dr. Hal Skinner is Medical Director of the Cath Lab. Dr. Michael Jones is Medical Director of the Baptist Heart and Vascular Institute. The Baptist Heart and Vascular Institute board consists of physicians and administrative staff who oversee the cardiac services operations. Do you have cross-training? Who scrubs, who circulates and who monitors? Each cath lab team consists of 3 staff members, a mixture of RNs and radiologic technologists. The RT(R)s primarily scrub with the physician, and RNs are responsible for circulating, giving medications and patient assessments. RNs have learned to scrub as a personal goal, but are not required to do so. Patient monitoring is performed by either a RN or a RT(R). Before staff is scheduled to monitor independently, they must pass a competency exam that covers numerous areas, including rhythms, waveforms, and documentation. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? One RT(R) is always present in each cath lab procedure. Which personnel can operate the xray equipment (position the II, pan the table, change angles, step on the fluoro pedal) in your cath lab? An RT(R) and physician pan and operate the x-ray equipment in the cath lab. What are some of the new equipment, devices and products introduced at your lab lately? We have 4 fixed iLab ultrasound units (Boston Scientific) installed in our labs and one Stereotaxis Magnetic Navigation System (St. Louis, MO) for interventional cardiology. Can you describe the system(s) you utilize? We use the Axiom Sensis (Siemens Medical, Malvern, PA) for hemodynamic Left to right: Michael Jones, MD, Medical Director of Baptist Heart & Vascular Institute, and Gary Boliek, MD, Medical Executive Committee Member, BHVI Board Member. Left to right: Trish Shearer, RT(R), Debbie Gatewood, RN, BSN, Cath Lab Educator, Renee Adkins, RN, Lemont Humphrey, Transporter, Michelle Irvin, RN, and Jai Benton-Lee, RN. and clinical data monitoring, Axiom Artis (Siemens) for radiography, and Volcano Corporation’s FloWire (Rancho Cordova, CA) and the iLab for intravascular ultrasound (IVUS) imaging. Our Sensis system is interfaced with billing and patient information management, which has improved overall charge efficiencies. The AGFA/Heartlab digital archiving system (Westerly, RI) has been in place for over a year and includes web access for viewing outside the facility. How is coding and coding education handled in your lab? We have two dedicated nurse auditors that audit all cath procedures. Nurse auditors communicate with a corporate charge master who approves and verifies all procedural and supply charges. How does your lab handle hemostasis? Our physicians hold varied opinions on hemostasis and closure devices. Some opt to use closure devices frequently and others opt for manual pressure for any interventional procedure. Several of our physicians use 4 French diagnostic catheters routinely, which has minimized patient discomfort, decreased time holding pressure, and reduced bed rest for patients. The most commonly used hemostasis devices at this facility are Angio-Seal (St. Jude Medical, Minnetonka, MN), Starclose (Abbott Vascular Devices, Redwood City, CA), Perclose (Abbott) and SyvekPatch (Marine Polymer Technologies, Danvers, MA). Our department includes a state-ofthe-art, 30-bed pre/post CardioVascular Observation Unit (CVOU). Patients enter at the CVOU and are prepped for their procedure. If a PCI procedure is done, they go to the hospital’s postinterventional unit, which is easily accessible from the cath labs. If the patient is being discharged after the procedure, they return to the CVOU for recovery and discharge. At present, about 50% of our patients are discharged the same day from the CVOU. Does your lab have a hematoma management policy? Central Baptist’s hematoma/

Table of Contents Feed for the Digital Edition of Cath Lab Digest - January 2008

Cath Lab Digest - January 2008 Central Baptist Hospital Contrast Media Use in High-Risk Patients An Ergonomic Survey of Cath Lab Repetitive Stress Injuries Contents Clinical Editor’s Corner Takotsubo Cardiomyopathy, a.k.a., Transient Left Ventricular Apical Ballooning Syndrome: An Acute Coronary Syndrome Imposter Searching for the Key to D2B STEMI Intervention News STEMI Interventions: Commentary The Massachusetts Stent Study The Value of Educating Staff Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab SICP* Chapter Updates The Society of Invasive Cardiovascular Professionals Holds an RCIS Review Course at New Cardiovascular Horizons 18:20 To Denver — One Student’s First Clinical Experience CEU Education Center Meetings Calendar What Do You Think? Clinical & Industry News Classifieds The Ten-Minute Interview with…Heather Vardon, RN Advertisers Index

Cath Lab Digest - January 2008

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