Cath Lab Digest - February 2008 - (Page 40)

40 SICP: PROFESSIONALS OUT IN FRONT FEBRUARY 2008 DRUG-ELUTING STENT SOLUTIONS The Ten-Minute Interview with… Debbie Charlton, RN Director of Cardiology Services Mobile Infirmary Medical Center, Mobile, Alabama have been in the healthcare industry since May of 1983. I started my nursing career in the critical care unit (CCU) while working in the Army Nurse Corps. Once I left the Army Nurse Corps, I was a flight nurse with the Air National Guard for 7 years. My last 17 years of nursing have been in the cardiac cath lab. I started out as a nurse at Vanderbilt University Medical Center in Nashville, Tennessee, and worked my way up to management, which included electrophysiology (EP), pediatric and adult patients. We started with 2 labs and progressed to 5 inpatient labs. We also built a 12-bed holding area and an outpatient swing lab. From there, I went to Shands AGH in Gainesville, Florida, where I was the director of cardiovascular services. I have now been working at the Mobile Infirmary Medical Center in Mobile, Alabama, for almost 3 years. Why did you choose to work in the invasive cardiology field? While working as a nurse in CCU, I was always the one who received the cath lab patients. I thought it was fascinating and exciting to hear what could be done for these patients and I wanted to be a part of that process. Opportunity opened the door for me with an opening in a cath lab and I took it. It has been the best decision I have ever made. Can you describe your role in the cath lab? My current role is Director of Cardiovascular Services at the Mobile Infirmary Medical Center, which includes 4 cath labs, 1 EP lab, a 21-bed holding room, a congestive heart failure clinic, and the Electrocardiogram (EKG) and Echo departments. I see my role as a multi-faceted servant-leader. It is my role to serve the patient/family, the staff and the physician. My role means being part cheerleader, part servant, part teacher, part counselor, part clinician, part risktaker, part advocate (staff as well as patient), and part listener…all rolled into one. What is the biggest challenge you see regarding your role in the lab? I would have to say the biggest challenge is balancing a budget with all the influencing factors of new technology, new product and reimbursement issues that we constantly face in this environment. What motivates you to continue working in the cath lab? I love the constant changes that this environment provides. I love working with the staff and the physicians. They all bring their own unique individuality to the department and they are able to provide wonderful service to our patients, who put their trust and faith in us. Making a difference in that patient’s life is what it’s all about. Is there an unusual case you have been involved with? I really can’t think of any unusual cases that I have been involved with. When I worked in the pediatric cath lab, I found some of the heart defects challenging but rewarding and a learning experience. When work gets stressful and you experience low moments (as we all do), what do you do to keep your morale high? I know that all areas experience these moments. I think you have to find what motivates each individual and get creative whenever possible. I think you have to support them as much as possible and get them through each difficult situation. We try to do “kudos” moments, pizza lunches, and/or meal cards to recognize those who have worked hard at making a difference. You have to allow people to vent their frustrations and work with their ideas on how to improve your labs or moments that are difficult to get The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents This monthly column in Cath Lab Digest reviews important points of distinction in drug-eluting stents (DES), from characteristics to techniques, so that physicians have valuable and relevant information about this revolutionary technology. By Lowell F. Satler, MD Dr. Lowell Satler, Director of Interventional Cardiology at the Washington Hospital Center, practices cardiology, internal medicine, and interventional cardiology in Washington, D.C. He is wellrenowned in the application of new coronary device developments in interventional cardiology. Dr. Lowell Satler has been practicing for 30 years. Q Recently, the Washington Hospital Center presented a unique analysis on the clinical impact of intravascular ultrasound (IVUS) on drug-eluting stent (DES) placement at the 2007 annual meeting of the American Heart Association. What was the objective for this novel analysis? DES have proven to be highly effective in reducing restenosis compared to bare-metal stents. Despite this, DES are not free of restenosis and are subject to stent thrombosis. IVUS has suggested that sub-optimal stent deployment is a significant etiology underlying both DES restenosis and thrombosis. Given the importance of optimal stent deployment in proper stent expansion and apposition to the vessel wall, it was intuitive that IVUS guidance should yield a clinical benefit. As a result, we examined the hypothesis that IVUS-guided percutaneous coronary intervention (PCI) with DES yields clinical benefit in terms of stent thrombosis and rate of major adverse cardiac events (MACE). What was the design of the study? We evaluated more than 1,700 DES patients at the Washington Hospital Center. Approximately half of these patients had IVUS-guided DES implantation and half had DES implantation guided only by angiography. Clinical follow-up was conducted at 30 days and one year. The patient groups were well matched in terms of their complexity. Pre-dilatation was less frequent in the no-IVUS group compared to the IVUS group (60 percent vs. 72 percent), whereas post-dilatation, rotational atherectomy and use of the Cutting Balloon® device was more common in the IVUS group. What conclusions came from this study? Which did you find particularly interesting? There were reduced thrombosis and repeat revascularization rates in the IVUS-guided cohort, suggesting that IVUS-guided DES implantation has the potential to influence treatment strategy. We further concluded that IVUS guidance should be considered for routine use during DES continued on next page I A Q A Q A

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

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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