Cath Lab Digest - March 2008 - (Page 60)

60 ASK THE CLINICAL INSTRUCTOR What Do You Think? Multiple new and ongoing questions from readers. Your responses are welcome! Answer or pose a question at cathlabdigest@aol.com. New Questions Figure 2. Reprinted with permission from Wes Todd’s Cardiovascular Self-Assessment. This waveform is indicative of a restrictive pathology. There are elevated venous pressures, but the left ventricle (LV) and right ventricle (RV) are not equal, as they would be in constrictive diseases. Here, a “stiff” LV fills rapidly in diastole, then the pressure plateaus. This square root sign √ pattern is also described as a “dip and plateau pattern.” Cross-Training Duties In a cross-trained lab, do RTs and CVTs document equipment only and the RN separately handles the moderate sedation and patient care documentation? Thank you, Diane Cronin, BSN, RN Clinical Educator Invasive Cardiology Lahey Clinic Email: Diane.M.Cronin@lahey.org Cc: cathlabdigest@aol.com Staffing with Case Fluctuation I am doing some research into how to handle staffing when the census/# of cases fluctuates in the cath lab. Any suggestions about how to keep employees’ schedules relatively stable when the case load bounces around so much? Lois Roorda, RN Human Resources Business Partner Banner Heart Hospital Email: Lois.Roorda@bannerhealth.com Cc: cathlabdigest@aol.com presented with chest tightness upon exertion, progressive dyspnea and orthopnea. Echo indicated an ejection fraction of approximately 30%, compared to normal left ventricular function a year earlier. Bi-atrial enlargement was also present and there was a positive history of early aged sudden cardiac death in the family. Left heart cardiac catheterization was performed, which yielded normal coronary arteries. The left ventriculogram revealed obvious global myopathy with regurgitation into a very large atrium. (Angiograms can be seen at http:// www.rcisreview.com/AskTheInstruct orMarch2008.htm). With this history and normal coronaries, an infiltrative disease must be ruled out. At the time of this article, a definitive diagnosis is not available. When you have a ‘negative’ case after the patient had presented with acute coronary signs and symptoms, but cardiomyopathy is present, infiltrative disorders, such as amyloidosis, should be considered as a possible pathology. Next month, we will answer a question about procedures to evaluate aortic and mitral valves. ■ Manual Pressure References 1. Stedman’s Medical Dictionary for the Health Professions and Nursing, 5th edition. Philadelphia: Lippincott Williams & Wilkins, 2004. 2. Baim DS, Grossman W. Grossman’s Cardiac Catheterization, Angiography, and Intervention, 6th edition. Philadelphia: Lippincott Williams & Wilkins, 2000. 3. Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald’s Heart Disease, 8th edition. St. Louis: Saunders, An Imprint of Elsevier, 2007. 4. Grogan M, Gertz MA, Kyle RA, et al. Five or more years of survival in patients with primary systemic amyloidosis and biopsy-proven cardiac involvement. Am J Cardiol 2000; 85:664–665, A11. 5. Chamarthi B, Dubrey SW, Cha K, et al. Features and prognosis of exertional syncope in light-chain associated AL cardiac amyloidosis. Am J Cardiol 1997;80:1242–1245. Normal Caths & Standard Ambulation Times How does your institution handle the following items? 1) Do you track normal cardiac cath numbers? If so, how? If yes, what is the criteria in place that defines a normal cardiac cath (i.e., no blockages greater than 15% in any major artery greater than 2mm diameter)? 2) What are the standard ambulation times after a diagnostic cath using 5 or 6 Fr sheaths, when the patient has not received heparin. How long do you keep patients on bedrest after hemostasis is achieved? (Manual holds only, no devices used for closure.) For those responding to this question, do you know of any studies or articles/research that supports this ambulation time? Thank you! Annie Ruppert Email: Annie.Ruppert@sharp.com Cc: cathlabdigest@aol.com I work in the cath lab. My main job is to hold manual pressure on all post cath patients. I am trying to find out how many cath labs use manual pressure compared to closure devices. Do any other cath labs have one person that is responsible for holding pressure? Thank you! Tim Boylan Email: hematomas69@verizon.net Cc: cathlabdigest@aol.com Cross Training with Recovery Unit Due to some staffing issues in our cath lab and recovery units, our director of nursing wants cross-training between the areas. We are a 2-room cath lab that also does electrophysiology studies as well as pacer and ICD implants. In the lab, we have 3 fulltime (FT) RNs, 1 part-time (PT) RN, 3 FT RTs and 1 PT RT. The 12-bed recovery area has 5 FT RNs and 3 PT RNs. Does anyone cross-train with their recovery area? Our cath lab RNs do cover recovery for lunches and breaks. I am concerned about the constant changes within the lab and keeping the recovery staff up to date. Thank you! Sue Irwin, RN, Cardiac Interventional Educator St. Lukes Hospital, Maumee, OH Email: susan.irwin@stlukeshospital.com Cc: cathlabdigest@aol.com Data on Pre/Post Beds per CCL I am looking for data or research that supports the number of pre/post beds per cath lab. Are there any guidelines on recommendations ratios? Thanks for your help. Kind regards, Melissa A. Muller Cardiovascular Service Line Administrator Bronson Methodist Hospital Kalamazoo, MI Email: mullerm@bronsonhg.org Cc: cathlabdigest@aol.com “The only foolish question is one left unasked.” New Staff: Your suggested topics and questions are needed! (You are welcome to remain anonymous.) Email us at: tginapp@rcisreview.com http://www.rcisreview.com/AskTheInstructorMarch2008.htm http://www.rcisreview.com/AskTheInstructorMarch2008.htm http://www.rcisreview.com/AskTheInstructorMarch2008.htm

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

Cath Lab Digest - March 2008 Are You Being Paid Fair Market Value in 2008? A Cardiac Cath Lab Professionals Survey by Cath Lab Digest and the Society of Invasive Cardiovascular Professionals Saint Joseph’s Hospital Invasive Imaging Tools for Optimizing Coronary Stent Deployment Contents Clinical Editor’s Corner A Workflow Revolution in Cath Lab Reporting Advantages of a New Digital Lab at Baystate Medical Center Cardiac Computed Tomography: What Does it Mean for the Cath Lab? The Latest in Cardiac Magnetic Resonance Imaging (MRI) Cellular Cardiomyoplasty and Cardiac Regeneration Intravascular Ultrasound in the Cath Lab: A Powerful — and Underutilized — Tool to Improve Patient Outcomes The Stentplus™ Patient Success Program Cardiac Cath Lab Clutter — or, Spring into Action! Groin Bleeds and Other Hemorrhagic Complications of Cardiac Catheterization: A List of Relevant Issues Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab What Do You Think? Experience with a New Guidewire: The Terumo Runthrough NS The Ostial Pro™ Stent Positioning System: Perfecting Aorto-Ostial Stent Placement Precious Minutes The Ten-Minute Interview with…Mark Bowles, BSN, CCRN Vascular Care in the Cath Lab: Planning a Smooth Transition Cath Laughs CMS 2008 OPPS Final Rule Review An Extensive Set of Review Courses for the CCI Basic Science, Non-Invasive Echocardiography and Vascular, and ARDMS Ultrasound Exams Meetings Calendar CEU Education Center Clinical & Industry News STEMI Interventions Classifieds Advertisers Index

Cath Lab Digest - March 2008

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