Cath Lab Digest - April 2008 - (Page 18)

18 SPOTLIGHT continued from page 1 APRIL 2008 Kaiser San Rafael Medical Center Our pre-op/recovery area has two beds and is staffed by the same staff. Our lab opened in October 2005. The staff had critical care and/or emergency department backgrounds. All staff was required to complete extensive training in San Francisco Kaiser’s highvolume cath lab. What procedures are performed at your facility? A wide array of procedures are performed at our facility, both cardiac and IR, including: • Bilateral cardiac catheterizations • Primary angioplasty and stenting on an emergent basis • Intra-aortic balloon pump insertions • Temporary pacer wire insertion • Pericardiocentesis • Peripheral artery angiograms and stenting • Peripheral and coronary atherectomy • Peripherally inserted central catheter (PICC) line insertion by MDs and RNs • Hepatic, lung and renal biopsies • Ablation of hepatic and gastrointestinal bleeds • Dobutamine stress tests • Insertion of varicocele coils • Drain placement • Tunnel catheter placement • Fistulagrams and declots • Renal stenting • Vein closure • Carotid and cerebral angiography • Transjugular intrahepatic portosystemic shunts (TIPS) • Uterine fibroid embolization (UFE) • Chemo radio frequency ablation (RFA) • Kyphoplasty • Elective cardioversions • Transesophageal echocardiograms (TEE) We average 25-30 IR procedures and 6-10 diagnostic cardiac caths per week, along with 4-6 non-invasive cardiac studies per week. Since you are a single-lab facility, can you describe how interventional radiologists and cardiologists perform procedures in the same area? The cardiologists and interventional radiologists all share the same space and staff. IR days are Monday, Tuesday and Thursdays. Cardiac days are Wednesday and Fridays, though in practice, IR days can be a mix of both. We have become adept at switching between cardiac and IR procedures. Does your cath lab perform primary angioplasty with surgical backup on site? Since March of 2006, we have provided primary emergent angioplasties for acute ST-elevation myocardial infarction (STEMI) patients without cardiovascular surgical backup. If, during the diagnostic phase of an emergent cath for STEMI, it is ascertained that the case is unsuitable for angioplasty/stenting, the patient is stabilized and transported to Kaiser Permanente’s main cardiac surgery facility in San Francisco — Geary St campus. We can transport with a balloon pump if needed. This routine is facilitated by our Heart Alert algorithm, which places a critical care-equipped ambulance at our facility during the alert. Our cardiologist will accompany the Critical Care Transport (CCT) team to the city and if the patient has a balloon pump or is unstable, with one of the cardiac cath team RNs. What procedures do you perform on an outpatient basis? All of our procedures are performed on an outpatient basis, but some are admitted if they will require an extended recovery period. What percentage of your patients is female? Using available data, 44 percent. What percentage of your diagnostic cath patients go on to have an interventional procedure? Our data shows the following patient treatment breakdown. • True cardiac emergent cases – 10% • Cardiac cases that go on to elective stenting – 17% • Cardiac cases requiring valve repair – 11% • Other modalities (med Rx, pericardiocentesis, etc) and normals – 63% Who manages your cath lab? The cath lab management team consists of our Assistant Medical Group Administrator and Director of Outpatient Nursing, Vincent Reed, RN, the Lab Manager, Vicki Miller, RN, an Assistant Manager, Virginia Vivian, a Erin Larson, Nurse Intern, and Robert Flannagan, RN, checking par levels. Gigi Perlman entering data into the ACC-NCDR database. Charge Nurse, Inger Alt, RN, a Senior Staff Specialist, Trevor Cost and a Perioperative Specialist, Colleen Cerda. Do you have cross-training? Who scrubs, who circulates and who monitors? We have designated staff for the cardiac cath lab and IR. Everyone in the cath lab is cross-trained within their license. RNs are trained to circulate and monitor all cases, and scrub training will begin shortly. RTs are trained to scrub, monitor, and circulate cases (excluding giving medications and pulling of arterial/venous sheaths). At least 1 RN is assigned to circulate any case. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? Some minor cases may be performed with only a physician (who is fluorocertified) and an RN. These cases usually only require a single fluoro shot or minimal runs, but a certified RT is always in the area if needed to assist the MD in managing the fluoro table. Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the fluoro pedal) in your cath lab? Only a physician with a fluoro license and certified RTs are permitted by California law to perform these functions. What are some of the new equipment, devices and products introduced at your lab lately? We use an Allura Philips PT 20 large format image C-arm (Bothell, WA), and McKesson’s Horizon Cardiology Hemodynamic and Cath charting software (San Francisco, CA). All our monitors are high-resolution flat panels. In the next two months, the radiology department will acquire a 64-slice CT scanner, which will enable less invasive rule-outs.

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

Cath Lab Digest - April 2008 Kaiser San Rafael Medical Center Orbital Atherectomy: A New Treatment for Complex Peripheral Arterial Disease Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Contents Clinical Editor’s Corner CEU Education Center The Missing Link in STEMI Interventions — Thrombus Aspiration during Primary Percutaneous Coronary Intervention Predicting Stent Thrombosis Using A Clinical Risk Score Use of a New Guidewire: The Tigerwire Should I Stay or Should I Go? Weighing Options for New Opportunities Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead The National Society of Radiology Practitioner Assistants (NSRPA) Holds 9th Annual Educational Conference For Medical Imaging Physician Extenders and Mid-Level Healthcare Providers Cath Lab & Beyond: A Meeting Update The Ten-Minute Interview with… Dale Hansen RT, CVT Sometimes, You Just Know Twin Circumflex Arteries: A Rare Coronary Artery Anomaly What Do You Think? Meetings Calendar News from the American College of Cardiology (ACC) Scientific Session and the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions in Partnership with the ACC i2 Summit Clinical & Industry News Cath Laughs Classifieds Advertisers Index

Cath Lab Digest - April 2008

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