Cath Lab Digest - April 2008 - (Page 6)

6 CLINICAL EDITOR’S CORNER APRIL 2008 Fixing the Sheath Last month in my lab at University of California-Irvine, Mr. Kent McAllister showed me two new tricks, which I know will be helpful to many labs around the country. The first new idea he showed me is used in radial artery catheterization. Kent demonstrated the use of a Tegederm 4x3-inch clear film plastic bandage. It is placed over the radial artery sheath and secures it in place. The “Kent” bandage permits easy visualization of the access site, and fixes the sheath and sidearm to the wrist, thus eliminating suturing the sheath to the skin and the associated problems with any suture approach. This novel method is widely available, and is a wonderful advance in the sheath securement department of our procedures. operators avoid biplane coronary angiography for precisely this reason. Cath lab teams can spend considerable time setting up the biplane system and moving the table height to minimize panning and capture all the image data. This juggling of table height and plane position is frustrating and time-consuming. To overcome this problem, Kent suggested we place both the LAO and RAO planes in the cranial angulation, instead of the opposing cranial-caudal plane positions. In this configuration (cranialcranial), when we pan, the coronary arteries stay in the appropriate field for both LAO and RAO planes and loss of information by panning out of the field is nearly impossible. This cranial-cranial or caudal-caudal set up for the LAO and RAO planes CEUS Education Center CEUs offered by HMP Communications and Cath Lab Digest FREE! Available on www.naccme.com All following FREE activities are sponsored by the North American Center for Continuing Medical Education (NACCME). Check out both the “cardiovascular” and “vascular” CEU options. • Contrast Media Use in High-Risk Patient: The Latest Data Supported by an educational grant from Bracco Diagnostics Inc. • Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines. The CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel Report – III Supported by an educational grant from Sanofi-Aventis. • Recent Advances in Cardiac PET and CT Angiography for the Management of Patients with Coronary Artery Disease Supported by an educational grant from Bracco Diagnostics Inc. • Infection Prevention for Minimally Invasive Interventions Supported by an educational grant from Enturia. An Evidence-Based Approach to CIN in Angiography: Defining Best Practices Supported by an educational grant from Bracco Diagnostics. I’d like to invite those of you who have good ideas to share them with our colleagues and readers in Cath Lab Digest. Biplane Coronary Angiography Made Easy Secondly, Kent taught our lab something new about biplane coronary angiography. Although many labs do not routinely use biplane imaging for coronary angiography, this modality is particularly helpful when you would like to limit the contrast load or in patients who have congenital anomalies or complex structural heart disease. As traditionally practiced, the anteroposterior (AP) and the lateral planes are moved into position with the heart placed in isocenter. The AP and lateral planes are then rotated together to the left anterior oblique (LAO) and right anterior oblique (RAO) angles, and then each rotated to cranial and caudal projections moving the C-arms in opposite directions. This setup is quite adequate for adult left ventriculography provided the heart is in isocenter when little or no panning is necessary. However, for coronary angiography, problems arise if panning is required and the heart is not in isocenter. In this case, panning into the LAO cranial projection will move the heart out of the imaging field of the RAO plane, and vice versa. Losing imaging data during panning produces a suboptimal study. Many makes biplane coronary angiography easy, quick and complete, especially since panning is so often necessary. This setup was new to me, but I believe should be evaluated and widely used when performing biplane coronary angiography. I compliment Kent and many of my past and present cath lab associates and staff who have come up with many brilliant ideas, making great contributions through small steps. Identifying and sharing new ideas in the cath lab with our colleagues will improve our procedures and is one of the most stimulating and helpful cath lab staff activities. I still have an outstanding bet to pay to anyone who can figure out how to make the intravenous lines come to the patient from the head of the table without becoming entangled in the C-arm. I’m sure many new ideas such as the ones described above have been discussed in labs around the country and may already be in place. I’d like to invite those of you who have good ideas to share them with our colleagues and readers in Cath Lab Digest. Who knows — the next great cath lab technique may come from your lab. ■ • • AntiPlatelet Strategies in the DES Era Supported by an educational grant from Bristol-Myers Squibb/Sanofi Pharmaceuticals. Expires May 24, 2008 • Anticoagulation Techniques for Peripheral Vascular Interventions Supported by an educational grant from The Medicines Company. • Evidence-Based Groin Management: Putting CONTROL Back Into the Nurse/Tech’s Hands Supported by an educational grant from The Medicines Company. Cath Lab Digest University An innovative, online, continuing education series, for cath lab professionals – BY cath lab professionals. 6 programs for $50! Programs: • • • • • Clinical Review of Carotid Artery Stenting Coding and Reimbursement Update Medical Management of ACS and Thrombosis Systematic Approach to Improving Door-to-Intervention Times Endovascular Advancements in the Treatment of Critical Limb Ischemia (CLI) • CTA for Detection of Vulnerable Plaque Find it online at: www.naccme.com/cldu/ Supported by an educational grant from Boston Scientific and Schering-Plough. http://www.naccme.com http://www.naccme.com/cldu/

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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