Cath Lab Digest - May 2008 - (Page 22)

22 INTERNATIONAL CATH LAB SPOTLIGHT MAY 2008 Dr. Walid Hassan performing a routine adult procedure: “Four pairs of eyes are better than one for continuous monitoring.” Left to right: Victoria Ananzeh, Research Assistant, Rachel Pilar, Secretary, Fatma Al Maharish, Ambulatory Care Services Representative. follow-up consultation by the medical team before discharge. What percentage of your patients is female? Statistically, 40% of our patients are female. This may not cause problems in most centers worldwide, but is a staffing consideration in Saudi Arabia. Cultural and gender sensitivity play a major role and where possible, we try to address the needs of our female patients with Arabic-speaking, female staff. What percentage of your diagnostic cath patients go on to have an interventional procedure? Forty-six percent of pediatric patients and 52% of adults proceeded from diagnostic catheterization to an interventional procedure within the last year. Who manages your cath lab? Mr. Abdulkareem Al-Humaidan is our manger, responsible to our cath lab director, Dr. Majid Al Fayyadh and deputy director, Dr. Hani Al Sergani. Dr. Charles Canver is the director of the King Faisal Heart Institute, supported by Dr. Jehad Al Buraiki as his deputy. Mr. Al-Humaidan is a qualified CVT who started in the department in 1991 as a student from the King Saud University, Riyadh. He completed his training at Duke University in North Carolina and progressed through the ranks to become manager in 2001. He is supported by four senior staff members: Dina AlZawawi, CVT, Arnel Reyes, CVT, Walid Rafeh, senior radiographer, and Jeya Ezhilrajan, assistant head nurse. Do you have cross-training? Who scrubs, who circulates and who monitors? All of our nursing and technical staff are cross-trained to perform scrub duties. Our radiographers and CVTs perform the x-ray duties. Monitoring is the sole responsibility of the CVTs and circulation is the role of the SN1s. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? No, but we have three radiographers on board for equipment quality control (QC) and troubleshooting, radiation safety and education, quantification and analysis, and for any networking/archival/retrieval problems that may arise. 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? The cardiologist will step on fluoro/ cine and pan the table, but all II movement and table up and down positioning is performed by the CVT or radiographer. A solo radiographer, in the presence of a cardiologist, may perform valve motion assessment cases. What are some of the new equipment, devices and products introduced at your lab lately? Although some equipment is “new” to us at KFHI, it may have been on the market for some time now. Our primary focus is patient safety and so new innovations have that purpose in mind. We have just introduced wireless ICDs, which have helped to improve implant times and eliminate a possible source of infection. Cryotherapy (2nd generation), with its stability, site mapping and associated thermal reversibility, has improved patient safety and enhanced the precision of our ablations when working around the area of the atrioventricular (AV) node. Intra-cardiac echo (ICE) gives us a better “look” of the surrounding anatomy and has improved the accuracy/suitability of device implantation. It is preferred to trans-esophageal echo (TEE) and has the major advantage of not requiring general anesthesia for our pediatric patients. We are presently renovating Lab 2 to include an ambient atmosphere, which is exciting, as it will be the third ambient, biplane cath lab in the world and the first in the Middle East and the Gulf Cooperation Council (GCC) countries. Can you describe the system(s) you utilize and how they work in cath lab daily life? Utilization of established clinical pathways (structured, multi-disciplinary plans of best clinical practice) and procedural sedation protocols have become a part of our cath lab culture. The transfer of patient demographic and clinical information to other services is via the hospital information system, where this data can be updated at each point. Each lab is equipped with digital flat-panel biplane x-ray systems and all x-ray data is accessible throughout the hospital through our cath lab network. Hard copy CDs and paper reports, however, are still sent to referring hospitals. How is coding and coding education handled in your lab? The senior desk person, at the conclusion of each case, records the coding of procedures. These codes are verified with the patient’s file report the following day and entered into the hospital’s database by the file clerk. The cath lab secretary is responsible for the billing calculations of our pacemakers based upon the supplies used and entered into the pacemaker database. This is all done for statistical and budgeting purposes, but it should be pointed out that eligible Saudi nationals are not charged for medical services at KFHI. How does your lab handle hemostasis? Pediatric sheath removal and manual pressure is performed by the scrub person in the lab immediately after the procedure and while the child is still under sedation. Pressure bandages are not used and the access site is left exposed for monitoring. For adult cases, the sheaths are removed in the holding area and pressure bandages are only applied if the patient is uncooperative or incoherent. Post-PTCA sheaths are sutured in situ and removed in the holding unit/ward once an acceptable ACT has been reached. We have also just introduced a suture closure system for our percutaneous valves, which may require vessel dilation up to 22 French. Does your lab have a hematoma management policy? Our lab has a sheath removal policy inclusive of hematoma management. All cath lab staff are required to complete an annual sheath removal competency assessment. Complications arising from hematoma are recorded in the patient’s chart and on the hospital’s adverse occurrence reporting system, where they are tracked by our quality resource management department. How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies? Maintaining adequate levels of inventory is a problem experienced by most cath labs, but because of our location, “getting it right the first time” is crucial. Some supplies may take up to two to three months for overseas delivery and clearance. We have two methods of replenishing cath lab supplies. High-volume

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

Cath Lab Digest - May 2008 The King Faisal Specialist Hospital and Research Centre Cell Therapy in the Cath Lab for Heart Failure: A Look at MyoCell® Therapy and the SEISMIC Trial Performance Improvement Strategies Speed Up Treatment Times in the Management of ST-Elevation Myocardial Infarction (STEMI) Patients Contents Clinical Editor’s Corner Commentary: Performance Improvement Strategies Speed Up Treatment Times in the Management of ST-Elevation Myocardial Infarction (STEMI) Patients Ask the STEMI Expert Comparing Drug-Eluting Stents and Bare-Metal Stents SICP: The Ten-Minute Interview with… Christopher Kambak, RT(R) Cardiac Cath Lab Economics in a Public Hospital of a Developing Country Keeping Your Heart & Vascular Employees: Proven Ideas for an Effective Retention Plan Unspoken Words Ask the Clinical Instructor Society of Invasive Cardiovascular Professionals Meetings Calendar Education Center What Do You Think? Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - May 2008

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