Cath Lab Digest - May 2008 - (Page 4)

4 CLINICAL EDITOR’S CORNER MAY 2008 EDITORIAL Hemodynamic Data Collection at Square 1: From transducer to recorder MORTON KERN, MD Clinical Editor Clinical Professor of Medicine Associate Chief Cardiology University of California Irvine Orange, California LAURIE GUSTAFSON Executive Editor H emodynamic studies require accurate data collection technique. For complex cases we record simultaneous pressure waveforms, working with multiple transducers. I have had some questions from our staff as to what is the best and easiest way to collect hemodynamic data. As a caveat, I am sure most of you already know that there is more than one way to do nearly everything in the lab, and that includes setting up and recording hemodynamics. Let’s spend a few moments addressing how we record hemodynamics in our cath lab. I tell our fellows, “if you’re going to do it (measure hemodynamics), spend the time to do it right. No data is better than wrong data.” REBECCA KAPUR Managing Editor ELIZABETH MCTAMNEY Layout/Production Manager PAUL MACKLER President/CEO KEN FISHER Chief Financial Officer PETER NORRIS Executive Vice President/General Manager JEFFREY MARTIN Vice President/Group Publisher Cardiology Division ALEX SLONIM Vice President/Associate Publisher of Cardiology CARSON MCGARRITY Senior Account Director NICK OTRANTO Account Manager BRENDA O’CONNOR Cardiology Sales Associate BILL NORTON Vice President, Meeting and Trade Shows LUCINDA BESKA Classified Advertising Sales Manager FRED KLUMPP Manager of Information Systems KATHY MURPHY Production Director STEFANIE TULEYA RENEE OLSZEWSKI Special Projects Editors PATRICIA LEVY Director of NACCME Step 1. Check the cables: Transducer connections to the recorder. This step is one of the greatest points of confusion and frustration. It is generally an annoying experience for the nurses and technologists who come in to the laboratory to find all the cabling connecting the transducers to the table and the hemodynamic recorder unplugged and uncoiled, scattered over the catheter table and floor. We number and color code all cables and their inputs so that reconnections and match-ups can be made easily and quickly. Label clearly and read the labels when MORTON KERN, MD connecting. GE cables do not work in Prucka recorders. This problem of reconnectClinical Editor ing cables has been a continuous battle, as our cleaning personnel unplug the cables Clinical Professor of Medicine for better access around the tables. In addition to clear labeling of the cables, an Associate Chief Cardiology attachment device for the coiled cables to the tableside, such as Velcro strips or other University of California Irvine tape, is also very helpful. Orange, California On the sterile field, it is also worthwhile numbering and color-coding the transducmortonkern005@hotmail.com ers and tubing so that communications for recording the waveforms from the operators to the control room can proceed smoothly. For example, “Zeroing transducer number 1; pressure is up on number 1; number 1 is a femoral artery pressure.” Clear communications are always helpful and this is the best method to reduce frustration, save time and decrease confusion during hemodynamic measurements. Step 2. Set up the transducers: On the sterile field or on the injector device. To set up transducers for the sterile field, a small rack with transducer mounting brackets is placed opposite the operators and set at the patient’s mid-chest level. Transducers are connected electrically to the cath table sockets, sending the signals to the recorder. The transducers are flushed with saline through plastic tubing to be connected to the catheters on the sterile field. The transducers are flushed to ensure bubbles are eliminated. All connections to stopcocks and tubing should be flushed and tightened. If possible, the shortest and stiffest tubing should be used to produce the best pressure transmission pathway. After flushing, the tableside transducers are zeroed at the mid-chest level of the patient. The transducers are opened to atmosphere; the recording technologist zeros the signals on the hemodynamic recorder. The transducers are then closed. It may be necessary to reflush the transducers to be sure they are free of air bubbles. Any remaining bubbles may produce underdamped pressure waveforms. This setup applies for multiple transducers and will provide accurate hemodynamic measurements for all cases. In our laboratory, we also use the ACIST power injection system (Eden Prairie, MN), which has a built-in transducer. We like it very much for angiography but it has a minor limitation for pressure measurement. The ACIST transducer is mounted on a built-in bracket with rubber-padded backing through which the pressure is transmitted to an electrical sensor. Although the transducer on the ACIST device is accurate, because of the mechanical plate interface, the signal is delayed about 50 to 100 msec relative to the CIRCULATION: Contact the Subscription Dept Tel: (800) 237-7285, ext 5 Or (610) 560-0500 ext. 5 E-mail: subscriptions@ hmpcommunications.com SUBSCRIPTION INFORMATION CATH LAB DIGEST STATES. ALL AS IS FREE TO QUALIFIED CATH LAB PERSONNEL WORKING IN THE UNITED OTHER SUBSCRIPTION RATES ARE FOLLOWS: continued on next page INTERNATIONAL: ABILITY-U.S. UNITED STATES: $50.00, $100.00. SINGLE OR $10.00; INTERNATIONAL REPLACEMENT COPIES ARE SUBJECT TO AVAIL- Editorial Correspondence: Rebecca Kapur, Managing Editor, HMP COMMUNICATIONS Cardiology Editorial Offices, 7427 Winding Way, Brecksville, OH 44141 Tel. 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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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