Cath Lab Digest - October 2007 - (Page 17)

OCTOBER continued from page 1 2007 SPOTLIGHT 17 Saints Medical Center We perform approximately 20 cases per week and recently have started to perform peripheral cases as well, including renal, femoral, and iliac percutaneous transluminal angioplasty (PTA) and peripheral interventions. How did you begin performing peripheral cases? The hospital administration realized that this is a continuing paradigm shift and that the cath labs, special procedure labs, neuro-interventional labs and vascular surgery all need to work together. The decision was made to ready the cath lab to accommodate peripheral procedures. We also met with the finance and coding departments to ensure we had the proper charges in place, and compared them with the special procedure department to make sure they were in line with their coding. What training was instituted so staff could be competent and skilled in performing peripheral procedures? We sent some of our staff to the special procedures department to observe and orient. We also hired two RNs and 2 CVTs from a large tertiary center with a great deal of peripheral experience. Do interventional radiologists, vascular surgeons and cardiologists perform procedures in the same area? Not currently, but we welcome the interventional radiologists to utilize our cath lab space when needed. Vascular surgeons do not use the cath lab as they do their endovascular work in the special procedures area. However, we would also welcome them to use our cath lab when available. What procedures do you perform on an outpatient basis? Diagnostic cardiac caths, TEEs, cardioversions, and generator changes. We also do our own pre-admission testing. What percentage of your patients are female? Forty-five percent of our patients are female. What percentage of your cases are “normal” and what percentage of diagnostic cath patients go on to have an interventional procedure? Three percent of our cases are normal and 18% convert to percutaneous transluminal coronary intervention (PTCI). Does your cath lab perform primary angioplasty without surgical backup? Yes. We are currently enrolled in two studies looking at this issue. MASS COMM, run by the state of Massachusetts, is a study to compare (elective) percutaneous coronary interventions (PCIs) performed in our facility, which does not offer surgical backup, as compared to a hospital that does. Patients must meet certain criteria prior to enrollment. If an intervention is needed, they are then randomized to one of the two hospitals. Three of every four patients are done at Saints Medical Center (without surgical backup), and one will go to our collaborating facility which offers surgical backup. Since August 2004, we have also been enrolled in the Atlantic Cardiovascular Patient Outcomes Research Team (C- PORT) trial, which allows patients in the community setting to have primary PCI for ST-elevation myocardial infarction (MI) in the community hospital rather than being transferred to another tertiary facility. Our median door-to-balloon time since its inception is 79 minutes. We have been able to achieve this benchmark through a continuum of care, beginning with our paramedics, who have been serving the greater Lowell, Massachusetts area since 1983. The sequence begins with either early recognition and field activation by our paramedics or by the emergency department (ED) staff upon diagnosis of acute MI. Have you had any cath lab-related complications in the past year requiring emergent cardiac surgery? Since we began our PCI studies, we have not needed to send any of our patients out emergently for cardiac surgery due to a cath lab-related complications. Who manages your cath lab? We have a Nurse Manager, Erin Boutin, RN, ASN, who manages dayto-day operations and a Director of Cardiovascular Services, Jennifer McCarthy, RN, MS. Dr. James Waters, Medical Director, Cardiac Cath Lab reviews his case. Saints Medical Center cardiologists and cardiac cath lab staff before a recent meeting. James Waters, MD, Medical Director, Cardiac Cath Lab; Robert Shulman, MD, Chief of Cardiology; Richard Birkhead, MD, Cardiologist; Benjamin Smith, MD, Electrophysiologist; Jennifer McCarthy, MSN, RN, Director of Cardiovascular Services; Erin Boutin, RN, ASN, Nurse Manager, Cardiac Cath Lab; Jeff Peters, RTR, BA; Stacey Cayer, RN, ASN; Rosany Rosario, CVT-RCIS. CVT-RCIS Do you have cross-training? Who scrubs, who circulates and who monitors? The RNs, RTs and CVTs cross-train into all roles, including circulating, monitoring, and scrubbing, but medication is only given by the RN. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? Yes. 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 physician or the RT. Can you describe the system(s) you utilize and how they work in cath lab daily life? We have the Coroskop angiographic and monitoring system by Siemens (Malvern, PA). The x-ray component has peripheral capabilities which allows us to perform basic peripherals. We are currently looking to upgrade our hemodynamic system, to either GE Healthcare’s Mac-Lab (Waukesha, WI) or to Philips Medical’s Witt Calysto (Bothell, WA). Updating our hemodynamic system will help facilitate portions of our data input for the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR ™) database and other reporting/querying. Did your facility need to make any changes to the imaging equipment to accommodate peripheral procedures? No, we continue to use our Siemens Coroskop/HiCor system. It allows us to do digital subtraction and angio acquisitions appropriate for peripheral procedures. What are some of the new equipment, devices and products introduced at your lab lately? We just added the Fetch™ Aspiration catheter (Possis Medical,

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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