Cath Lab Digest - November 2007 - (Page 13)

13 stents (DES) and bare metal stent platforms when clinically appropriate. We offer Driver (Medtronic, Inc.) and Cypher (Cordis Corporation, Miami Lakes, FL) as our front-line stents. The Taxus Express stent (Boston Scientific) and the MultiLink Mini Vision and Multi-Link Ultra stent (Abbott Vascular, Redwood City, CA) are also available. A full array of interventional guidewires is available to the cardiologists, including the recently added Steer-it deflecting tip guidewire (Cordis Corp.). The Tornus Specialty Catheter (Abbott Vascular) is being used for chronic total occlusion (CTO) interventions. The Starclose vascular closure device (Abbott Vascular) has been a recent addition to our groin management options. Most of the new equipment that we have introduced into our lab has been related to peripheral procedures. For peripheral cases, the new devices we are using are the SilverHawk (Foxhollow Technologies, Inc., Redwood City, CA), a linear plaque excision deice, the PolarCath cryoplasty balloon device (Boston Scientific) and the FrontRunner catheter (Lumend, Inc., Redwood City, CA) that facilitates lumen through a chronically occluded vessel. Can you describe the system(s) you utilize and how they work in cath lab daily life? We have been filmless since 2001. Today, the systems we utilize in our daily operations consist of the Siemens Axiom Artis cardiac cath labs, Siemens Axiom Sensis hemodynamic recorders, and Siemens ACOM network, a digital mass storage system for image archive and diagnostic quality image distribution. This storage network has allowed our physicians to be able to retrieve patient films quickly and by themselves. Siemens Sensis technology also allows all reports to be accessible via a hospital-wide electronic medical record within 24 hours. There is a viewing station in the OR where vascular operations are performed, allowing surgeons to immediately recall their patient’s procedure images. We also are capable via the web to enable our physicians to view studies from anywhere in the hospital, their offices or even their home. How is coding and coding education handled in your lab? We are very fortunate to have one dedicated coder in our department who handles all coding issues. Separate EP, peripheral or coronary catheterization billing forms are given to our attending physicians following procedures to document the performed procedure and codes. Billing forms are forwarded to the coder. Our coding specialist reviews procedural reports, and physician indications and codes reports. Final reports are then further processed directly through electronic sessions to insurance companies. Certified Professional Coder conferences are offered throughout the year to constantly update our charge master and amend our billing practices to adhere to all regulatory demands. How does your lab handle hemostasis? Hemostasis is usually a matter of physician preference. The majority of our diagnostic catheterization and peripheral procedures are performed using 4 and 5 French catheters and as a result, manual compression is a preference. Following visual verification with femoral angiography, physicians use vascular closure devices such as Perclose (Abbott Vascular) and Angio-Seal (St. Jude Medical, Minnetonka, MN) in the lab. The SyvekPatch (Marine Polymer Technologies, Danvers, MA) is used with manual compression hemostasis in our recovery area. The nurse who circulates the patient’s diagnostic procedure is responsible for removing the sheath and providing hemostasis post procedure. Following percutaneous coronary interventions, we have 2 multi-disciplinary RNs who are responsible for removing sheaths following interventions when ACTs are less than 175 seconds once patient reaches their overnight destination in the hospital. What is your lab’s hematoma management policy? We do not have a hematoma management policy per se, but we do have arterial sheath management and hemostasis guidelines for post procedural cases. Incidence of hematomas is routinely collected and monitored by a data collection nurse for quality assurance purposes. Hematomas are handled immediately with either manual pressure or a FemoStop (Radi Medical Systems, Wilmington, MA). Any site indication of potential hematoma is Interventional cardiologists. Left to right: Abdulrahman Arabi MD, Akshay Khandelwal MD, Aaron Kugelmass MD, Director Cardiac Cath Lab, Hrishikesh Iyengar MD, interventional fellow. Research RNs collaborate with nurse practitioner staff. Left to right: Raquel Pangilinan RN BSN, Julianne Longlade RN BSN, Janet F. Wyman MSN APRN-BC, Christine Swanson MSN NP. We are a teaching institution and we have first-, second- and third-year diagnostic fellows and two fourth-year interventional fellows. Generally, the cardiology fellows scrub, the nurses circulate and the technologists monitor. However, we currently have 4 RNs and 1 RCIS that are able to scrub or monitor when needed. Our goal is to train all nurses in the lab to be able to monitor cases. Does an RT (radiologic technologist) have to be present in the room for all fluoroscopic procedures in your cath lab? No, an RT does not need to be present in the room during procedures. Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on the flouro pedal) in your cath lab? The cardiac fellow and staff-attending cardiologist operate the x-ray equipment. The physicians primarily control the positioning of the II, table panning and stepping on flouro. Do interventional radiologists and cardiologists perform procedures in the same area? Dr. Adam Greenbaum pioneered our peripheral program in the cath lab at Henry Ford Hospital. Today, both attending cardiologists and vascular surgeons perform peripheral interventions in a lab suite dedicated to peripheral procedures. Vascular surgeons have dedicated lab time on Tuesday and Thursday, and our cardiologists, Monday, Wednesday and Friday. Our cardiology staff has been performing peripheral diagnostic and interventional procedures for over 6 years. In the planning stages, Siemens installed its state-of-the-art Angiostar x-ray system, equipped with desired features like digital subtraction angiography (DSA), and table stepping for performing diagnostic aorto-iliac run-offs. What are some of the new equipment, devices and products introduced at your lab lately? We are currently using drug-eluting

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

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.