Cath Lab Digest - December 2007 - (Page 19) 19 Does an RT have to be present in the room for all fluoroscopic procedures in your cath lab? In complying with a very strict interpretation of California state regulatory laws, only a licensed x-ray tech or a fluoroscopy-certified physician is able to position the II, pan the table, change angles, and step on fluoro pedal in our cath lab. There is no exception. All certifications must be current or privileges are suspended. We have an RT for each case, in each room, running the x-ray equipment. The RTs also perform required quality control/quality analysis of the x-ray equipment. There is a designated RT (Steve Jones, RT) for the Radiation Safety Committee. What are some of the new equipment, devices and products introduced at your lab lately? Our cath lab frequently participates in new product research, development and market launching. Recently, we launched a newly FDA-approved closure device in our lab. We actually participated in the development and research of this device, called the Mynx™ Vascular Closure Device (AccessClosure, Inc., Mountain View, CA). One of our cardiologists, Dr. Puneet Khanna, was intimately involved in all phases of this product. Dr. Khanna also involved our lab in a trial for peripheral artherectomy with the Diamondback Orbital Artherectomy System, (Cardiovascular Systems, Inc., St. Paul, MN), recently approved by the FDA. We are hosting a physician training course for this system on January 15, 2008. Dr. Khanna is currently involved in innovative ostial and bifurcation stent development. These stents are just starting trials outside the United States. According to Dr. Khanna, Eisenhower will probably be one of the first U.S sites to trial these stents when available. Can you describe the system(s) you utilize and how they work in cath lab daily life? Our digital imaging equipment is the GE Innova (Waukesha, WI). We get optimal images with this equipment, as well as ease of use for the operator. Our enhanced capabilities for the peripheral runoffs and superb imaging are an asset to patient treatment. The GE Mac-Lab® system for hemodynamic monitoring is used for procedure charting and physician reporting. We have a link to a digital management system (DMS), GE Cardiology Centricity, which is a continued from previous page reduced in the second year compared to the first year, but the fact is that there are still some events taking place, so we’ve learned that one-year data is not enough. It looks like we need to follow patients at least two to three years and maybe even five years. Q A We saw five-year data from TAXUS IV at TCT. Any overall impressions based on that data? The improvement and efficacy of DES has been maintained both in the TAXUS IV five-year data and the SIRIUS data. These data show that DES have maintained the same advantage over BMS that we saw in the first year of the trials, and we’ve seen a complete flattening of the rate of verylate stent thrombosis with both the TAXUS Stent and CYPHER Stent. Given the real-world registry data presented at TCT 2007, how should physicians now weigh the risks and benefits of DES vs. BMS? I think that the pendulum has swung as far back to the left as it needed, and now we can begin to use DES in a more educated, more sophisticated fashion. Now it’s our job to educate our patients by discussing with them the risks and benefits. It’s clear that people should not get a DES unless they can take a minimum of one year of dual anti-platelet therapy. In selected cases, this may extend to two or even three years. Interventionalists must determine what their patients are capable of doing. Are they reliable to take medications? Can they afford to take the medications? Are there any comorbidities or concomitant medical conditions that will prevent them or put them at risk for taking prolonged dual anti-platelet therapy? From there, we need to focus on the future. We need to figure out how to prevent the relatively infrequent, but certainly worrisome, problem of verylate stent thrombosis. In order to be able to apply DES across the board, we need to come up with better technology — more rapidly healing DES, DES that endothelialize so they become biologically neutral, etc. Hopefully, within the next decade, we’ll be able to apply DES without any significant concerns for our patients in terms of very-late stent thrombosis and dualantiplatelet therapy. CYPHER is a trademark of Cordis Corp. Sponsored by Boston Scientific Corporation Q A A view from Eisenhower Medical Center in Rancho Mirage, California. peripheral and diagnostic coronaries are not entered into the ACC database. In 2006, we did 180 PCIs for females. Of the total PCIs, 27.1% were females. (This does not depict peripheral procedures.) What percentage of your diagnostic cath patients go on to have an interventional procedure? In 2006, we did a total of 677 PCIs as entered in the ACC database. We did not distinguish the diagnostic-only procedures (coronary or peripheral) from those that moved into intervention in the database. In the last fiscal year, we billed for 2,123 left heart caths. From the numbers, it is safe to assume that approximately less than one half of diagnostic exams evolve to interventional procedures. Who manages your cath lab? Our cath lab is unique in that many management duties have been handled collaboratively over the past two years. Our cath lab administrative director, Lynn Hart, RN, delegates certain manager duties to the team. She gives us the opportunity to function outside our regular roles to manage supplies, inventory, vendor requests, clinical documentation issues, scheduling and timekeeping. This collaboration has helped our group function at a higher level, creating solid cooperation — and a heightened respect for the position of cath lab manager! Do you have cross training? Who scrubs, who circulates and who monitors? All of our RTs can scrub, circulate, and run x-ray equipment. Our RCIS scrubs, monitors, and circulates. All of our RNs monitor and give IV medications, and a few scrub. Mike McKeever, RT (photographer), his work behind him.
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