cardiac catheterisation laaboratory - altaf faiyaz
Post on 19-Oct-2014
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Basic Structure, Function & Human Resources in a Cath labTRANSCRIPT
Presented By :
Dr Altaf K. Faiyaz
“ Coronary Artery Disease is currently one of the leading
causes of premature death in both developing as well
as developed countries “
1. Introduction
2. History
3. Evolution & Advancement
4. Procedure & Conduct
5. Types of Facilities
6. Physical Arrangement & Space Requirement
7. Equipment
8. Human Resource
9. Performance Evaluation
10. Quality Assurance
The Cardiac Catheterisation Lab is one of the Biggest Advances of this century in Cardiology.
The expansion & widespread application of this technology throughout the world today could hardly have been imagined by Wenner Frossman, when in 1929, he was the first to pass a catheter into the heart of a living person himself.
Procedures in the Cardiac Cath Lab have evolved from purely diagnostic & research techniques to potentially life-saving interventional procedure
1941 – Right Heart Catheterisation in Humans to study cardiac physiology
1950 – First retrograde left heart catheterisation, by Zimerman & co-workers
1950s(Late) – Advent of selective coronary angiography
1960s(Late) – Development of aorto-pulmonary bypass surgery
1970 – Balloon tipped flow directed catheters introduced by Swan & Ganz
1977 – Percutaneous transluminal balloon angioplasty, by Gruntzig
1970s(Late) – Dr. Mason Sones introduced Brachial approach.
Safe & expeditious catheterisation from femoral route- Dr Judkins & Amplatz
•In the 1980s , the scope of interventional Cardiology increased with the introduction of new therapeutic modalities( Valvuloplasty,Stent etc. )
•ACC/AHA guidelines for Cardiac Catheterisation Labs published in 1991
•Cath Labs have now evolved into multipurpose facilities, by performing ‘non-cardiac’ vascular investigations involving peripheral, renal & carotid vasculature.
•Cardiac Catheterisation is the insertion & passage of small plastic tubes ( catheters ) into the arteries & veins upto the heart to obtain X-ray pictures of coronary arteries & cardiac chambers as well as to measure pressures in the heart ( intra-cardiac haemodynamics )
•Locate & identify irregularities within the heart & its vasculature, in the aorta ad venacava and to define size & severity of the lesions.
1. Diagnostici. Coronary Angiogramii. Right & Left heart Catheterisationiii. Electrophysiological Proceduresiv. Intravascular Ultrasound
2. Therapeutic
i. Coronary angioplasty with stentingii. Rotablator Atherectomyiii. Percutaneous Transluminal Valvuloplastyiv. Pacemaker Implantationv. Implantation of Cardioverter Defibrillatorvi. Retrieval of Broken Cathetersvii. Deployment of various devices for closure of septal defectsviii. Laser Angioplasty
Patient Preparation
Informed Consent from patient/guardian
Strictness of Sterile Techniques
Special Clothing For workers
Hepatitis B vaccination for Employees
Following SOP
Adequate post-procedural Holding area, proper nursing care and monitoring
1. Hospital-Based Labs with in-house thoracic surgical programmes
2. In-Hospital labs without Cardiac surgery capability
3. Free Standing Labs
4. Mobile Labs
Goals of Free-standing / Mobile Labs
To reduce cost
Convenience of Location
Used in case of low-risk patients
Mostly used for diagnostic purposes.
However the setting up of such labs is still controversial and a matter of debate
The following facilities are required when the cath lab is a stand-alone entity
Main Divisions
1. Procedure Room – Should be constructed to contain radiation and provide electrical safety
2. Control/Console Room – Should be of a size & configuration to allow ready and unencumbered access to X-ray controls, image recording devices ( video tapes, discs and digital controls) and physiological monitors & recorders
3. Equipment Rooms – Proper temperature control for computers and data storage
4. Clean Utility Room – For clean & sterile supplies and disposables
5. Patient Holding Room ( preferably equipped with ECG monitors )
6. Patient Recovery Room
7. Technician’s Work Room
8. Dark room for 35mm film ( if necessary )
9. Chemistry Lab ( for blood gas analysis ) or Electrophysiology Labs
10. Scrub Facilities
11. Storage space for case carts
12. Alcove for wheelchairs & stretchers
13. Soiled Utility Room
14. Toilets
Use Suggested Minimum Size (sq. ft.)
Procedure Room 500-600
Control Room 150-200
Equipment Room 100-120
Scrub facility 30
Holding Room >120
Patient Preparation Room 120
Recovery Room 120
Catheter & Other Storage Room
100
Patient Dressing Room 70
Staff Dressing Room 70
Patient Toilet 30
Staff Toilet 30
Pharmacy Space 30
Blood Gas Analysis 20
Staff Lounge 70
Reception Area 70
Film viewing Area 70
Archival Area 70
Darkroom Processing( or Computer Management)
70
Soiled Utility 70
Janitorial space 20
Offices ( space per office)
70
Conference Room 120
Library
Traditionally located within the diagnostic radiology suite.
Aseptic Conditions similar to surgical suites
Advantage of 2 procedure rooms – can have single control room for both, thus economical
Safety & Efficacy depends on available equipment & its physical arrangement
Space for development & access to newer technology will require modification. Eg. Computer review stations are replacing cine film and record storage.
Larger areas to allow more space for ancillary equipment.
Dimensions vary in accordance with the type of radiographic equipment & manufacture.
Control Room at foot-end of the table
Radiographic Equipment
High Quality Digital Video display
Therapeutic Procedures require more detailed fluoroscopy
Biplane Fluoroscopy – Saves time for interventional procedures.
Goal – Highest Quality Images with least radiation exposure to staff
Limitation – Cost & space requirement
Radiographic Equipment
1. X-ray generator
2. X-ray Tubes
3. Image Intensifiers
4. X-ray Detectors
5. Video Camera
6. Contrast Injectors
7. Cinefilm Viewer ( optional )
All these should be compatible
Radiographic Equipment
Digital Storage & Display
For medium and long term storage, digital media based on DICOM standards Should be used
Advantages of DICOM
i. Data Equivalence is assured ii. Any receiving system that uses this interface can be used for storage and reviewIii Telemedicine Application Electronic transmission of clinical image data over long distances to support clinical decision making at remote sites
However as far as possible, analysis should be made on original image data acquired at the time of procedure
# Chief Cardiologist
# Assistant Angiographer
# Laboratory Director
# Cardiovascular Trainee
# Nursing Personnel - Scrub Nurse Float/Circulating Nurse
# Technical Staff – Radiation Technologist Radiation Physicist
Lab Technologist Dark Room Technician Computer Technician Monitoring Technician
# Non-Technical Staff – Medical Transcriber Clerks, Aides
The department staff is responsible for procuring necessary suppliesas well as preparing the room and the patient before the procedure andfor monitoring patient’s recovery.
Qualification and Experience are of prime importance while recruiting personnel for the cardiac catheterisation laboratory
All members of catheterisation team must complete a basic course in CPR
Radiation Safety
Radiation Exposure Recommendations
Measuring Radiation Exposure
1. Film Badges
2. Thermo-Luminescent Dosimeter ( TLD ) badge Dosimeter badge should be worn with the front of the badge in direct line of the scattered x-rays.
Average background radiation exposure - 0.1 rem/year
Average operator exposure ( per procedure ) - 0.004-0.016 rem
Maximum Annual exposure for Medicos - 5 rem/year
Maximum Lifetime exposure for medicos - 1 rem x Age
Administrative Issues
Utilization levels
Lab performance Evaluation
QualityAssurance
1) Laboratory
For optimum lab performance & cost-effectiveness – Adult Studies – Min. caseload of 300/year Paediatric Studies – Min. 150 cases/year
2) Physician- Operator
For adequate performance & preventing excessive radiation exposure –
Individual physician – About 150 cases/yearPaediatric Physician – 50-100 cases/year PTCA - 50 cases/yearElectrophyiological Studies – 100 cases/year
Lab Performance Evaluation
Laboratory Safety and Efficiency is measured by –
1. Complication Rates ( through records )
2. No. of studies that must be repeated because of inadequate data or image quality.
Indicators
Deaths related to catheterisation - < 0.1-0.2%
To Limit Complications, Ensure :
Stringent Credentials for training and experience
Regular performance review
The QA program in Cardiac Cath Lab has 3 components –
1. Clinical Proficiency
2. Equipment Maintenance & Management
3. Quality Improvement Program Development
The Cardiovascular program should be assessed within context of 3 outcomes -
1. Clinical ( Mortality, Complication, Readmission rates )
2. Financial ( Volumes, Cost per case, Profits per case )
3. Satisfaction ( patient & relatives )
Increase in Community Hospitals without CV surgical backup and free standing laboratories
Decline in risks associated with diagnostic & interventional cardiac catheterisation
Cinefilms being replaced by compact discs & computerised archiving system
Evolution of paediatric cardiac cath. from purely diagnostic to interventional lab.
Think About …..
Fluctuation of Patient load on a day to day basis
Long Break-Even Point
Market Competition
Bibliography
1. Hospital: Facilities planning & ManagementG.D. Kunders
2. www.google.com
Special Thanks To :
Dr. Samarendra Hota, MHA 2nd Year