Technical aspects of the cardiac catheterization laboratory

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Parts of an Ideal Catheterization Laboratory

Although it may vary with technical equipment requirements and number of laboratories used in the hospital, there should be adequate space in every catheterization laboratory for following ;

• An acclimatized and properly sanitized procedure room with a scrub station
• A separate, radiation free control room for supervising
• A proper, humidity safe equipment room for catheters and other devices
• A recovery room for patient preparation and holding.
• A dressing room and toilet for patients
• A staff room with dressing place and toilets
• A temperature monitored refrigerator and proper space for pharmacy
• A post procedural film reviewing station and medical reporting offices
• Secured computer management and film archiving area
• A power generator or an adequate power supply for uninterrupted workflow.
• Portable monitors for invasive and non invasive evaluations
• Adequate numbers of defibrillators
• Height adjustable patient transfer beds
• Intra aortic balloon pumps
• A respirator / ventilator

Personnel Related Issues

• Adequate training for procedural skills, and board certification in interventional cardiology for operators
• Knowledge of recognition and management of complications
• All team members should complete a basic CPR course (ideally certification in A.C.L.S.)

Procedural Issues

• Patient preparation

• Adequate sedation and relaxation required for all patients.
• Preparation for possible "Contrast allergy"
• Patients with renal function abnormalities (e.g. renal insufficiency)
• Diabetic patients
• Patients on antithrombotic and/or antiplatelet drugs
• Patients with hearing impairment
• Patients with prosthesis and amputated limbs

• Operator safety during interventional procedures in patients with communicable diseases;

• Using proper caps and masks
• Careful disposal of needles, catheters, tubes and fluids from infected patients
• Proper gloves (double gloves) and eye shields / facial shields
• Disposable shoe covers

• Procedure related performance

• Proper catheter (size and curve type) selection
• Assurance of bubble free connections and adequately flushed equipment
• Injection of coronary arteries: The use of nurses, cardiovascular technicians, or physician’s assistants to inject the coronary arteries has become increasingly popular. It remains the responsibility of the individual invasive cardiologist to ascertain whether paramedical personnel or power injectors are capable of administering contrast into the coronary arteries. The responsibility for safety ultimately residing with the invasive cardiologist.
• Adequate use of angiographic projections, filming time and visualizations of entire coronary tree, and vein and/or arterial bypasses in previously operated patients.
• Careful monitoring of heart rate, rhythm, waveforms and pressures, and recording as required for postprocedural references and/or evaluation.

Radiation Safety

Every team members, even maintenance related person in catheterization laboratory should have adequate training on radiation safety and continuously controlled by a certified institute for acquired radiation dose.

Every procedure room should have separate (installed) dosimeter to control radiation safety of x-ray source.

Patients should also monitored regularly and informed for procedure related radiation dose issues.

All operators should avoid from unnecessary filming, and using longer radioscopy.

Patients with longer procedural time and higher radiation exposure should be referred for dermatology/oncology consultation and follow up.