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Cath Lab Changes to Cut Radiation Exposure

Radiation dose received by patients during invasive cardiology procedures has the potential to cause skin damage and is assumed to include a small cancer risk. To help ensure patient safety, it is desirable to minimize patient radiation dose to patients undergoing these procedures. An inherent benefit of reduced patient dose is reduced dose to physician operators and staff. Previous studies have tested patient radiation dose-reduction initiatives for radiofrequency ablation and invasive coronary artery procedures. Few studies, however, have explored the effects of using sustained patient radiation dose-reduction initiatives in larger, diverse invasive cardiovascular settings. A Progressive Movement on Patient Radiation In an issue of JACC: Cardiovascular Interventions, Kenneth A. Fetterly, PhD, and colleagues had a single-center study published that investigated the effects of sustained practice and x-ray system technical changes on radiation doses administered to adult patients during invasive cardiovascular procedures. Data were categorized to include all procedures, PCIs, coronary angiographies, noncardiac vascular angiographies and interventions, and procedures to treat structural heart disease. Under the guidance of a cardiovascular invasive labs radiation safety committee convened by the Mayo Clinic, several clinical progressive changes were implemented from 2008 to 2010 to elevate radiation awareness and reduce patient radiation dose. The changes included: [polldaddy poll=6965513] Establishing a multidisciplinary catheterization laboratory radiation safety committee. Announcing radiation doses during procedures at 3,000 mGy intervals to increase awareness and minimize high-dose procedures. Documenting the radiation dose in final reports upon conclusion of procedures. Mandating that fellows be trained on x-ray imaging and radiation safety. Standardizing x-ray protocols. Increasing spectral filtration for acquisition imaging. Setting the default fluoroscopy program to a low dose rate. Reducing...

A Consensus on Cath Lab Patient Flow

The atmosphere of a catheterization laboratory poses challenges to maintaining and prioritizing high-quality care and patient safety. Despite these challenges, healthcare providers performing procedures in the cath lab are expected to maintain appropriate communication, clinical management, documentation, and universal protocol. A Uniform Standard for Cath Labs My colleagues and I, on behalf of the Society for Cardiovascular Angiography and Interventions (SCAI), published a clinical expert consensus statement on best practices in the cardiac cath lab in the March 20, 2012 online issue of Catheterization and Cardiovascular Interventions. Previous standards from the American College of Cardiology and SCAI have focused on how to set up a cath lab and run it as an administrator, but the new consensus statement focuses on the processes of patient flow. Following cardiac catheterization, careful patient monitoring is crucial during the hospital stay. Several vital components should be reviewed and documented prior to performing cardiac catheterization. Because percutaneous procedures are often complex, patients should be well informed about the procedure and their possible outcomes. When patients arrive at the cath lab, it’s recommended that a checklist be filled out documenting informed consent, history and physical exam information, medications, and allergies. It’s also important to document each patient’s candidacy for drug-eluting stents as well as sedation and anesthesia, their healthcare proxy status, and results of laboratory evaluations that are needed prior to the procedure. It’s highly recommended that use of any checklists cover all the nuances that can be easily missed if they’re not properly recorded. The SCAI recommends that best practices during cardiac catheterization include a thorough review of patient medical records, access site concerns,...
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