Cath Lab Professionals Review: Cath Lab Essentials With Dr. Morton Kern (Educational Video Series)

DVD; 2 hours, 30 minutes; produced by Park Bench Media
Available online at www.cathlabessentials.com and www.amazon.com, for $69.99.

Review by Jason Money, RN, RCIS, Bay of Plenty, New Zealand:

I had the honor of reviewing the latest offering from Dr. Morton Kern, a DVD entitled ”Cath Lab Essentials (Educational Video Series).” I must say that it is a very welcome addition to my educational collection that also includes Dr. Kern’s Cardiac Catheterization Handbook. I found the video very well presented (as detailed below) and like any good product, it left me yearning for more (you can view my wish list, too). I hope this will be the first in an ongoing educational series from Dr. Kern. The visual/auditory format appeals to many learners out there like myself.

The hemodynamics section is extremely well done. Dr. Kern takes very difficult concepts and walks us through with excellent supporting images. The discussion of the angles for cine is an absolute must for learners. I enjoyed the walk-though of the cath lab and the basic equipment needed. I have always believed the basics are very important for higher understanding and Dr. Kern does an excellent job, essentially showing anyone how to set up and perform a cath properly. I also enjoyed the review of drugs used in the cath lab.

I would be interested in seeing future installments address:

• Common complicating issues, e.g. tortuous vessels and wire suggestions, crossing the aortic valve etc.
• A section on plain percutaneous coronary intervention (PCI)
• More on radial access and radial technique (we are 75% radial in my lab)
• A more detailed discussion of the angiographic appearance of different disease states (plaque types, thrombus, etc.)

I am not sure how practical the excellent Impella (Abiomed, Inc., Danvers, Mass.) demonstration was for those not using the product. I presume, as it was the only brand mentioned [other than the Boomerang (Cardiva Medical, Inc., Sunnyvale, Calif.)], that there was some support from the company on the project. As it came in its own section, I don't feel that it influenced the presentation of other areas.

Overall, I feel it this video is an excellent (and no doubt future “must-have”) training tool for cardiac cath from the one person who is best at it. I think obtaining it in companionship with the classic The Cardiac Catheterization Handbook would be of benefit for all types of learners to enjoy.

Thanks, Dr. Kern, for your continued commitment to education in the cardiac cath lab.

Review by Annie Ruppert, RN, BSN, San Diego, California:

The “Cath Lab Essentials” (Educational Video Series) with Dr. Morton Kern is well worth the time spent watching it. This video should be an available hospital resource for every cath lab staff member. It consists of eleven chapters that basically cover the majority of the topics needed to work in a cardiac cath lab.

The video begins with Dr. Kern summarizing the indications, contraindications, and risks of a catheterization procedure. He reviews patients who would benefit from having a catheterization performed and what their diagnosis might be. Also, the correct way to consent a patient for the procedure is discussed.

Pictures of the basic equipment used in a cath lab are shown as Dr. Kern explains each one. Covered in this section are percutaneous needles, sheaths, wires, the manifold, and x-ray equipment. A brief discussion regarding fluoro and cine acquisition is also presented.

Drugs commonly used in the cath lab, such as antiplatelets, antithrombins, and thrombolytics are reviewed. Other drugs such as atropine, nitroglycerine, and verapamil are also discussed.

A patient is shown coming into the cath lab and being prepared for a procedure. Patient prep is demonstrated and setting up of the sterile field is also shown.

Dr. Kern presents basic hemodynamic monitoring, necessary equipment, and balancing and zeroing the transducers for accurate pressure acquisition. Basic pressure tracings are shown for right heart pressures, aortic pressure and left ventricular pressure. More advanced hemodynamic monitoring and calculations are covered. Included in this section are shunt calculations, valve gradients, and area calculations for mitral and aortic valves.

Dr. Kern discusses obtaining femoral access with use of the appropriate landmarks, and he undertakes a brief discussion of radial access. Possible complications of femoral punctures such as hematomas, arterio-venous (AV) fistulas, retroperitoneal bleeds, and pseudoaneuryms, as well as several other potential complications, are covered.

Angiography is the next discussion, with Dr. Kern sitting at a monitor station in a cath lab. This section is particularly good for the person just starting in the cath lab. I wish someone had explained the LAO, RAO, cranial, and caudal views in relationship to the coronary arteries this way when I first started working in the lab. The manner in which Dr. Kern explains the various positions of the camera and how it would lay out the arteries is excellent. He makes it simple and easy to understand. It was also helpful that he showed examples of each artery in the various angulations on the monitor screen in the lab. Dr. Kern discusses a left ventriculogram and the viewer is shown the various aspects of the left ventricular wall as it would appear on cine. Some other topics discussed, including grading of regurgitation, TIMI flow, collateral filling of occluded vessels, and anamolous take-off of coronary arteries.

The final chapters review high-risk PCI and the available support therapies currently available. Examples were shown, with brief discussions of the intra-aortic balloon pump (IABP), TandemHeart (CardiacAssist, Inc., Pittsburgh, Penn.), Impella (Abiomed, Inc., Danvers, Mass.), and cardiopulmonary support (CPS). A detailed demonstration of the set up, insertion and monitoring of the console for the Impella device is available in its own separate chapter. Finally, a left heart catheterization procedure was shown being done in the cath lab.

This video is an excellent resource to incorporate into the orientation of new staff, as well as for a thorough review for staff already working in the lab. It covers many topics and shows examples of almost everything one sees in the lab. I found it a great review as I watched. I feel confident that anyone who works in a lab would feel the same.