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We are revising our processes and relocating our pre and post cath patient care area. I’d like some ideas on staffing, training, hours, whether or not both in and outpatients pass through there, and especially whether there are patients from any other areas, such as radiology. Is it the same area for pre and post? Where do the families wait? HAVE A SUGGESTION FOR A FUTURE QUESTION? Email us at cathlabdigest@aol.com One Pre/Post Area With 30% Daily Patient Add-Ons I work in an area that prepares OP for cath lab and special procedures as well as takes care of outpatients post procedure. We also take care of the inpatient population immediately prior to cath (the inpatient nurses prepare the patient, and we are essentially a holding area), and we take care of the patients post procedure, for a minimum of one hour post procedure. Our staff does the line pulls on all patients, M-F, non-holiday. In addition, our facility does not have an area to care for outpatient medical procedures (i.e., blood, IV antibiotics, etc). All non-ICU patients transferring to our hospital to have a cath lab procedure also come to us. It is a very difficult area to staff with all the changes and additions that occur daily. 30% of our daily census are add-ons. I would be interested in any input you have on staffing a pre/post area, and staffing a pre/post area with expanded patient responsibilities. Thank you, Carol Wynn CAROLWY@waushosp.org 4-Bed Holding Area Keeps Inpatients Until Sheath Pulled We have a 4-bed holding area that is used for both pre and post cath procedures. We also are responsible for keeping myleogram patients (pre and post). Inpatients are kept in the holding area, if they have been on heparin and their cath is negative, until we pull their sheath in 4 hours. We have a separate family waiting room and we try to limit the number of family members at the cart side to two. Carletta@weirtonmedical.com Weirton Medical Center Weirton, West Virginia For Cath Lab Procedures, Specials and Radiology At the cath lab where I work full time, we have a 28-bed CSSU. Of these, 15 can be used for 23-hour private beds. The rest are open or bayed with pull-around curtains for privacy. It is staffed by RNs and PCTs. The PCTs are trained to pull sheaths and gain hemostasis. This frees up the RNs to do other needed work with other patients. If it is a known difficult hold, then the RNs will pull. If there are any problems, which is seldom with the PCTs pulling, the RNs will also take over the process. Training is done by a preceptorship for six weeks for seasoned staff and up to 12 weeks for the inexperienced. RNs are normally from the units or one of the monitored floors. All are ACLS-certified. PCTs are either CNAs who have cardiac experience or nursing students. Everyone goes through a basic rhythms course. Both outpatients and inpatients pass through here for Cath Lab, Specials, and Radiology. Outpatients are prepped and recovered completely in the CSSU. Inpatients are transported to the cath lab by cath lab staff and then recovered in CSSU. If the inpatient is going to stay more than one night in-house, they are sent back to their room an hour after pull. If they are going to be sent home the next day, then the patient will stay in one of the 23-hour private rooms overnight. Families stay at bedside except during the procedure and during pull time. During this time, we have a waiting area with a liaison who stays in contact with the cath lab to update the family and answer questions. We are currently outgrowing our CSSU, so the hospital is building a new recovery area for the radiology patients. Kevin, RN, BS ldrich3@comcast.ne Holding Area Staff Should Not Be CCL Staff Taking Call We have a Cath Lab Holding Area which we utilize as a pre and post cath patient area. The hospital day surgery admitting area takes care of the pre cath admitting papers, labs, EKG, etc. Once the patient is preadmitted, then they are sent to our holding area for pre op preparation such as signature of consents, initial vital signs and assessment, and IV placement. Once they are set, they proceed into the cath lab for their procedure. Patient family members will wait for the physician in the family waiting room, which is also used by the other units as a waiting room. Once the procedure is done, the physician speaks with the patient’s family and the patient is sent into the holding area for recovery either to go home or to wait for a hospital bed for a full admit. This type of setup is nice for the patients because the crew that sets up the patient in the holding area also recovers the patients and there is continuum of care. But the crew that is staffing the holding area is the cath lab staff, and sometimes these staff members might be on call. We have run into many problems, such as when the patient waiting for an admit bed does not receive one until well over closing time. Our lab runs from 7am to 5:30 pm and anything after 5:30 is call crew. There are many days that the call crew is basically taking care of the patient until a bed is available. That creates a serious problem when a hot MI is downstairs in the ER. My biggest suggestion is for the pre/post patient care area not to be staffed by the cath lab crew, unless this crew is not going to be on call. It makes it a lot easier if the staffing comes from the IMC units, where it can be staffed 24/7. I have heard of units primarily made for post procedures or post anesthesia units that are a catch-all. They receive patients post any/all procedures. If a bed is needed, they stay there until a bed is available. Another problem that we’ve experienced is that when a patient from a medical telemetry unit has an angioplasty done, they need an IMC bed or post-plasty bed. If there are none available, they always end up in our holding area and again wait there until a bed is available. Also, we have experienced situations where doctors’ offices or other facilities need to transfer a patient for an angiogram or EPS/AICD procedure. These patients seem to end up in our holding area pre and post procedure. This area could provide great revenue, but think about what might happen to your call crew if your cath lab is staffing the area. Good luck, Jo Ann joann@skylink.net Heart Center Holding Area for CCL We currently have an area that preps and recovers our patients. We have a Heart Center, with central registration for all patients receiving treatment in the CV area. For invasive cardiology, the patients register in the lobby, have their blood work, chest x-ray, etc. done if needed, and then are escorted to the holding area. They sign their consents, have IVs started, and are seen by the physician if needed. The holding area informs the board when the patient is ready for their procedure. Following the procedure, the patient returns to the holding area for post care. If the cath is negative, they are discharged to home from there. If they have an intervention, they remain there only until their bed is ready on the telemetry unit. Initially, we would transport patients from the floor to this area prior to their cath, and send the patient back to this area following their cath, but the volume of patients we now have prevent us from taking care of inpatients in this setting. The patients’ families wait for the patients in the Heart Center Lobby while the patient is being prepped and also during the procedure. Our facility has a separate holding area for radiology patients that functions in a similar fashion. Sheila DeBastiani, RT(R), Supervisor/Educator WakeMed Invasive Cardiology, SDebastiani@wakemed.org CCL Patients Use Same Day Surgery Area We do not currently have a pre/post procedure area. Same day surgery (SDS) is adjacent to our CCLs so our patients use that area. SDS is not monitored so only patients with sheaths already out go there. We would like to create a pre/post area that would, for purposes of synergy and efficiency would also include the radiology patients. Our concept is that this area could then be used for post PCI patients with sheaths as well. JErnest@stmarys.org

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