Looking Back: Spotlighted Labs of 2011

A completely unscientific survey of what CLD’s 12 spotlighted labs reported in 2011.

Do any of your physicians routinely utilize transradial access?

Yes: 10 (83.3%)
No: 2 (16.7%)

Yes, Dr. Iyengar. He utilizes a standard micropuncture needle/kit for initial access. Then a Terumo hydrophilic 6 French (F) sheath is introduced into the artery. A cocktail of 200 micrograms of NTG and 2000 U of heparin is given slowly through the sheath.

Use of radial access for interventions has been actively been used for the last 15 months. Post procedure, patients will have a radial band placed by lab staff while in the lab, which is then slowly unbuckled at 20 minute intervals in the holding bay by the holding bay RNs.

-Manatee Memorial Hospital, Bradenton, Florida

We have one physician that regularly gains access via the radial artery. The majority uses the femoral approach.

- Texas Health Presbyterian Hospital Dallas, Dallas, Texas

We currently have 7 physicians using the transradial approach on certain patients and are beginning to use this approach on ST-elevation myocardial infarction (STEMI) patients that are stable enough.

-Moses H. Cone Memorial Hospital Cardiac Cath Lab, Greensboro, North Carolina

Yes. We started our radial program late 2009. Currently 80% of our cases are being performed via the radial approach.

-Maury Regional Medical Center, Columbia, Tennessee

We do not utilize radial artery access at this time.

- North Suburban Medical Center, Thornton, Colorado

Access is determined primarily on a case-by-case basis, specifically catering to the patient’s needs, requests, and best outcome. Our physicians have and continue to use radial artery for both diagnostic and interventional procedures with excellent results. 

- Deborah Heart and Lung Center Cardiac Catheterization Laboratory, Browns Mills, New Jersey

Not at this time.

- Nacogdoches Medical Center, Nacogdoches, Texas

Three of our interventional cardiologists regularly gain access via the radial artery. The other physicians prefer groin access, but will do a radial access case if requested by the patient or if it is necessitated by the patient’s condition. Overall, approximately 80 percent of our coronary interventions are performed via the radial approach.

- Lane Cardiovascular Center, Zachary, Louisiana

Yes. Currently, between 10-12 of our 120 physicians gain access via the radial artery on a fairly routine basis.

- Florida Hospital, Orlando, Florida

We have several physicians who prefer to use the radial artery for procedures. At this time, we are doing approximately 60% of our cases through radial access. The Allen’s test is done immediately preceding the procedure to ensure adequate blood flow for patient safety. These patients are generally prepped anticipating using the right wrist with the right groin as an alternative. The waveform is recorded post procedure along with color, motion, and sensitivity (CMS).

- Rochester General Hospital, Rochester, New York

We have two interventional cardiologists who regularly gain access via the radial artery. There are also several diagnostic physicians who are beginning to train in radial techniques.

- Wentworth Douglass Hospital Cardiovascular Lab, Dover, New Hampshire

Samer Kazziha, MD, FACC, established our radial program in November of 2010. Upon the completion of 100 successful cases by Dr. Kazziha, some of our other physicians started using radial access on their patients as well. We are in the process of having our facility registered as an official radial program center. Also, we have begun gaining radial access on our stable ST-elevation myocardial infarction (STEMI) patients. Currently 80% of our procedures are being performed by radial access. Recently, Dr.Kazziha successfully performed an abdominal aorta and lower extremity runoff using the radial approach.

- Crittenton Hospital Medical Center, Rochester, Michigan

How does your lab handle call time for staff members?

We have three team members on call 24/7, and at least one member is an RN. All team members are expected to arrive within 30 minutes of being paged.

-Manatee Memorial Hospital, Bradenton, Florida

Every staff member must take 7 days of call per month and one weekend a month. We have at least one RN, and one RCIS or RT(R) on call. Our call time goes from 5:30pm until 7am on weekdays, and 24 hours on the weekends and holidays. We also do self-scheduling.

- Texas Health Presbyterian Hospital Dallas, Dallas, Texas

The call schedule is currently over an 8-week period and a nurse has to be on every call team.

-Moses H. Cone Memorial Hospital Cardiac Cath Lab, Greensboro, North Carolina

We have three teams made up of three staff members. Call is rotated through the week and every third weekend. There is always at least one RN per team.

-Maury Regional Medical Center, Columbia, Tennessee

Since everybody is just about cross-trained, we look at call differently than most cath labs. We make sure we have a “scrubber,” a circulator, and a monitor person. Each person must be 100% comfortable in their position since we get complex emergencies. There is not a specific mix of credentials needed for the on-call team.

- North Suburban Medical Center, Thornton, Colorado

Our cath lab call team is assigned one week of call every 4–6 weeks. The call team typically is comprised of an RT, RN, float (RT or RN), fellow, and attending. 

- Deborah Heart and Lung Center Cardiac Catheterization Laboratory, Browns Mills, New Jersey

Call is rotated on a biweekly basis; three team members must be on call at any one time. A minimum balance of credentials is necessary: the call team must consist of at least one RN and one RT.

- Nacogdoches Medical Center, Nacogdoches, Texas

All staff members are required to take call an equivalent of every other week. Each call team consists of 2 RNs and 2 RTs.

- Lane Cardiovascular Center, Zachary, Louisiana

On-call shifts are from 6:30 pm to 6:30 am, 7 days a week. Team members are on call 1-2 weekdays per week and 1 weekend every 6 to 7 weeks. We do not staff our call teams with any specific credentialed team members as all members have been cross-trained.

- Florida Hospital, Orlando, Florida

Our call guidelines require each staff member to be on call one night per week, one weekend per month, and two holidays per year. A complete call team is comprised of two RNs and 1 RT, and 1 additional staff member to monitor. We have self-scheduling for our daily schedule as well as for on-call. Staff signs up based on department needs in balance with their personal needs. Two staff members have assumed responsibility to assure the schedule is complete.

- Rochester General Hospital, Rochester, New York

Staff is on call one day a week and one weekend a month. Our lab has a four-member call team consisting of at least one nurse and one scrub tech. The other two positions may be filled by any other combination of staff. There are four set call teams that follow a rotation to give all members a predictable schedule for the year.

- Wentworth Douglass Hospital Cardiovascular Lab, Dover, New Hampshire

Our clinical coordinator organizes the call schedule and makes it available to the staff a month ahead of time. Staff is allowed to make changes to the schedule to accommodate their personal lives. This makes for a great work-life balance. We have a three-person call team that has to include at least one nurse.

- Crittenton Hospital Medical Center, Rochester, Michigan