Cath Labs

Sasha

Sasha

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I've asked several people and can't seem to get an answer, so I'll pose the question to the brains of the board and see if we can get an answer.

What is the logic behind a diagnostic only cath lab?

A cardiac cath is a risky procedure to begin with, why would you want to do it once, find something, pull out, shuttle them over to another hospital for stent placement in their cath lab?

Personally, I've never experienced it before, but I don't think I'd want someone poking through my femoral artery and around my heart more than once.
 
There is a lengthy application process to becoming a full fledged cath lab. The diagnostic is sort of a trial run, to measure competency, efficiency as well as how truly beneficial it will be to have one running in the area.

Would you put great confidence in a full service cath lab that does < 10 a year? Helicopter, please!
 
vquintessence said:
There is a lengthy application process to becoming a full fledged cath lab. The diagnostic is sort of a trial run, to measure competency, efficiency as well as how truly beneficial it will be to have one running in the area.

Would you put great confidence in a full service cath lab that does < 10 a year? Helicopter, please!
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If they do less than 10 a year, then what is the point of wasting money and resources on a cath lab in the first place?
 
Sasha said:
I've asked several people and can't seem to get an answer, so I'll pose the question to the brains of the board and see if we can get an answer.

What is the logic behind a diagnostic only cath lab?

A cardiac cath is a risky procedure to begin with, why would you want to do it once, find something, pull out, shuttle them over to another hospital for stent placement in their cath lab?
Click to expand...

So far as I can tell, it sounds like a money making scheme to me. It does seem against logic to put a cath in, say yep, he sure got a blocked one, yank it out, transport to an actual lab,, then do it all over again. :wacko:

Personally, I've never experienced it before, but I don't think I'd want someone poking through my femoral artery and around my heart more than once.
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WHAT? You've never had a heart cath? ;) At one of the hospitals we transport to sometimes they have stared going in thru the radial artery. :unsure: I dunno why. Seems like the femoral would be more direct.
 
There are many other procedures besides cardiac catheterization that can be accomplished in an interventional radiology suite.
 
Sasha said:
I've asked several people and can't seem to get an answer, so I'll pose the question to the brains of the board and see if we can get an answer.

What is the logic behind a diagnostic only cath lab?

A cardiac cath is a risky procedure to begin with, why would you want to do it once, find something, pull out, shuttle them over to another hospital for stent placement in their cath lab?

Personally, I've never experienced it before, but I don't think I'd want someone poking through my femoral artery and around my heart more than once.
Click to expand...

Assessment. Because there are cardiac pts that do not need PTCA or other cath lab interventions. They only need to be treated medically. But they do need to be assessed at the site.

Also it is more expensive for a cath lab to do interventional cardiology. The main reason being you cannot do an interventional cardac cath without a CV surgeon on standby. If anything goes wrong in the stent placement, you'll have literally just a few minutes at the most to get their chest cut open and surgically fixed before they die. Those OR suites, personnel, and especially the CV surgeon don't come cheap.
 
Assessment. Because there are cardiac pts that do not need PTCA or other cath lab interventions. They only need to be treated medically. But they do need to be assessed at the site.
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How do they determine that the patient will only need assesment prior to catheterization?
 
Sasha said:
How do they determine that the patient will only need assesment prior to catheterization?
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That is good question, Sash. They should have a good idea of how bad and/or where the lesion is clinically through ECG's, assessment, labs, etc, but, now I'm speculating here, they will need to see it for confirmation.

Sometimes it's worse than they anticipated, and the pt will need to be transferred to interventional cardiology up to and incuding CABG.
 
While the diagnostic cath lab still makes up well over half of the total number of labs, its future is uncertain since the CT Scanners that do cardiac imaging are now more prevalent. Also, almost half of the cardiac caths done in diagnostic labs are normal. Many of the abnormal may not require immmediate attention and others will have to be treated surgically. The cases handled in diagnostic labs are not the emergent STEMI. They are usually the 9 - 5 appointments from referrals or even self referrals from advertisements.

Florida was also one of the most notorious states in the 1980s for the "cath in a can" era. Portable cath labs roamed the land looking for a place to park at any hospital. They also slipped through the certificate of need requirements. That is the reason I posted the updated info from the statutes and the healthcare councils. Florida is one state that is attempting to advance in technology and to provide the appropriate service to those that require interventional procedures.
 
For additional reading on the Cardiac CT, here is an interesting article about the LA firefighters.

http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=80603

Cardiac CT saves money and time as first-line heart test

Two studies presented on Monday at the 2008 American College of Cardiology (ACC) meeting in Chicago are emblematic of a new wave of evidence supporting the first-line use of CT in subjects with and without suspected heart disease.

First, a study led by the institute's Dr. Nicole Weinberg examined the use of cardiac CT as a gateway to cardiac catheterization in 495 asymptomatic firefighters. Using gated coronary CT calcium scans, the researchers were able to effectively triage the subjects into follow-up cardiac CT angiography (CTA) -- or send them back to work without further workup.

In a second study, researchers led by Dr. Ronald Karlsberg, the cardiology program director at Harbor-UCLA Medical Center, integrated coronary CTA into an office-based cardiology practice. Incorporating coronary CTA reduced the need for myocardial perfusion imaging and exercise treadmill testing. Moreover, doctors were able to identify more coronary artery disease and provide more aggressive lipid management, while keeping office income relatively stable.
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Firefighting is known as a high-risk profession, but not all of the risks are obvious. Take heart disease. A 2005 survey by the National Fire Protection Association revealed that 43.7% of deaths among active firefighters between 1995 and 2004 were from sudden cardiac death, including coronary artery disease.
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MSDeltaFlt said:
Sometimes it's worse than they anticipated, and the pt will need to be transferred to interventional cardiology up to and incuding CABG.
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Would it not make sense to cut out the need to ambulance or helicopter them around to a different hospital if it turns out to be worse, and just take care of the problem right then and there? I'm sure the patients would prefer it that way! It seems like such a waste of resources to have a diagnostic only cath lab in places where an interventional cath lab is just a short ambulance ride away. I could understand the need in more "stretched out" areas, though.

But thank you guys for answering my questions!
 
Sasha said:
It seems like such a waste of resources to have a diagnostic only cath lab in places where an interventional cath lab is just a short ambulance ride away.
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It would also be a waste to tie up interventional labs with routine caths. People do come in for regular checkup of their stents and now with the problems of the drug coated stents, the diagnostic labs have been very busy.
 
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