A Whole-hearted Approach

Since technology is continually changing, a cookie-cutter approach to designing a cath lab for either a renovation project or new construction simply does not exist. There are, however, some major elements to consider when designing any cath lab. For maximum success, they should be addressed in the following order: 1. Overall room placement in the facility. Cath labs very much resemble a surgical suite in space requirements, support and traffic flow. Whenever possible, it is best to be near the CVOR (cardiovascular operating room) unit for limited patient transfer if complications arise during the procedure. 2. Space and proportion of the suite. The cath lab, a suite of three or four rooms (one or two cath labs, an equipment room and a control room) must meet state guidelines for space and must be flexible enough to accommodate ever-changing equipment. 3. Placement of devices and supplies. Cath labs contain a lot of equipment, all of which needs to be accessible yet easy to keep clean, and sealed from both dirt and the water used to remove that dirt. Addressing these elements may seem like a daunting task, especially when designing a cath lab as a retrofit in an existing facility. Fortunately, experience has provided numerous solutions for creating cath labs that are efficient and functional. 1. Place the cath suite next to or near the CVOR. This is a top priority and should be addressed during the strategic planning stage, before looking at the specifics of the layout within the suite between the cath lab, the equipment room and the control room. Even a minimally invasive procedure may have complications arise occasionally. If this happens, a patient must be moved to the OR. Having the lab near the OR minimizes patient travel and saves time, allowing for faster patient stabilization. Granted, it isn™t always possible to situate the cath lab next to or near the CVOR, especially when the addition is part of a renovation. When this is the case, an architect can help to explore what efficiencies can be implemented to reduce patient transfer. In some cases, surgical support equipment has been added to the cath lab to allow a patient to be operated on within the cath lab itself. 2. Build the equipment room large enough to accommodate a bi-plane cath lab, even when only installing a single-plane cath lab. In building a cath lab, moving from the planning stage to the equipment installation stage can take one to two years, during which time more money may become available for newer technology or equipment. It is sometimes difficult to plan ahead regarding future technology. We can, however, plan a flexible space to accommodate different procedures. For instance, plan for bi-plane equipment even if single-plane is being ordered. Because a bi-plane equipment room requires twice as much space as a single-plane equipment room, planning from the beginning allows the flexibility to change to a bi-plane cath lab at any time without being landlocked. With the least amount of impact, the equipment can be taken out and upgraded to another piece of equipment. 3. Sandwich one shared control lab between two procedure rooms. Asking staff to share one control lab when you have two procedure rooms creates space efficiency within a suite. In some cases, this may not be preferred because it creates more noise and some congestion, so two control labs are planned, one for each procedure room. In other cases, the space efficiency is more important. Neither way is better than the other this is purely a facility-driven issue. 4. Consider sealed subfloor trenching if the lab is on a ground floor. In designing a cath lab, one question that must be addressed is: How do we get all the equipment hooked up from the computer room to the cath lab table? Some of the wiring comes down from the ceiling, and some of it comes up from the floor. However, if the cath lab is on a ground floor, installing and/or changing out wiring that comes up from the floor can be troublesome. In this situation, one approach that works well is using sealed subfloor trenching from the equipment room to the table pedestal. This approach does have to be sealed carefully, and kept sealed against dirt and water (from mopping the floor). 5. Plan in advance for cable length of different manufacturers. A huge coordination issue that must be addressed during design is the maximum length of cabling run offered by the different equipment manufacturers. Waiting until installation to address this issue may produce a situation where there isn™t enough run to hook up all the equipment, in which case the space that was already so carefully planned will need to be rearranged (and costs go up). If a hospital is in the middle of planning a lab and decides to change from one manufacturer™s equipment to another™s, parties should remember to address this issue as well, because not all manufacturers provide the same cabling length. The change may require some space adjustments. It™s easier to change the equipment out when working with conduit runs or a trench, but not everyone has that luxury. Therefore, planning ahead is imperative. 6. Recessed cabinets allow for maximized work space. Catheters come in thousands of different sizes, creating both storage and quick-access challenges. It™s common to want to store them within the procedure room, for which recessed cabinets work well. Outfitting the cabinets with glass doors allows the contents to be seen easily so the right catheter can be accessed quickly. Many manufacturers sell new cabinets complete with the hooks installed. But retrofitting existing cabinets to accommodate catheters can be a challenge because many manufacturers sell only the hooks needed to hold the equipment. Be prepared to thoroughly research this option. Cath labs are becoming more and more technologically sophisticated. The suites need to be as spacious and flexible as possible because of the continual introduction of new procedures and disciplines. In both renovations and new construction, be sure to address overall room placement in the facility, space and proportion of the suite, and placement of devices and supplies. This whole-hearted approach can ensure a successful project. Truby.McDougal@perkinswill.com

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