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Re: Post Procedure Care for Brachial Access Patients

Along with a major increase in radial artery cardiac catheterizations, we are seeing an increase in the amount of peripheral procedures and cardiac catheterizations being done through the brachial artery. I have not been able to find any data that supports the best practice for post procedure care of these patients, including best time for sheath removal, transferring the patient to the patient care area with sheath in place, activity, and extremity immobilization. As I am the educator for both the lab area and the cardiac floors our patients go to post procedure, I would appreciate any protocols, policies, order sets, or even good reference material that you might have to offer. Thank you!

Respectfully,
Lynne Maccubbin, Service Line Educator
Heart and Vascular Center, Yale New Haven Hospital
New Haven, CT
Email: lynne.maccubbin@ynhh.org

We posted this question for Facebook readers at www.facebook.com/cathlabdigest. Here are some of the responses:

Diane: Sheath is removed in our lab right away using the QuikClot (Z-Medica). Docs love it. […] The stretchy band is like a girdle around the wrist. In two hours, every other cord is cut. Then couple hrs later, rest is cut.

We also use the radial band, but now that QuikClot came out more docs are requesting it.

Steven: With radials, sheaths should come out immediately and a TR Band (Terumo) or some compression device should be used, because the artery is so small. With brachials, the sheath can stay in until the ACT comes down. But we use a small arm board and ACE bandage to stabilize the elbow.

Sabriena: Agree with Steve (Mobile, Alabama cath lab).

Leslie: Lynne, lots of great information on transradial at this link: https://www.transradialuniversity.com/Clinical_Procedural_Info

Re: Safety Straps on the Cath Table

1) Do you currently us a safety strap/belt when patients are placed on the cath Lab table?
2) If so, what type of safety strap/belt do you currently use?
3) Do you secure all patients or just those you consider at risk?
4) If you use safety straps/belts for at-risk patients, how do you determine patients at risk?

Thank you so much!
Lou Ann Janney RT(R), RCIS, Cardiac Catheterization Lab
Educational Preceptor, Carilion Clinic
Email: lbjanney@carilionclinic.org

We posted this question for Facebook readers at www.facebook.com/cathlabdigest. Here are some of the responses:

Cheryl: We use Velcro 4-inch straps on all patients and place them at the chest along with arm boards (rests).

Sharon: Are the straps single use only for infection control? If not, how do you clean them? Also straps should only be for support — they would not stop a patient falling!

Re: Hybrid Lab Floorplans/Designs

My name is Jeremy Naik, the chief radiographer in a busy cath lab in Melbourne, Australia. Our current cath lab is due for replacement at the end of December 2012, and the hospital’s plan is to replace the existing one as well as provide a hybrid lab next to the existing space. However, the new space is currently used as a day procedure admission area. I am hoping that someone out there is able to forward any suggestions of possible floorplans/designs which would suit two adjacent rooms, each 7x15 metres.

Thanking you in anticipation.

Kind regards,
Jeremy Naik
Email: naikj@ramsayhealth.com.au

Re: Cath lab productivity/use of suites

Does anyone have any resources regarding the utilization of cath lab suites and productivity measures? Utilization of suites details: turning over a room but staying in the same room for the next case? Or going into a different room?

If you can provide an example:

• How many cases does your cath lab do on an average day?
• Average turnover time? 
• How do you schedule outpatients & add-ons (in-house patients needing a procedure)?
• Do you use block scheduling?

Thank you!

Megan Bliss
Email: mbliss3@uic.edu