Nurse & Technologist Education

Highlights From the 2024 TCT Nurse and Technologist Symposium With Bailey Estes, NP
Held October 27, 2024, Washington, D.C.

Bailey Ann Estes, AGNP-C, MSN, RN-BC, RCIS, RNFA

11/05/2024

At the 2024 TCT meeting, Rebecca Kapur, Managing Editor with Cath Lab DIgest, caught up with Nurse and Technologist Symposium Program Director Bailey Estes, AGNP-C, MSN, RN-BC, RCIS, RNFA.

Listen in as Bailey shares highlights from the day's presentations around heart failure, endovascular procedures, and challenges in the cath lab that were discussed at the Symposium:

The transcript below has been lightly edited for clarity:

This is Rebecca Kapur with Cath Lab Digest. I'm here with Bailey Estes, who was part of the Nurse and Technologist Symposium yesterday. Bailey, I'll let you introduce yourself. Go ahead.

Hi, my name is Bailey Estes. I am a nurse practitioner in the cardiac cath lab currently in Lubbock, Texas, and one of the program directors for the Nurse and Technologist Symposium for TCT.

So can you tell us some of what was presented at the symposium yesterday? And then you spoke on a couple of things.

Yeah, absolutely. It's a one-day program. We were trying to be very cognizant of the needs of the staff in the cardiac cath lab. So we have a session focused on coronary, peripheral, structural heart, and then just focusing on the clinician — what are the needs today of our staff and our healthcare workers and dealing with burnout, dealing with our patient interactions. We wanted to have a comprehensive day where everyone gets a little bit of something out of it and hopefully takes something new home back to their cath labs to implement.

There was some discussion of heart failure. Is that something you anticipate becoming even more of an issue in the cath lab?

I think so. I think there's more and more companies today creating technology around what's called interventional heart failure. And it's really exciting because we're seeing now with patients living longer even, especially with previous coronary artery disease, they're prone to heart failure. Now we're dealing with that long-term, also with overlap with even electrophysiology and structural heart. We're now diving more into what can we do beyond just medical therapy. Even when you get into, say, diastolic heart failure, there's not really any good true medical therapy. So now they're looking into devices or procedures to help offload the heart and the cath lab's going to be the forefront of that.

So one of the talks was about the right heart cath, and I wasn't aware of this, but apparently some people view it with a little bit of, oh, another right heart cath.

Yes, yes. I think they have historically kind of gotten a bad rap, and there's always been the issue of Swan Ganz, do you use them? Do you not use them? And I think hopefully we should be coming around to finding the importance, especially when we're getting more into heart failure and interventional heart failure. The importance of the right heart cath is paramount. Once you get into it, if you can really learn the hemodynamics of it, it makes it more exciting, figuring out where exactly is the pathology, what are we looking at? A lot of it's going to take, I think, the physicians getting the team involved and really teaching them, what do these waveforms mean? What are we trying to get out of this? And then it becomes more interactive and fun. And then when we compare it with an interventional procedures, of course, because we like to do things, be very technical, be very skilled, taking those numbers and then putting them into work, to try to see whether we're going to improve the patient and make them better. I think we'll make it more exciting hopefully. And there's a lot of work to be done, I think on the right heart cath side of things of where we can improve and really hone those skills.

Your area of focus, of course, is endovascular work, lower limbs. Can you talk about that?

It is also another exciting area that's also kind of had a bad rap. I originally got into peripheral artery and endovascular because that was the procedure nobody wanted to do. They're like four hours long, they last a long time. But really once you dive into the pathology and the patients, and see how sick they are and think about how important our limbs are when you have a major amputation, not only for the patient but for their family, for the community, it creates a burden of care. If we can improve those outcomes, and sometimes it's starting in the cath lab of just getting the most flow that we can, I think is important for the patients to keep their limb, even if it's just for a couple more months or for a year, really redefining what our expectations are. One of the things I talked about yesterday was guideline-directed medical therapy and the role of a multidisciplinary team because these patients are so complex, the intervention really is just one part of it and they need to be very strongly medically managed.

There are ways that the cath lab team can get involved with these patients. Studies have shown patients with coronary artery disease and peripheral artery disease that have had interventions still aren't on a simple aspirin and a Plavix or maybe a high-intensity statin therapy. Those are things that as we're going through looking at our patients, either pre or post op, we can say, Hey, we're missing something here. Or I can take the initiative, tell my doctor, we need to be on these simple medications, or maybe let's escalate therapy, or let's work with our pharmacy programs to make sure that everyone leaving the hospital has their dual antiplatelet therapy in hand. I think it's simple things that make a difference, and it's taking that first step to get there. That's important.

We were talking about how exciting some of the devices and their abilities can be, but really you can make the most impact with simple steps like this.

Absolutely. The devil's in the details. You can do these amazing revascularization procedures that take hours and hours and hours, but if they go home and they don't take their dual antiplatelet therapy, they can close everything off and then you're right back to square one. So you have to have a full approach. You can't just put in the device, do the stent and walk away. That's just one part of it, but it is made so much better when you have all the different pieces working together.

Any additional presentations that you might want to highlight or discuss?

I think there was a really great discussion about shared decision-making and what is the role of the team. As we are getting more into advanced therapies, structural heart, and now looking at advanced heart failure therapies, I think it's important to know what your role is in expanding that role and being an advocate for the patient — pairing the team with surgery, with endovascular therapies, or percutaneous therapies, and looking at that as a whole. We need to be a part of that team to decide what's best for my patient, how am I educating my patient for them to make the best decision for themselves when we're implanting these devices, whether they're lifesaving, or we're doing a lot of things that are preventative now. So anything that we implant in the body has a long-term impact. And also in educating the patients, we are empowering them. They feel a sense of worth, self-worth, to have a major role in their care. They understand, okay, you can put this device in, but I still have work that I have to do on my end taking my meds. It all comes full circle, but I'm glad to see the cardiovascular team really taking ownership and leading that initiative of being patient advocates.

Someone I knew went in to get a consult about wounds in their foot, and their thinking going in was, just take the leg off. Do you ever see that?

I do. And a lot of it is a big conversation to have with the patient. Some of them will be like, Hey, let's just take it off from the get-go. Some of them want you to do everything in the world to save them, and a lot of it's just meeting the patient where they're at and really being realistic of where their wound is. When they come in with a black foot, you're already way behind. So some of it is setting expectations of here's what we realistically can do. Here's what's going to be best for you. Also functionally. So I've had patients come in that they're like, do everything. I don't care if it takes 10 procedures to get there. Dr. Matthew Bunte did a great presentation during the symposium on deep vein arterialization (DVA). DVA is definitely not a one-and-done procedure. You have to prepare the patient. You're going to have to come back for maintenance of this. It's a long process to get that wound healed, but depending on what their goals are, if it's to keep as much foot as possible, then we have those options. Sometimes. I had a patient that was a wonderful patient. She worked three jobs, had a really bad wound in the heel, and we told her how things were going to go. We think we can save the foot, but this is what your plan of care is going to look like for the next one to two years. And she said, I just can't do that. I can't offload my foot. I have to get back to work. Can we just go with an amputation? I get a prosthesis and I get back to work. I have to pay my bills. And we thought that was really realistic for her. She wouldn't be able to come do the rehabs and the wound care several times a week. Her jobs just wouldn't allow her, and she didn't want to be left jobless. So we ended up primarily going for an amputation for her, and she did wonderfully. She got fitted for a prosthesis. She went back to work. It's really patient-specific and how you present things to them I think is very important.

That really does tie back into shared decision-making, which can be incredibly complex.

Absolutely. We have to start treating these as they are chronic illnesses. We think, okay, we'll go put in a stent. You're going to be fixed forever, or five to 10 years, and we're just seeing it's not that way for a lot of people now. They've got so many comorbidities. We kind of almost have to treat them like they're an end-stage dialysis patient, or they have cancer. This is a long-term plan. When you get diabetes, you don't just take insulin once and then go on about your life. You have to keep taking it. You have to maybe go up on your dose, go down on your dose. So I think that's how we have to approach this as well.

Do you have any message for the attendees or for people who wanted to attend but couldn't attend?

Absolutely. I think try to jump in as much as you can. Look for these conferences. There are more and more popping up that have dedicated nurse and tech symposiums. Look for those. I think TCT also has online recordings and things that you can watch and jump into, tap into. Also, social media is such a great resource of people posting about what they've learned and engaging with those people as well. People are very open to engagement on social media, and that's a free way to get information. So I recommend that. And just keeping plugged in as much as you can and really advocating for your institutions to see the importance of coming to these and collaborating and not working

Wonderful. Thank you so much for talking to me! I appreciate it.

Great. Thank you! It was fun.