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Updated Consensus Document Highlights Best Practices in Modern Cath Lab
Several professional organizations, including the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions, have convened to create a new consensus document that provides interventional cardiologists with recommendations for maintaining high standards in a contemporary cath lab setting.
This document, which also features contributions from the Society of Thoracic Surgeons and the Society of Vascular Medicine, updates a similar one published in 2001. Among the notable changes with the new version include the acknowledgment of the newer procedures such as valvular, peripheral and congenital disease interventions. With the advent of newer procedures came the need for developing hybrid cath labs that are suitable not only as a cath lab but also an operating room, which the authors address in detail, including special considerations for designing, building and equipping a hybrid lab.
Due to the paucity of data indicating that undergoing an interventional procedure in cath labs with surgical backup is safer and estimates suggesting that around one-third of all cath labs do not have backup, the new document removes a number of prior restrictions on patients who undergo catheterizations in facilities without surgical backup. The document features direction on how to put together a quality assurance/quality improvement program, emphasizing quality oversight over minimum volume numbers. Participation in national databases to allow benchmarking of one’s own laboratory is also stressed. In addition, the authors delve into measures to minimize radiation exposure and specific considerations for pediatric cath labs.
Other noteworthy modifications to the new document include the following recommendations: keeping all cath labs with STEMI programs open 24 hours/7days a week; changing nothing by mouth (NPO) times to 2 hours of fasting after clear liquids and 6 hours after meals; eliminating the routine use of prothrombin time and acetylcysteine as a means to reduce contrast nephropathy; and suggestions for incorporating new anticoagulant and antiplatelet therapies into practice.
For more information:
Bashore TM. J Am Coll Cardiol. 2012;59:2221-2305.
Thomas M. Bashore
The 2001 document was put together at a time when the major changes going on included the location where caths were being performed (mobile and outpatient caths), but we were still doing mostly CAD cases. In the last decade, the cath lab has changed from just a diagnostic lab to one in which we are doing more interventions, not only in coronaries, but also in valve disease, structural heart disease and congenital disease. In fact, in many labs half of the procedures are for non-coronary indications. Along with these changes came the emergence of hybrid cath labs and advancements in X-ray equipment from analog to digital. So there was a real need to finally bring everyone up to date.
This new document, in addition to laying out best practices, provides national benchmarks so that operators can look at their labs and see how they’re doing. If they want to change their practice, particularly if they are building a new lab but even if they just want to make modifications to a present lab, the document is meant to provide a blueprint to see what the current national standards are and find out whether they meet them.
– Thomas M. Bashore, MD
Clinical Chief, Division of Cardiology
Duke University Medical Center, Durham, N.C.
Disclosure: Dr. Bashore was the chair of the writing committee for the consensus document; he reports no relevant financial disclosures.