SCAI updates cath lab best practices for delivery of high-quality care
The Society for Cardiovascular Angiography and Interventions has updated its guideline on best practices in the cardiac catheterization laboratory.
“We want to guide lab directors, hospitals and health systems in establishing best practices for cath labs with their oversight, and also promote standardization across all potential venues, including ambulatory surgical centers, outpatient facilities and in-hospital settings,” Srihari S. Naidu, MD, FACC, FAHA, FSCAI, director of the cath lab at Westchester Medical Center, professor of medicine at New York Medical College and chair of the writing committee, said during a presentation at the virtual SCAI Scientific Sessions.
The document, endorsed by the American College of Cardiology, the American Heart Association and the Heart Rhythm Society and simultaneously published in Catheterization and Cardiovascular Interventions, encourages a transradial-access-first approach for PCI and use of vascular ultrasound for guidance in all procedures, Naidu said, noting that the document also endorses same-day discharge when possible.
The document also contains new recommendations on cath lab governance, including recommending a dyad leadership structure consisting of a cath lab medical director and an administrative/nursing director or manager, he said.
“The medical and administrative leadership dyad is responsible for setting an example, assigning respective roles, responsibilities, expectations and culture for all other medical, clinical and administrative personnel,” the authors wrote. “Along with other stakeholders, the medical and administrative/nursing leaders are also responsible for developing policies, establishing criteria for granting and renewing privileges, reviewing physician performance and overseeing clinical and administrative personnel. Additionally, the medical and administrative/nursing leaders should partner with all relevant stakeholders on quality improvement, operational excellence, fiscal performance, patient throughput, personnel recruitment and retention, onboarding, provision of debrief and feedback after adverse events, delegation of authority and facilitating education and mentorship to all personnel.”
A novel aspect of the document is that it contains advice about coordination with the electrophysiology team, Naidu said. According to the document, this pertains to procedures that can be performed by either team such as left atrial appendage occlusion; to high-risk procedures in which pacemaker implantation may result; and to certain catheter ablation procedures in which coronary angiography may be necessary before or during the operation.
“The optimal cath lab team should reflect the specific procedure and sedation plan rather than one size fits all,” Naidu said.
He said the document emphasizes the use of risk calculators for bleeding, transfusion, mortality and acute kidney injury to improve the patient-selection and informed consent processes.
Despite the endorsement of the transradial-first approach, “we do feel that maintaining competency in both radial and femoral is important in the current era,” Naidu said.
The document also addresses antithrombotic therapy in patients with atrial fibrillation who undergo PCI and require dual antiplatelet therapy after it.
“Particular attention should be given to patients requiring ‘triple therapy’ (antiplatelets/anticoagulants), and duration of each medication should be explicitly stated,” the authors wrote. “Due to increased bleeding risk, triple therapy should be maintained for the least amount of time possible (eg, 1 week to 1 month). There is growing experience with using a single antiplatelet agent along with oral anticoagulation to minimize bleeding risk and this should be considered.”
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Naidu SS, et al. SCAI Clinical Documents. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; April 28-May 1, 2021 (virtual meeting).