Cardiology PDF

BANGALORE BAPTIST HOSPITAL Page: 1 of 43
DEPARTMENT OPERATING MANUAL Version No: 03

Effective Date :
PM/DOM-03/CAR CARDIOLOGY
01/06/18
TABLE OF CONTENTS
Sl No. Topic Page No.
1 Scope of cardiology 3
2 Scope of cardiac catheterization laboratory 4

3 CAG procedure 6
4 Radiation safety programme 9

5 TLD badge monitoring guideline 13
6 Non Invasive TMT 16
7 Non Invasive Ambulatory BP Monitoring 19
8 Dobutamine stress echocardiogram 21
9 Non –invasive echocardiogram 23
10 Non –invasive electric cardioversion 25
11 Transesophageal echocardiogram 27
12 Non -invasive holter monitor 29
13 Non -invasive head up tilt table test 30
14 Time frame for imaging results 32
15 Procedure for Reuse of Catheterization hardware 33
16 Cardiac Transfer Procedures 34
17 SOP For Receiving Patient To Cathlab 37

18 SOP for echo procedure 38
19 List of Associated Records 40
Reviewed & issued by: Division Head Approved by: Director(CEO)

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Annexure
Role of
A. Consultant
Annexure No. I B. Cathlab Technician
C. Staff Nurse
D. Nursing Aid
Annexure No. II Organogram

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1. SCOPE OF CARDIOLOGY
1.1. Purpose
The department of Cardiology aims at delivering High quality total patient cardiac care
combined with compassion, care and understanding.
1.2. Scope
Patients with known or suspected to have cardio vascular disease.
1.3. Responsibilities & Authority:
Head of the Department
1.4. Quality objectives
The quality objective of department of Cardiology is to diagnose, to medically and
interventionally manage coronary arteries due to heart attacks, angina, and other heart
diseases such as valvular incompentency, septal defects, and electrophysiological
conduction blocks.
1.5. Definitions
Department of cardiology is one of the important unit in Bangalore Baptist Hospital. This
Unit mainly focuses and looks for the warning signals at an early stage of a disease when
there are no symptoms and thereby advice to prevent or reduce the intensity of future
health problems. It helps to avoid serious complications and improve quality of life. A
healthy individual is an asset to the society and to the nation
The theme behind the concept of cardiology “Organizational team- spirit in delivering
highest quality of clinical and nursing care through personalized service in utmost ethical
way” – binds all of us together. It is the spirit that is helping us to create a difference for all
our patients, their relatives and their friends who come to us.
Note* -For all the general nursing procedures refer OP- nursing department
operating manual as mentioned in the Annexure IV

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2. SCOPE OF CATH LAB

2.1. Purpose:
Cardiac catheterization is most commonly performed to diagnose, manage, and examine the
coronary arteries due to heart attacks, angina, and other heart disease. Cardiac
catheterization may reveal the presence of other conditions, including enlargement of the left
ventricle; ventricular aneurysms (abnormal dilation of a blood vessel); narrowing of the
aortic valve; insufficiency of the aortic or mitral valve; and septal defects that allow an
abnormal flow of blood from one side of the heart to the other.
2.2. Scope:
Head of The Department.
2.4. Quality Objective:
The quality objective of the cardiac catheterization is to diagnose, to medically and
interventionally manage coronary arteries due to heart attacks, angina, and other heart
diseases such as valvular incompentency, septal defects, and electrophysiological
conduction blocks.
2.5. Definitions And Abbreviations:
Cardiac catheterization is a diagnostic and therapeutic procedure that allows a
comprehensive examination of the heart and surrounding blood vessels. It enables the
cardiologist to take angiograms, record blood flow, calculate cardiac output and vascular
resistance, perform an endomyocardial biopsy, and evaluate the heart's electrical activity.
Cardiac catheterization is performed by inserting one or more catheters (thin flexible tubes)
through a peripheral blood vessel in the arm (antecubital artery or vein) or leg (femoral
artery or vein) under x-ray guidance.
CAG – Coronary angiogram
PTCA – Percutaneous Transluminal Coronary Angioplasty
PPI – Permanent Pacemaker Implantation
IABP – Intraortic Balloon Pump
PTRA - Percutaneous Transluminal Renal Angioplasty

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PTPA – Percutaneous Transluminal Peripheral Angioplasty

PTLICA–Percutaneous Transluminal Left Internal Carotid Angioplasty
PTRICA-Percutaneous Translumen Right Internal Carotid Angioplasty
PTCCA - Percutaneous Translumen Common Carotid Angioplasty
IVCFI – Inferior Venacava Filter Implant
TPI – Temporary pacemaker implantation
Pericardiocenthesis

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3. CAG PROCEDURE
3.1. The groin area around the skin crease where the lower belly meets the upper thigh is cleaned
and shaved for use as a tiny portal of entry to the femoral artery. Alternatively, sometimes the
arm is used, either near the elbow crease (brachial artery) or near the wrist (radial artery).
3.2. Once in the catheterization laboratory (a.k.a. cath lab), the skin at the selected entry site is
numbed with an injection of local anesthetic. From this point forward, there should be no
pain.
3.3. A sheath (essentially just a small tube with a one-way Hemostatic [acting to stop bleeding]
valve on the back end to prevent blood from escaping as various catheters are sequentially
introduced) is inserted into the artery. The remainder of the procedure is performed through
the sheath. The hole in the skin is typically about half the diameter of a pencil.
3.4. A long thin hollow tube (catheter) is fed into the sheath and advanced to the heart using X-
ray guidance.
3.5. With the tip of the catheter in one of the arteries that supplies the heart muscle (coronary
artery), a special iodine solution (contrast) is injected while an x-ray image of the heart is
recorded. The contrast blocks x-rays and thus provides an outline image of the artery.
Multiple images are recorded from various “camera” perspectives.
3.6. This catheter is removed and the same procedures repeated for any additional arteries or
chambers that require angiography.
3.7. Certain other measurements, such as pressure recordings in various heart chambers are
typically also obtained.
3.8. Once all the required information is gathered, all catheters are removed and the sheath is
removed.
3.9. Bleeding is stopped either by holding firm pressure for a period of time, or by using a closure
device that either plugs, staples, or stitches the small hole in the artery.
3.10. PTCA – Procedure for PTCA will be the same as 3.1 through 3.5 and the following
addition:
3.10.1. Informed Consent is obtained for PCI
3.10.2. A guide catheter is used to cannulate the stenosed coronary artery.

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3.10.3. The stenosis is wired and a balloon is passed over this wire and dilated. The balloon then
is removed and a stent is passed through the wire and deployed across the stenosis.
3.10.4. Angiographic views are obtained to check the patency of the vessel and the guide catheter
is removed. The sheath is sutured to the groin and the patient transferred to coronary care
unit.
3.11. PPI – Left Infra clavicular area is prepared and draped under sterile conditions. Local
anesthesia is administered and two inch incision is made. Subclavian vein is punctured
and a sheath introduced. A steroid eluting screw in atrial and ventricular tined lead is
anchored in the atrium and ventricle. The leads are then connected to the pacemaker on
completion of threshold test. The pocket is irrigated with antiboitic solution and the
wound is closed in two layers and the patient is transported to CCU.
3.12. IABP – Procedure for IABP will be the same as 3.1 through 3.5 and the following
addition:
3.12.1. Intraaortic balloon is advanced through the sheath and placed in the descending aorta
with the distal balloon placement being above the renal arteries. The pressure tubings are
connected to the arotic balloon and the pressure and ECG are monitored. The helium
tubing of the arotic balloon is connected to the helium port of the intraarotic balloon
pump. The balloon pump is then switched on in the auto ECG trigger mode in ratio of 1:1.
3.13. PTRA – Procedure for PTRA will be the same as 3.1 through 3.5 and the following
addition:
3.13.1. A renal guide catheter is advanced into the renal artery and angiographic views
obtained. The renal artery is then wired and a balloon is passed over the wire across the
stenosis and dilated. The balloon is removed and a stent is passed over the wire and the
lesion is stented. The catheters are removed and the sheath is sutured to the groin and
transported back to ICU.
3.14. PTPA/PTLICA/PTRICA/PTCCA-Procedure for all these are the same as 3.1 through 3.5.
3.15. IVCFI – The right femoral vein is punctured and a sheath is introduced. Contrast is
injected and a venogram is obtained. The renal veins are visualized. IVC filter is advanced
through the sheath and placed above the renal veins and deployed. Venogram is once again

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obtained to check the position of IVC filter. The sheaths are removed and the patient is
transported back to medical ICU.
3.16. EQUIPMENT NECESSARY:
3.16.1. Guide wires
3.16.2. Sheaths
3.16.3. Manifolds
3.16.4. Pressure Tubings
3.16.5. Inflation devices.
3.16.6. Balloons
3.16.7. Angioplasty wires
3.16.8. Puncture needles
3.16.9. Y connectors
3.16.10.Injector Syringes
3.16.11.Diagnostic guiding catheter
3.16.12.IV Set
3.16.13.Betadine solution
3.16.14.Puncture needle
3.16.15.Blade No. 10 & 11

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4. RADIATION SAFETY PROGRAMME

4.1. Purpose:
To ensure occupational and public health and to provide adequate protection from undue
exposure to radiation
4.2. Scope:
Diagnostic Radiology, Interventional Radiology, C-Arm, Dental Radiography.
4.3. Responsibility:
Radiologist, Cardiologist, Radiographers, CathLab Technician, Staff Nurse.
4.4. QUALITY OBJECTIVE:
Radiation protection is an integral component of the working infrastructure of any hospital.
The objective of the Radiation Safety Program is to protect occupational and public health
and to provide adequate protection from undue exposure of radiation to personnel directly or
indirectly involved with radiation, without unduly limiting the benefits of radiation exposure:
The components of radiation protection include:
4.4.1. Justification of the procedure involving the radiation exposure.
4.4.2. Use of minimum radiation exposure compatible with the procedure, which provides
adequate diagnostic information Use concept of As Low As Reasonably Achievable
(ALARA)
4.4.3. Shielding of the personnel and patient from unwanted radiation exposures and
monitoring of radiation exposure to the occupational workers and the working
environment.
4.4.4. Regular surveillance of the department for radiation levels and monitoring of the
radiation protection programs and regular educational activities form an integral part of
the responsibilities of the HOD and other administrative authorities of the
department/hospital
4.5. Activities of the program
4.5.1. Radiation Symbol- The radiation Symbol should be prominently displayed in areas
where exposure to radiation or contamination is likely and on all containers (including
those used for transport), which contains radioactive materials.
4.5.2. Patient Protection:

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To protect the patient from overall radiation exposure, efforts are made for adequate
coning on the patients body.
4.6. Personnel shielding
Radiation exposure to occupational workers can be optimized by judicious applications of
time, distance, and shielding:
4.6.1. Personnel should remain in the radiation environment only when necessary.
4.6.2. The distance between the personnel and the patient should be maximized when
practical and while not interfering with work efficiency as the intensity of radiation
decreases as the square of distance (inverse square law).
4.6.3. Shielding apparel should be used as and when necessary which comprise of lead
aprons and thyroid shields.
4.6.4. The occupational workers must use monitoring devices such as Thermo luminescent
Dosimeter (TLD) and pocket dosimeters to record the exposure to radiations.
4.7. Lead aprons: Lead Aprons are shielding apparel for radiation workers. These aprons
protect an individual from radiation and should be worn by the employees as and when
required during the course of their work.
4.8. Thermoluminescent dosimeters (TLD’s): It is used to estimate the personal dose
equivalent for external occupationally exposed workers during their course of work. TLD’s
policies need to be in place for all occupationally exposed individuals. It is responsibility of
the employer to see that these rules are followed. The TLD’s should be worn over the
clothing.
4.9. Personnel Dosimetry: Personnel dosimetry refers to the monitoring of individuals who are
exposed to radiation during the course of their work. Personnel dosimetry policies need to
be in place for all occupationally exposed individuals. It is up to the employer to see that
these rules are followed. The data from the dosimeter are reliable only when the dosimeters
are properly worn, receive proper care, and are returned on time. Proper care includes not
irradiating the dosimeter except during occupational exposure and ensuring proper
environmental conditions.

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4.10. Medical Examination of Radiation Worker- Every radiation worker at subsequent

intervals not exceeding 12 months shall be subjectto a proper medical
examination.(Applicable to radioactive materials)
4.11. High radiation exposure to the employee- When an unexpectedly high dosimetry value
is returned for an individual, which is in excess of the permissible limits appropriate
steps to be taken for reducing the hazards and the employer shall comply with all the
directions and orders of the competent authority in this behalf.
4.12. Duty of the employer to give alternative work to a radiation worker in certain cases-
If a radiation worker has to discontinue radiation work under the orders of the competent
authority, the employer shall make every reasonable effort to provide such a radiation
worker with alternative work not involving exposure to radiation.
4.13. Radiation protection survey
BARC/ AERB who performs a regular radiation protection survey.
Following Surveys are made
4.13.1. Measurements of Exposure levels at variaous places from the radiation generating
equipments
4.13.2. Output measurement
4.13.3. Various technical calbibration including Kvp,mAs linearity
4.13.4. Action to be taken if the values are beyond the limit
4.14. Patient waiting area
Patient waiting areas are provided outside the radiation areas. A suitable warning signal such
as red light and a warning signs is provided at a conspicuous place outside the X-ray rooms,
During the interventional procedures the area fully closed and only the authorised person can
access to enter.
4.15. Conclusion
The components of radiation protection include justification of the procedure involving the
radiation exposure, use of minimum radiation exposure compatible with the procedure
which provides adequate diagnostic information, shielding of the personnel and patient from
unwanted radiation exposures and monitoring of radiation exposure to the occupational
workers and the working environment. Regular surveillance of the department for radiation

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levels and monitoring of the radiation protection program and regular educational activities
form an integral part of the responsibilities of the HOD and other administrative authorities
of the department/ hospital.

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5. TLD BADGE MONITORING GUIDELINE

5.1. Purpose
5.1.1. To monitor individual doses regularly in order to ensure compliance with the
stipulated dose limits
5.1.2. To report and investigate over exposures and recommend necessary remedial
measures
5.1.3. To maintain lifetime cumulative dose records of the users
5.2. Scope: This policy applies to all the personnel working in the radiology and imaging
department who are exposed to radiation
5.3. Responsibility and Authority
Radiation safety officer(RSO) / Head Of Department /Area supervisor
5.4. Quality Objective
The objective of TLD Badge monitoring is to assess the level of radiation dose received by
the Radiation worker over a period and maintain the lifetime cumulative dose records
5.5. Definition And Abbreviation
5.5.1. TLD – Thermo Luminescent Dosimeter
5.5.2. BARC – Baba Atomic Research Centre
5.5.3. AERB- Atomic Energy Regulatory Board
5.5.4. RPAD- Radiological Physics Advisory division
5.5.5. mSv – milliSievert
5.6. Procedure:
5.6.1. The staff working in the controlled areas of the following departments will be issued
TLD badges after due consideration by the RSO/ Dept Head/Supervisor.
a. Radiotherapy
b. Radiology ( X-Ray & CT)
c. Endoscopy
d. Operation theatre
e. Cath lab
f. Dental

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5.6.2. Application forms for TLD badges for staff identified by the RSO/ Dept
Head/Supervisor after completion will be sent to Avanttec Laboratories. A copy of the
application form will be filed with the RSO for reference.
5.6.3. Once the badges with name of the staff and TLD badge number are received from
Avanttec Laboratories, the same will be handed over to the respective staff and an
acknowledgment of the same will be documented in the application copy.
5.6.4. At the end of every quarter of a calendar year the badge shall be returned to the RSO
who in turn will send the badges to Avanttec laboratories for periodic dosage reports.
5.7. Over exposure:
5.7.1. As per the AERB regulatory limits, the effective dose for an individual staff shall not
exceed 20 mSv averaged over 5 consecutive years and any single year shall not exceed
30mSv. In case a staff receives a dosage reading of more than 10mSv in one quarter, it
will be considered as over exposure. In case of high dosage readings the RSO shall
inform the respective staff and head of the department/ supervisor. The staff is referred
for medical checkup followed by blood tests. In case of high blood counts the staff is
advised rest/transferred to an non radiation work area
5.7.2. The RSO shall examine the working conditions and the circumstances that might have
resulted in the above excessive exposure and report the details to RPAD,BARC within
15 days from the date of receipt of the dosage report.
5.7.3. A written statement from the staff, explaining the cause for the reported exposure shall
also be forwarded along with the RSO’s investigation report. This is to take preventive
steps to avoid such exposure in future.
5.8. Guidelines for using TLD badge
5.8.1. The TLD badges are to be worn at all times during working hours
5.8.2. TLD badges should be always worn at chest level.
5.8.3. If lead apron is used, TLD badge should be worn under the lead apron
5.8.4. After work hours the badges should be kept in the cupboards within the department. As
the badges measures occupational radiation exposure thus they should not be taken
home after work hours.

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5.8.5. Ensure that the badge are not left in the radiation field or near hot plates, ovens,
furnaces, burners etc
5.8.6. Effectively use Time-Distance-Shielding principles (TDS)
5.8.7. TLD badges should not be exchanged amongst staff
5.9. Maintenance of Records
5.9.1. The dose records of all the staff is maintained by the RSO and a copy of the same is
distributed to each department supervisors every quarter.
5.9.2. A copy of the dosage report is issued to the staff leaving the organization and the TLD
number is also informed to the staff, if requested.

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6. NON INVASIVE TMT

6.1. Purpose
6.1.1. Demonstration of inducible myocardial ischaemia.
6.1.2. Prognostication after myocardial infarction.
6.2. Scope:
6.3. Responsibility and Authority
6.3.1. To be performed by Senior Residents/Clinical assistants under the supervision of a
Cardiologist
6.3.2. To be prepared by technicians and nursing staff.
6.3.3. In case of female patient either female nursing staff or female GENERAL DUTY
ATTENDANT should be present.
The quality objective of TMT is to diagnose presence of Coronary Artery Disease non
interventionally.
6.5. Contraindications To Exercise Testing
6.5.1. Unstable angina with recent chest pain.
6.5.2. Uncontrolled life threatening cardiac arrhythmias.
6.5.3. Uncompensated CHF.
6.5.4. Advanced AV block
6.5.5. Acute Myocarditis or pericarditis.
6.5.6. Severe HCM (obs.)
6.5.7. Uncontrolled Hypertension.
6.5.8. Acute systemic illness.
6.6. Equipments
6.6.1. Tread Mill Machine.
6.6.2. Electrodes & Razor
6.6.3. Crash Cart
6.6.4. Defibrillator

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6.7. Preparation
6.7.1. Informed consent
6.7.2. Stop the betablocker prior to the TMT
6.7.3. Overnight fasting or 4 hour fasting prior to test.
6.7.4. Shaving of the chest with prior discussion with the patient.
6.8. Medications
6.8.1. All rate lowering drugs are stopped 48 hours prior to the test.
6.8.2. Other medications to be continued as usual.
6.9. Procedure
6.9.1. Explanation & demonstration to walk on tread mill.
6.9.2. The test is started as per desired protocol, commonly Bruce protocol will be used.
6.9.3. B.P. is checked in every stage & documented.
6.9.4. Chest is examined for rates.
6.9.5. CVS is examined for any murmur or third heart sound.
6.9.6. End point is achievement of age predicted target heart rate or reaching certain end
points.
6.10. Termination Of The Test
6.10.1. Severe fatigue or dyspnoea.
6.10.2. Ataxia.
6.10.3. Grade III/IV chest pain.
6.10.4. Ischemic ST depression >3.0mm
6.10.5. Ischemic ST elevation >1.0mm in Non Q leads.
6.10.6. Unsuspected appearance of VT.
6.10.7. Ectopic SVT.
6.10.8. Progressive reproducible decreased in SBP.
6.10.9. Abnormal high BP >250/120.
6.10.10.Decreasing heart rate.
6.11. Interpretation Of Test (Selzer’s)
6.11.1. Mildly Positive
6.11.2. HZ ST depression 1-1.5mm

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6.11.3. J depression with slowly upslopping ST slope that remain depressed foe 1.5mm at J 60.
6.11.4. Moderately Positive
6.11.5. HZ ST depression 1.5-2mm
6.11.6. US ST depression >2.5mm at J 80
6.11.7. VPCs 15-20% of QRS over 1 sec at HR <130 bpm with ST ↓
6.11.8. DS ST depression with J ↓1-2mm.
6.11.9. Strongly Positive
6.11.10. DS ST depression with J ↓> 2mm.
6.11.11. HZ ST depression >2.5mm
6.11.12. DS or HZ ST depression in stage 1 or persisting beyond 8 min of recovery
6.11.13. Complex VPCs, Salvos, Runs of VT or VF.
6.11.14. Duke Score
6.11.15. EX Time – 5 x ST depression (max) – 4 x Angina Score
6.12. ANGINA INDEX
6.12.1. No Angina - 0
6.12.2. Typical Angina - 1
6.12.3. Angina requiring test termination - 2
6.12.4. Score 5 years survival
6.12.5. <-11 72%
6.12.6. >5 97%

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7. NON INVASIVE AMBULATORY BP MONITORING

Ambulatory B.P monitoring is a continuous B.P recording of a patient for 24 hours . Blood pressure
is being measured as patient moves around without affecting normal daily life .It uses a small digital
blood pressure machine that is attached to a belt which is connected to a cuff around the upper arm.
7.1. Indications: Uncontrolled B.P, Resistant hypertension, white coat hypertension , masked
Hypertension, Hypertension with target organ damage.
7.2. Purpose:-
7.2.1. The purpose of the ambulatory B.P monitoring is to record the blood pressure for a
period of 24 hours during normal activity.
7.2.2. If the blood pressure reading varies from different places and timings, there is a need to
monitor accurate readings.
7.2.3. To verify if the Antihypertensive medicines are working and to make sure they are
controlling the blood pressure through out the day and night times.
7.3. Scope:- Patient with known or suspected Hypertension.
7.4. Responsibility and Authority:-
7.4.1. Cardiologist –Experienced in interpreting ambulatory B.P monitoring.
7.4.2. Technician / Staff nurse for instructing patient on the procedure . Attaching the
Ambulatory BP around the arm. Setting the time according to the doctors order.
7.5. Definitions and Abbreviations:-
Ambulatory B.P is a machine that continuously records the blood pressure for 24 hours
during normal activity.
7.6. Procedure:-
7.6.1. Explain the procedure to the patient
7.6.2. Ensure patient’s previous notes and all required documentation is available
7.6.3. Verbally confirm the identity of the patient by asking for their Name, Hosp.no,
Address and date of birth
7.6.4. If client is unable to confirm, check his identity with family members.
7.6.5. Initialise the Ambulatory Blood pressure monitor using the installed spacelabs
software. B.P readings will be taken every 30 minutes for 17 hrs and every hourly
during the night for 7 hours.

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7.6.6. Remove any tight arm clothing around the arm

7.6.7. Assess the size of the cuff required, depending on the age, body size.
7.6.8. Cuff is applied to the arm
7.6.9. Time can be adjustable accordingly.
7.6.10. The machine will turn off once the duration of monitoring is completed.
7.6.11. Check the skin condition of the upper arm following the procedure.
7.6.12. Upload monitor on the computer using spacelabs software and take a print and
evaluation of the same is done by the expert.

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8. DOBUTAMINE STRESS ECHOCARDIOGRAM

8.1. Purpose: The purpose of the dobutamine stress echocardiogram is to evaluate the region
wall motion abnormalities for patient suspected for having ischemic heart disease and who
are incapable of going through the treadmill test procedures. Dobutamine stress echo is
performed on patient suspected with ischemic heart disease to assess regional wall
abnormalities, pharamacology induced inotropic and chronotropic response,estimation of
ventricular function and regurgitation during stress and demonstration of valvular or sub valvular
gradient in selective cases.
8.2. Scope:
8.3.1. Cardiologist – Performing the procedure and interpreting the dobutamine stress echo
data.
8.3.2. Nurse – Positioning the patient for the procedure, monitoring the patient’s EKG, and
monitoring vital signs, and administering IV dobutamine/atropine.
The quality objective of dobutamine stress echocardiogram is to diagnose non
interventionally patients suspected of having ischemic heart disease. The quality objective of
the cardiac catheterization is to diagnose, to medically and interventionally manage coronary
arteries due to heart attacks, angina, and other heart diseases such as valvular incompentency,
septal defects, and electrophysiological conduction blocks.
DSE - Dobutamine Stress Echocardiogram
MPHR – Maximal predicted heart rate
THR – Target Heart Rate
8.6. Procedure
8.6.1. Patient is placed on a supine position on the echo table (lies on his/her left side).
8.6.2. Calculate patient’s maximal predicted heart rate (220 minus patient’s age), 85% of
MPHR is the THR.
8.6.3. ECG leads are connected to patient and IV cannula inserted.

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8.6.4. Patient’s resting heart rate and blood pressures are being monitored.
8.6.5. Two dimensional echocardiographic cine views are obtained in the parasternal long
axis/short axis and four chambers views.
8.6.6. Dobutamine IV is started at 4mcg/kg/min for 3 minutes and two dimensional
echocardiographic views are obtained. Increase dobutamine drip every 3 minutes by
4mcg/kg/min until the patient reaches THR.
8.6.7. Vitals signs are monitored at the end of every stage. Every stage is consisted of 3
minutes.
8.6.8. When the patient reaches THR, the dobutamine drip is stopped. Patient is monitored
for 5 minutes until recovery.
8.7. Equipment necessary:
Echo Machine, IV cannula
8.8. Medications
Dobutamine IV, Atropine IV

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9. NON –INVASIVE ECHOCARDIOGRAM

Echocardiography may show abnormalities such as a poorly functioning heart valve or damage to
the heart tissue from a heart attack. It is especially useful for assessing disorders of the heart valves.
It evaluates the heart valves and detects abnormalities in the pattern of blood flow such as showing
the backward flow of blood through heart valves that are partially open (that should be fully closed).
This backward flow of blood through a valve is known as regurgitation. By assessing the motion of
the heart wall, echocardiography can help detect the presence, and assess the severity, of coronary
artery disease, as well as help determine whether chest pain is related to heart disease. Additionally,
echocardiography can help detect hypertrophic cardiomyopathy, in which the walls of the heart
thicken in an attempt to compensate for heart muscle weakness. It is also used to evaluate heart
murmurs (abnormal heart sounds), determine the causes of congestive heart failure, assess enlarged
hearts or hearts with septal defects (holes between pumping chambers), and monitor the heart in
patients with diseases that may affect heart function (e.g., lupus, lung diseases).
9.1. Purpose:
9.1.1. Delineation of cardiac anatomy.
9.1.2. Assessment of valvular function, stenosis/regurgitation.
9.1.3. Wall motion analysis.
9.1.4. Assessment of ventricular function.
9.1.5. Assessment of endocardial, myocardial and pericardial disease.
9.1.6. Assessment of great arteries.
9.1.7. Assessment of congenital heart disease
9.2. Scope: Patients with known or suspected to have cardio vascular disease.
9.3.1. Cardiologist – Performing the procedure and interpreting the echo data
monitoring vital signs
The quality objective of the Non Invasive Echocardiogram to diagnose non interventionally
and manage disorders of the heart valves. It evaluates the heart valves and detects

Effective Date :
01/06/18
abnormalities in the pattern of blood flow such as showing the backward flow of blood
through heart valves.
9.5. Definitions and Abbreviations:
Echocardiogram–(Echo): Echocardiography is a diagnostic test that uses ultrasound
waves to produce an image of the heart muscle and the heart's valves.
Procedure
9.5.1. Patient is positioned on the table (lies on his/her left side)
9.5.2. Transthoracic probe with ultrasound jelly is placed on the patient’s chest and two
dimensional views are obtained in the parasternal long axis/short axis and four
chambers views.
9.5.3. Measurements are made of the heart’s structure in the M mode.
9.5.4. The valves leakages and blood velocities are measured by color and pulse/continuous
doppler. Ejection fraction of the heart is calculated.
9.5.5. The various technical assessments made are .
a. M-mode assessment.
b. 2D assessment.
c. Doppler assessment.
d. Color Doppler assessment.
e. Contrast ECHO in selected cases.
f. Tissue Doppler assessment.
Echo Machine

Effective Date :
01/06/18
10. NON –INVASIVE ELECTRIC CARDIOVERSION

Electrical cardioversion (also known as "direct-current" or DC cardioversion) is a procedure
whereby a synchronized (perfectly timed) electrical shock is delivered through the chest wall to the
heart through special electrodes or paddles that are applied to the skin of the chest and back.. The
shock causes all the heart cells to contract simultaneously, thereby interrupting and terminating the
abnormal electrical rhythm (typically fibrillation of the atria) without damaging the heart. This split
second interruption of the abnormal beat allows the heart's electrical system to regain control and
restore a normal heartbeat. Cardioversion is a brief procedure where an electrical shock is delivered
to the heart to convert an abnormal heart rhythm back to a normal rhythm. Most elective or "non-
emergency" cardioversions are performed to treat atrial fibrillation or atrial flutter, benign heart
rhythm disturbances originating in the upper chambers (atria) of the heart. Cardioversion is used in
emergency situations to correct a rapid abnormal rhythm associated with faintness, low blood
pressure, chest pain, difficulty breathing, or loss of consciousness.
10.1. Purpose:
The purpose of electric cardioversion is to disrupt the abnormal electrical circuit(s) in the
heart and to restore a normal heart beat.
10.2. Scope:
Patients with known heart arrhythms such as atrial fibrillation or atrial flutter.
10.3. Responsibilities & authority:
10.3.1. Cardiologist – directing the procedure
10.3.2. Nurse – preparing patient, ensuring that patient has patent IV access, monitoring
vital signs, and administering medications.
The quality objective of electric cardioversion is to treat effectively Cardiac arrhythmias
arising out due to electrophysilogical conduction anamolies in diseased heart.
10.5. Definitions and abbreviations:
Cardioversion is the process of converting an abnormal heart rhythm to a normal rhythm;
this is done by delivering a synchronized electrical shock to the heart.

Effective Date :
01/06/18
10.6. Procedure:
10.6.1. Prepare patient by making sure that he/she has a patent IV line, assist patient into a
supine position
10.6.2. Apply the EKG leads to the patient and turn on the defibrillator monitor.
10.6.3. Keep defibrillator paddle on the patient’s chest, one on the right chest wall and the
other on the apex.
10.6.4. Turn the monitor machine onto synchronize mode then print an initial strip
10.6.5. Administer proprofol medication or drug of choice per physician’s instruction when
ready and have patient count backward starting from 100 after administration of
sedation medication.
10.6.6. Shock patient with 200J once the patient loses conscious and everyone is clear and
deliver the shock to the patient.
10.6.7. Print EKG strip if patient converted; If patient is not converted after the initial shock,
may deliver the second shock per Physician’s order.
10.7. Equipment necessary: Biphasic Defibrillator
10.8. Medication such as : Propofol

Effective Date :
01/06/18
11. TRANSESOPHAGEAL ECHOCARDIOGRAM

11.1. Purpose: Transesophageal echocardiography is a diagnostic test using an ultrasound
device that is passed into the esophagus of the patient to create a clear image of the heart
muscle and other parts of the heart including valvular and aortic disease, and cardiac
embolic sources such as thrombus and air embolus. Determining of LV preload intra-
operatively and 'acute hemodynamic compromise', especially in the critically ill,
Watching for intra-operative myocardial ischemia ,assessing the aortic atherosclerosis ,
Investigating of a possible cardiac embolic source (notably patent foramen ovale,
interatrial septal aneurysm, spontaneous contrast, and intracardiac thrombi) ,Assessing of
valvular heart disease, particularly native valve disease; this is particularly relevant in the
critically ill patient with possible infective endocarditis.
Valvular vegetations that were invisible on TEE are often easily seen. TEE is the
investigation of choice in looking for valve ring abscesses complicating infective
endocarditis, Investigating of intra- and para-cardiac masses, Assessing for aortic disease,
especially aortic dissection, looking for congenital heart disease, both pre- and intra-
operatively and detecting for air embolism in neurosurgery and Assessing for the
presence of thrombus in the left atrium prior to cardioversion.
11.2. Scope:
11.3.1. Cardiologist – Performing the procedure and interpreting the TEE data
monitoring vital signs, and administering IV sedation.
The quality objective of Transesophageal Echocardiogram is to diagnose interventionally
and manage disorders of the heart valves and detects abnormalities in the pattern of
blood flow such as showing the backward flow of blood through heart valves.
TEE - Transesophageal echocardiography: is the introduction of a transducer
attached to a fiberoptic endoscope into the esophagus to provide two-dimensional

Effective Date :
01/06/18
cardiographic images or Doppler information. A tube with a device called a transducer

is passed down into the patient's throat and into the esophagus (the food tube that
connects the mouth to the stomach). The transducer directs ultrasound waves into the
heart, and the reflected sound waves picked up by the transducer are translated into an
image of the heart.
11.6. Procedure
11.6.1. Before the procedure patient should be on NPO
11.6.2. Informed consent
11.6.3. The patient is made to lie on the left side.
11.6.4. A sedative is given through an intravenous (IV) line to help in relaxation and the
throat is sprayed with an anesthetic to "numb" it.
11.6.5. The TEE echo transducer is much smaller than the standard Echo equipment and is
positioned at the end of a flexible tube (similar to the tube used to examine the
stomach during endoscopy). The tube transfers the images from the transducer to the
Echo monitor.
11.6.6. The patient begins to swallow the tube and the procedure begins. The use of sedation
and the sedative minimizes discomfort and there is usually no pain. The tube goes
down the esophagus the same way as swallowed food.
11.6.7. The transducer at the end of the tube is positioned in the esophagus, directly behind
the heart. By rotating and moving the tip of the transducer, the physician can
examine the heart from several different angles.
11.6.8. The heart rate, blood pressure and breathing are monitored during the procedure.
Oxygen is given as a preventive measure and suction is used, as needed.
11.6.9. After the procedure, driving is not allowed for 12 hours (because of the use of
sedatives). Eating and drinking should be avoided for at least two hours because the
throat will still be numb and the food or drink could be aspirated into the lungs. Hot
food and drinks should not be used for about 24 hours. The throat may be sore and
throat lozenges can be used after two hours of the procedure.
11.6.10.Equipment necessary: TEE echo transducer / Echocardiography Machine, Nummit
spray, xylocaine visceous, xylocain jelly, cardiac monitor, mouth gag.

Effective Date :
01/06/18
12. NON -INVASIVE HOLTER MONITOR

A Holter monitor is a continuous tape recording of a patient's EKG for 24 hours. Since it can be
worn during the patient's regular daily activities, it helps the physician correlate symptoms of
dizziness, palpitations (a sensation of fast or irregular heart rhythm) or black outs. Since the
recording covers 24 hours, on a continuous basis, Holter monitoring is much more likely to detect an
abnormal heart rhythm when compared to the EKG which lasts less than a minute. It can also help
evaluate the patient's EKG during episodes of chest pain, during which time there may be telltale
changes to suggest ischemia (pronounced is-keem-ya) or reduced blood supply to the muscle of the
left ventricle
12.1. Purpose:
The purpose of the Holter Monitor is to record the heart’s rhythms for a period of 24-48
hours during normal activity.
12.2. Scope:
Patients with known or suspected to have electrophysiological conduction disorders
12.3.1. Cardiologist – interpreting Holter Monitor recordings
12.3.2. Cathlab Technican/staff nurse – instructing patient on the procedure, downloading all
the Holter data and scanning the data.
A Holter monitor is a machine that continuously records the heart's rhythms and is
usually worn for 24 - 48 hours during normal activity.
12.5. Procedure:
12.5.1. Shave patient’s chest and attach Holter leads
12.5.2. Start recording
12.5.3. Instruct patient to carry on with normal activities and document any events with time
such as syncope, dizziness, and palpitations.
12.5.4. Instruct patient to return to hospital on completion of 24 hours of Holter monitoring.
12.5.5. Remove the Holter leads and download Holter data onto the computer.
Holter Monitor

Effective Date :
01/06/18
13. NON -INVASIVE HEAD UP TILT TABLE TEST

The Tilt Table Test is performed to reproduce (bring on) symptoms of syncope while the person is
being closely monitored. It is postulated that in response to diminished venous return such as from
prolonged standing, adrenergic tone is enhanced. This results in vigorous myocardial contractions
which inturn stimulate intramyocardial mechanoreceptors (C Fibers). Activation of these C fibers
may overide the normal baroreceptor mediated reflux and produce bradycardia and vasodilatation
which leads to hypotension and syncope. Head up tilt table test entails reproducing symptoms of
neurocardiogenic syncopy by low dose infusion of Inj Isoproterenol and continous monitoring of
vital parameters
13.1. Purpose:
The purpose of Head Up Tilt Table Test is used to determine a cause of syncope (fainting
or loss of consciousness).
13.2. Scope:
Patients with known syncopal episodes.
13.3.1. Cardiologist – overseeing and interpreting the results of the procedure
13.3.2. Nurse – administering medications and monitoring vital signs
13.3.3. Cath Lab Technician – operating tilt table / Documenting Hemodynamic / ECG data
The Tilt Table Test is a procedure performed for patients with neuro cardiogenc syncopy
by reproducing symptoms of syncope while the person is being closely monitored.
13.5. Procedure:
13.5.1. Patient will be asked to lie supine on the tilt table and fasten with the safety belt to
the table.
13.5.2. An intravenous line (IV) is inserted into one of the arms and a blood pressure cuff (or
similar device) is attached to the patient’s other arm to monitor his/her blood
pressure during the test.
13.5.3. Patient is attached with electrodes (adhesive stickers) to an electrocardiograph (ECG)
recorder to monitor his/her heart rate. For patient’s safety, he/she is belted onto the

Effective Date :
01/06/18
tilt table. It is then tilted upright to a 60-80 degree vertical angle for approximately 45
minutes.
13.5.4. Patient is instructed to limit the movement of his/her legs and not to shift his/her
weight during the test. Patient will also be asked to describe any symptoms he/she
may be experiencing during the test.
13.5.5. If after 45 minutes if patient has not experienced syncope, a medication, usually
Isoproterenol/ Isuprel or sublingual nitroglycerin is administered while he/she is
tilted again, for up to another 45 minutes while patient’s heart rate and blood
pressure continue to be monitored.
13.5.6. If patient faints during the test, the table will be returned to a flat (horizontal)
position and vital signs are being monitored at regular intervals. Recovery is usually
immediate.
13.6. Typical symptoms of vasovagal or neurocardiogenic syncope includes:
13.6.1. Nausea
13.6.2. Sweatiness
13.6.3. Pallor
13.6.4. Light headedness
13.6.5. Sensation of palpitations
13.6.6. Near-fainting
13.6.7. Fainting
13.7.1. Tilt Table
13.7.2. IV Cannula
13.7.3. Arterial line
13.7.4. Bedside Monitor

Effective Date :
01/06/18
14. TIME FRAME FOR IMAGING RESULTS
14.1. Imaging Results for various procedures are available within a definite Time Frame
14.2. Coronary Angiogram / Angioplasty Reports /CD : The turnaround time for patients
undergoing Catheterization procedures is 5 hours, which includes from the time the
patient arrives to the Catheterization laboratory till the Angiographic reports / CD are
dispatched to the patient..
14.3. Echocardiographic / TMT Reports – 10 Minutes from the completion of the procedure.
14.4. Holter Monitoring : 24 hours from the time of disconnection of Holter monitor.

Effective Date :
01/06/18
15. PROCEDURE FOR REUSE OF CATHETERIZATION HARDWARE
15.1. All used catheterization hardware are washed with water, flushed with hydrogen peroxide
and immersed in hydrogen peroxide for 30 minutes.
15.2. After 30 minutes all hardware are once again washed with running water.
15.3. Compressed air is used to clear the water particles.
15.4. Hardware are then packed and sealed in steribag and sent for Ethylene oxide sterilization.
15.5. The labeling of single use and second use marked on the catheter hub.
15.6. The date is marked on the steribag in for six months.
15.7. Hardwares are then packed and sealed in covers and sent for Ethylene Oxide sterilization.
15.8. Documentation of reuse catheters done.

Effective Date :
01/06/18
16. CARDIAC PATIENT TRANSFER OUT PROCEDURE

16.1. Purpose:
To guide the process of transfer of stable and unstable patients.
16.2. Definitions:
16.2.1. Unstable Cardiac patient: Patient with a medical condition where deterioration is
possible to occur during transfer of the patient.
16.2.2. Stable Cardiac patient: Patient with a medical condition where deterioration is
unlikely, within reasonable medical probability, to result from or occur during the
transfer of the individual.
16.3. Policy:
16.3.1. All stable or unstable cardiac patients being transferred for therapeutic or diagnostic
purposes shall be safely transported from one point to another. Precautionary measures
shall be ensured during transfer of unstable patients.
16.4. Transfer of stable cardiac patients:

16.4.1. All preventive measures and necessary precautions shall be undertaken to avoid risks
complications during transportation of stable patient although the patient is not in a
life threatening situation (stable).
16.4.2. The transportation is affected through qualified personnel and transportation
equipment as required, including the use of necessary and medically appropriate life
support measures.
16.4.3. A proper handover of the patient shall take place when handing over is carried out at
the receiving end and the same shall be documented in patient’s medical record.
16.5. Transfer of unstable cardiac patients:
16.5.1. The decision to transfer a cardiac patient from one location to other shall be taken by
the treating cardiologist and made on proper assessment of the condition of the
patient and deciding that the benefits outweigh the risks.
16.5.2. Generally speaking, if the patient is likely to deteriorate it is better to withhold the
transfer as it is better to avoid death en route unless conditions are forcing the
decision.

Effective Date :
01/06/18
16.5.3. During the transportation of unstable cardiac patients, the family members shall be
appropriately informed of risks involved and their consent shall be sought.
16.5.4. During transportation of unstable cardiac patients, appropriately qualified and trained
staff as follows shall accompany the patient.
a. A qualified Physician with BCLS/ACLS training.
b. A qualified nurse with BCLS.
16.6. Inter facility transfer of cardiac patients:
16.6.1. Patients may be referred to other hospital when the patient needs a diagnostic or
therapeutic service not available in the hospital.
16.6.2. The treating doctor shall be responsible for making decisions regarding patient
referral to outside facilities.
16.6.3. The summary of the patient’s condition and the treatment under taken in the hospital
shall be documented in the specified form form.
16.6.4. While shifting the patient to the outside facility, the procedure for transfer of stable
and unstable patients shall be complied with.
16.6.5. All preventive measures and necessary precautions shall be taken to avoid risks/
complications during shifting.
16.6.6. When the patient is refereed to another hospital, the medical record shall contain the
date & time of referral, the reason for the referral and the name of the receiving
hospital.
16.6.7. The duplicate copy of the inter facility transfer form or referral letter shall be pasted
in the patient’s medical record for future reference.
16.6.8. The treating doctor shall decide the type of ambulance; the equipments needed en-
route & personnel who should accompany the patient based on the patient’s
condition.
16.7. Intra hospital transfer of patients:
16.7.1. Patients shall be transferred from one department or unit to another as appropriate to
meet patient needs. Patient transfer shall be considered when there is a change in the
condition of the patient which might require a different setting (i.e. Intensive

Effective Date :
01/06/18
care,Surgical interventions, diagnostic, therapeutic services etc.) in the hospital to

manage the care of the patient.
16.7.2. Based on the criteria for transfer the treating doctor shall be responsible for making
decision.
16.7.3. Before shifting the patient the treating cardiologist shall determine whether the
patient’s condition is stable or unstable and ensure the procedure for safe
transportation of patient is adhered to.
16.7.4. An internal transfer form shall be used to document the reason for patient transfer,
time & date of transfer, location of transfer and staff involved in the transfer, which
shall be entered in the patient’s medical record.
16.7.5. All preventive measures and appropriate precautions are taken to avoid risks/
complications during transportation of the patient.

Effective Date :
01/06/18
17. SOP FOR RECEIVING PATIENT TO CATHLAB

17.1. Purpose:
To help the patients undergo diagnostic/therapeutic procedures for containing care.
17.2. Scope:
All patients being received from other department in the hospital.
17.3. Responsibility:
Consultant/ staff nurses/ Anesthetist/ Cathlab technician.
17.4. Procedure:
17.4.1. Patient received from other department/unit in the hospital to fulfill the following
needs.
a. Investigation ECG, ECHO, TMT, report chest X-ray.
b. Blood investigation, Angio profile – CBC, creatinine, PT / PTT, FBS, CKMB,
Tropinin T, HBsAG, HIV and HCV.
17.4.2. Check the Doctor’s written order.
17.4.3. Ensure that the patient / relative have been explained about the procedure.
17.4.4. Obtain informed written consent if required.
17.4.5. Preparation of the patient to be done, groin and Right hand radial site.
17.4.6. Inform the patient about the time of the procedure.
17.4.7. Receive the patient to Cathlab by wheel chair/Trolley.
17.4.8. Assess and observe the patient during the procedure and document it.
17.4.9. Transport the patient back to the department on completion of the procedure

Effective Date :
01/06/18
18. SOP FOR ECHO PROCEDURE
18.1. Purpose: To define the process for ECHO procedure for IP and OP patients
18.2. Scope: All IP and OP patients advised for ECHO test
18.3. Responsibility: Doctor/ Nurses/Nursing Aides
18.4. Procedure
18.4.1. Out patient:
a. Any patient advised for ECHO test should have the requisition slip duly filled by
the treating Doctor with patient details (Name, Hosp. Number and/or Barcode) and
the clinical data.
b. The patient /attendant is instructed to take appointment from ECHO room in
cardiology OPD ( second floor) .
c. The staff in ECHO room shall gives appointment date and time.
d. On the day of the procedure, patient shall make payment and report to ECHO room
with the paid receipt.
e. Prior to the procedure the staff in ECHO room shall receive the paid receipt from
the patient, confirm the identity by calling out the patient name written on the
requisition slip and shall confirm the name and hospital number against the
requisition slip with the FOB/Shepherd Card which the patient holds.
f. After confirming the identity of the patient, the patient is called inside the ECHO
room and the nurse shall explain the procedure to the patient & provide privacy.
g. Incase of a female patient, the nurse shall inform that the procedure will be
performed by the male doctor.
h. Name of the patient, hospital number and gender will be entered in the computer by
the doctor performing the procedure. The doctor shall confirm the patient name and
hospital number match with the details on the requisition form prior to printing of
the report.
i. The ECHO room staff shall confirm that the patient name and hospital number match
with the details on the requisition slip.

Effective Date :
01/06/18
j. At the time of dispatch the staff shall confirm the patient identity as mentioned in
point No.5.
k. The date, time and name of the staff dispatching and the date, time and name of
person receiving the report is entered in the register for ECHO procedure.
18.4.2. Inpatient:
a. The ECHO request is filled by treating doctor in the ward.
b. The assigned nurse from the ward shall send the requisition slip duly filled in by the
treating doctor to the ECHO room.
c. The staff in the ECHO room shall call the respective ward for the procedure
according to the appointment time.
d. Incase of requiring emergency ECHO, it will be written on the requisition slip and
the patient will be called in immediately.
e. The patient shall be shifted to ECHO room in a trolley / wheelchair only.
f. The ECHO staff shall confirm the name and hospital number on the requisition slip
match with the details on identification band and the summary sheet in the patient
file.
g. After confirming the identity of the patient, the patient is called inside the ECHO
room and the nurse shall explain the procedure to the patient & provide privacy.
h. Incase of a female patient, the nurse shall inform that the procedure will be
performed by the male doctor.
i. Name of the patient, hospital number and gender will be entered in the computer by
the doctor performing the procedure. The doctor shall confirm the patient name and
hospital number match with the details on the requisition form prior to printing of the
report.
j. The ECHO room staff shall confirm that the patient name and hospital number match
with the details on the requisition slip.
k. At the time of dispatch the staff shall confirm the patient identity as mentioned in
point No.5.
l. The date, time and name of the staff dispatching and the date, time and name of
person receiving the report is entered in the register for ECHO procedure.

Effective Date :
01/06/18
19. LIST OF ASSOCIATED RECORDS

19.1. Register
19.1.1. Catheterisation Register - R/NS/Cath/01
19.1.2. Radiation Register - R/NS/Cath/02
19.1.3. Emergency Trolley Register - R/NS/Cath/03
19.1.4. Contrast Register - R/NS/Cath/04
19.1.5. Donated Material Register - R/NS/Cath/05
19.1.6. Drug Register - R/NS/Cath/06
19.1.7. Inventory Register - R/NS/Cath/07
19.1.8. Linen Register- R/NS/Cath/08
19.1.9. CSSD Register- R/NS/Cath/09
19.1.10.Invoiced Register- R/NS/Cath/10
19.1.11.Cardio statistic register R/NS/Cath/11
19.1.12.DC Register - R/NS/Cath/12
19.1.13.Echo register R/NS/Cath/13
19.1.14.Holter Register R/NS/Cath/14
19.1.15.TMT Register R/NS/Cath/15
19.2. Forms
19.2.1. Electro Cardio Graph Requisition & Report (cardiology) F/CAR/01
Signature: Signature:

Effective Date :
01/06/18
Annexure I
A. Role of Consultant
Cardiologist – responsibilities include: explaining risks of procedure, obtaining, performing
catheterization procedure safely
B. Role of Cath Lab Technician
1. Switching on the x-ray equipments
2. Ensuring that the radiation safety norms are followed by all the personnels such as wearing
of lead aprons/thyroid shields, Dosimeters and ensuring that all personnels stay clear of x-ray
tubes.
3. Entering patient’s details into the archiving systems.
4. Angulating the cath machine and panning the cath table for obtaining angiographic views
from different angles.
5. Performing QCA (measuring the stenosis length and diameter digitally) analysis.
6. Interrogating pacemakers telemetrically
7. Archiving the digital angiographic imagines and transfer of angiographic data into CDs in
Dicom format/laser prints.
C. Role of Nurse
1. Placing patient on cath table, monitoring ECG and vital signs.
2. Reassuring the patient such as teaching patient to take deep breath and hold and cough when
necessary.
3. Ensuring that the patient has a patent IV line and administering medications as and when
needed.
4. Preparing patient for cath procedure such as exposing, prepping patient’s groin or brachial
site.
5. Flushing all catheter tubes and other angiographic hardwares with heparinized saline, and
setting trolley for angiographic procedure.
6. Removing of sheath/obtaining hemostasis, and ensuring pedal pulses and monitoring vital
signs.

Effective Date :
01/06/18
D Role of Nursing Aid

1. Transfering and positioning the patient on Cath table.
2. Meeting the patient’s needs and comforts.
3. Providing psychological support, to the patient.

Effective Date :
01/06/18
Annexure II
Organogram
Director
Chief Medical Officer
CCU Consultant
Incharge Nurse
Team leader
Staff Nurse Technician Nursing Aid Clerk Housekeeping

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BANGALORE BAPTIST HOSPITAL Page: 1 of 43

DEPARTMENT OPERATING MANUAL Version No: 03

Sl No. Topic Page No.

2 Scope of cardiac catheterization laboratory 4

4 Radiation safety programme 9

16 Cardiac Transfer Procedures 34

17 SOP For Receiving Patient To Cathlab 37

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

2. SCOPE OF CATH LAB

Reviewed & issued by: Division Head Approved by: Director(CEO)

PTPA – Percutaneous Transluminal Peripheral Angioplasty

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

4. RADIATION SAFETY PROGRAMME

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

4.10. Medical Examination of Radiation Worker- Every radiation worker at subsequent

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

5. TLD BADGE MONITORING GUIDELINE

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

6. NON INVASIVE TMT

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

7. NON INVASIVE AMBULATORY BP MONITORING

Reviewed & issued by: Division Head Approved by: Director(CEO)

7.6.6. Remove any tight arm clothing around the arm

Reviewed & issued by: Division Head Approved by: Director(CEO)

8. DOBUTAMINE STRESS ECHOCARDIOGRAM

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

9. NON –INVASIVE ECHOCARDIOGRAM

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

10. NON –INVASIVE ELECTRIC CARDIOVERSION

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

11. TRANSESOPHAGEAL ECHOCARDIOGRAM

Reviewed & issued by: Division Head Approved by: Director(CEO)

cardiographic images or Doppler information. A tube with a device called a transducer

Reviewed & issued by: Division Head Approved by: Director(CEO)

12. NON -INVASIVE HOLTER MONITOR

Reviewed & issued by: Division Head Approved by: Director(CEO)

13. NON -INVASIVE HEAD UP TILT TABLE TEST

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

14. TIME FRAME FOR IMAGING RESULTS

Reviewed & issued by: Division Head Approved by: Director(CEO)

15. PROCEDURE FOR REUSE OF CATHETERIZATION HARDWARE

Reviewed & issued by: Division Head Approved by: Director(CEO)

16. CARDIAC PATIENT TRANSFER OUT PROCEDURE

16.4. Transfer of stable cardiac patients:

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

care,Surgical interventions, diagnostic, therapeutic services etc.) in the hospital to

Reviewed & issued by: Division Head Approved by: Director(CEO)