Presented By :

Dr Altaf K. Faiyaz
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1. Introduction

3. History

5. Evolution & Advancement

7. Procedure & Conduct

9. Types of Facilities

11. Physical Arrangement & Space Requirement

13. Equipment

15. Human Resource

17. Performance Evaluation

19. Quality Assurance

The Cardiac Catheterisation Lab is one of the
Biggest Advances of this century in Cardiology.

The expansion & widespread application of this

technology throughout the world today could hardly
have been imagined by Wenner Frossman, when in
1929, he was the first to pass a catheter into the
heart of a living person himself.

Procedures in the Cardiac Cath Lab have evolved

from purely diagnostic & research techniques to
potentially life-saving interventional procedure
1941 – Right Heart Catheterisation in Humans to study
cardiac physiology

1950 – First retrograde left heart catheterisation, by

Zimerman & co-workers

1950s(Late) – Advent of selective coronary

angiography

1960s(Late) – Development of aorto-pulmonary bypass

surgery
1970 – Balloon tipped flow directed catheters
introduced by Swan & Ganz

1977 – Percutaneous transluminal balloon

angioplasty, by Gruntzig

1970s(Late) – Dr. Mason Sones introduced

Brachial approach.

Safe & expeditious catheterisation from femoral

route- Dr Judkins & Amplatz
•In the 1980s , the scope of interventional
Cardiology increased with the introduction of new
therapeutic modalities( Valvuloplasty,Stent etc. )

•ACC/AHA guidelines for Cardiac Catheterisation

Labs published in 1991

•Cath Labs have now evolved into multipurpose

facilities, by performing ‘non-cardiac’ vascular
investigations involving peripheral, renal & carotid
vasculature.
•Cardiac Catheterisation is the insertion & passage of small
plastic tubes ( catheters ) into the arteries & veins upto the
heart to obtain X-ray pictures of coronary arteries & cardiac
chambers as well as to measure pressures in the heart
( intra-cardiac haemodynamics )

•Locate & identify irregularities within the heart & its

vasculature, in the aorta ad venacava and to define size &
severity of the lesions.
1. Diagnostic
i. Coronary Angiogram
ii. Right & Left heart Catheterisation
iii. Electrophysiological Procedures
iv. Intravascular Ultrasound

2. Therapeutic
i. Coronary angioplasty with stenting
ii. Rotablator Atherectomy
iii. Percutaneous Transluminal Valvuloplasty
iv. Pacemaker Implantation
v. Implantation of Cardioverter Defibrillator
vi. Retrieval of Broken Catheters
vii. Deployment of various devices for closure of septal defects
viii. Laser Angioplasty
Patient Preparation

Informed Consent from patient/guardian

Strictness of Sterile Techniques

Special Clothing For workers

Hepatitis B vaccination for Employees

Following SOP

Adequate post-procedural Holding area, proper nursing care and

monitoring
1. Hospital-Based Labs with in-house thoracic surgical programmes

4. In-Hospital labs without Cardiac surgery capability

7. Free Standing Labs

10.Mobile Labs
Goals of Free-standing / Mobile Labs

To reduce cost

Convenience of Location

Used in case of low-risk patients

Mostly used for diagnostic purposes.

However the setting up of such labs is still controversial

and a matter of debate
 The following facilities are required when the cath lab is a stand-
alone entity

Main Divisions
• Procedure Room – Should be constructed to contain radiation
and provide electrical safety

• Control/Console Room – Should be of a size & configuration to

allow ready and unencumbered access to X-ray controls, image
recording devices ( video tapes, discs and digital controls) and
physiological monitors & recorders

• Equipment Rooms – Proper temperature control for computers

and data storage

• Clean Utility Room – For clean & sterile supplies and

disposables
5. Patient Holding Room ( preferably equipped with ECG monitors )

6. Patient Recovery Room

7. Technician’s Work Room

8. Dark room for 35mm film ( if necessary )

9. Chemistry Lab ( for blood gas analysis ) or Electrophysiology Labs

10. Scrub Facilities

11. Storage space for case carts

12. Alcove for wheelchairs & stretchers

13. Soiled Utility Room

14. Toilets
 Use Suggested Minimum Size
(sq. ft.)
Procedure Room 500-600
Control Room 150-200
Equipment Room 100-120
Scrub facility 30
Holding Room >120
Patient Preparation Room 120
Recovery Room 120
Catheter & Other Storage 100
Room
Patient Dressing Room 70
Staff Dressing Room 70
Patient Toilet 30
Staff Toilet 30
Pharmacy Space 30
Blood Gas Analysis 20
Staff Lounge 70
Reception Area 70
Film viewing Area 70
Archival Area 70
Darkroom Processing 70
( or Computer
Management)
Soiled Utility 70
Janitorial space 20
Offices ( space per 70
office)
Conference Room 120
Library
Traditionally located within the diagnostic radiology suite.

Aseptic Conditions similar to surgical suites

Advantage of 2 procedure rooms – can have single control room

for both, thus economical
Safety & Efficacy depends on available equipment & its
physical arrangement

Space for development & access to newer technology will

require modification. Eg. Computer review stations are
replacing cine film and record storage.

Larger areas to allow more space for ancillary equipment.

Dimensions vary in accordance with the type of

radiographic equipment & manufacture.

Control Room at foot-end of the table

 Radiographic Equipment

Goal – Highest Quality Images with least radiation exposure to staff

High Quality Digital Video display

Therapeutic Procedures require more detailed fluoroscopy

Biplane Fluoroscopy – Saves time for interventional procedures.

Limitation – Cost & space requirement

Radiographic Equipment

1. X-ray generator

3. X-ray Tubes

5. Image Intensifiers
All these should be compatible
7. X-ray Detectors

9. Video Camera

11. Contrast Injectors

13. Cinefilm Viewer ( optional )

Radiographic Equipment

Digital Storage & Display

For medium and long term storage, digital media based on DICOM standards
Should be used

Advantages of DICOM

viii. Data Equivalence is assured

ix. Any receiving system that uses this interface can be used for storage
and review
Iii Telemedicine Application
Electronic transmission of clinical image data over long distances to
support clinical decision making at remote sites

However as far as possible, analysis should be made on original image data

acquired at the time of procedure
# Chief Cardiologist

# Assistant Angiographer

# Laboratory Director

# Cardiovascular Trainee

# Nursing Personnel - Scrub Nurse

Float/Circulating Nurse

# Technical Staff – Radiation Technologist

Radiation Physicist
Lab Technologist
Dark Room Technician
Computer Technician
Monitoring Technician

# Non-Technical Staff – Medical Transcriber Clerks, Aides

The department staff is responsible for procuring necessary supplies
as well as preparing the room and the patient before the procedure and
for monitoring patient’s recovery.

Qualification and Experience are of prime importance while

recruiting personnel for the cardiac catheterisation
laboratory

All members of catheterisation team must complete a basic

course in CPR
Radiation Safety
Radiation Exposure Recommendations

Average background radiation exposure - 0.1 rem/year

Average operator exposure ( per procedure ) - 0.004-0.016 rem

Maximum Annual exposure for Medicos - 5 rem/year

Maximum Lifetime exposure for medicos - 1 rem x Age

Measuring Radiation Exposure

4. Film Badges

6. Thermo-Luminescent Dosimeter ( TLD ) badge

Dosimeter badge should be worn with the front of the badge in direct line
of the scattered x-rays.
 Administrative
Issues

Utilization Lab performance Quality

levels Evaluation Assurance
1) Laboratory

For optimum lab performance & cost-effectiveness –

Adult Studies – Min. caseload of 300/year

Paediatric Studies – Min. 150 cases/year

2) Physician- Operator

For adequate performance & preventing excessive radiation exposure –

Individual physician – About 150 cases/year

Paediatric Physician – 50-100 cases/year
PTCA - 50 cases/year
Electrophyiological Studies – 100 cases/year
Lab Performance Evaluation
Laboratory Safety and Efficiency is measured by –

1. Complication Rates ( through records )

2. No. of studies that must be repeated because of inadequate data or

image quality.

Indicators

Deaths related to catheterisation - < 0.1-0.2%

To Limit Complications, Ensure :

Stringent Credentials for training and experience

Regular performance review

The QA program in Cardiac Cath Lab has 3 components –

3. Clinical Proficiency

5. Equipment Maintenance & Management

7. Quality Improvement Program Development

The Cardiovascular program should be assessed within

context of 3 outcomes -

1. Clinical ( Mortality, Complication, Readmission rates )

3. Financial ( Volumes, Cost per case, Profits per case )

5. Satisfaction ( patient & relatives )

 Increase in Community Hospitals without CV
surgical backup and free standing laboratories

Decline in risks associated with diagnostic &

interventional cardiac catheterisation

Cinefilms being replaced by compact discs &

computerised archiving system

Evolution of paediatric cardiac cath. from purely

diagnostic to interventional lab.
 Think About …..

Fluctuation of Patient load on a day to day

basis

Long Break-Even Point

Market Competition
 Bibliography

1. Hospital: Facilities planning & Management

G.D. Kunders

2. www.google.com

Special Thanks To :

Dr. Samarendra Hota, MHA 2nd Year