Pub Date : 2011-02-01DOI: 10.1177/2150133510388639
K. Musunuru
{"title":"Do Evidence-Based Clinical Guidelines Do More Harm Than Good?","authors":"K. Musunuru","doi":"10.1177/2150133510388639","DOIUrl":"https://doi.org/10.1177/2150133510388639","url":null,"abstract":"","PeriodicalId":320506,"journal":{"name":"Cardiac Cath Lab Director","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123124093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1177/2150133510395496
R. Nair, K. Quadros
Coronary stent fracture is a relatively uncommon and rare complication of stent implantation. The reported incidence of stent fracture among drug-eluting stents ranges from 1% to 8%. Since 2003, when the use of drug-eluding stents was approved by the FDA for the treatment of coronary atherosclerosis, a number of retrospective and prospective studies and case reports have been published. We reviewed these publications to determine the incidence, predictors, clinical implications, and different management strategies for drug-eluding stent fracture in the coronary arteries. A review of the literature showed that the risk for stent fracture was higher with right coronary artery location, increased vessel tortuosity and angulation prior to stenting, use of overlapping stents, and use of longer stents. A higher risk of bare metal stent fracture was reported in saphenous vein bypass grafts. The authors also report in this issue in the Department “Case Study” a symptomatic fracture of a sirolimus-eluding Cypher® stent in the mid-left anterior descending artery.
{"title":"Coronary Stent Fracture","authors":"R. Nair, K. Quadros","doi":"10.1177/2150133510395496","DOIUrl":"https://doi.org/10.1177/2150133510395496","url":null,"abstract":"Coronary stent fracture is a relatively uncommon and rare complication of stent implantation. The reported incidence of stent fracture among drug-eluting stents ranges from 1% to 8%. Since 2003, when the use of drug-eluding stents was approved by the FDA for the treatment of coronary atherosclerosis, a number of retrospective and prospective studies and case reports have been published. We reviewed these publications to determine the incidence, predictors, clinical implications, and different management strategies for drug-eluding stent fracture in the coronary arteries. A review of the literature showed that the risk for stent fracture was higher with right coronary artery location, increased vessel tortuosity and angulation prior to stenting, use of overlapping stents, and use of longer stents. A higher risk of bare metal stent fracture was reported in saphenous vein bypass grafts. The authors also report in this issue in the Department “Case Study” a symptomatic fracture of a sirolimus-eluding Cypher® stent in the mid-left anterior descending artery.","PeriodicalId":320506,"journal":{"name":"Cardiac Cath Lab Director","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123511044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1177/2150133510395574
B. J. Berger
Cath lab managers are involved in quality assurance and outcomes evaluation. One area of focus is contrast-induced nephropathy (CIN). CIN is important because it is the third leading cause of hospital-associated renal insufficiency, and even when it is clinically reversible it is associated with increased hospitalization, cost, and mortality. Assessment of nonmodifiable risk factors, treatment of modifiable risk factors, and evaluation of laboratory biomarkers is essential as predictors of CIN and to long-term survival.
{"title":"Evaluation of Nephropathy in Coronary Catheterization","authors":"B. J. Berger","doi":"10.1177/2150133510395574","DOIUrl":"https://doi.org/10.1177/2150133510395574","url":null,"abstract":"Cath lab managers are involved in quality assurance and outcomes evaluation. One area of focus is contrast-induced nephropathy (CIN). CIN is important because it is the third leading cause of hospital-associated renal insufficiency, and even when it is clinically reversible it is associated with increased hospitalization, cost, and mortality. Assessment of nonmodifiable risk factors, treatment of modifiable risk factors, and evaluation of laboratory biomarkers is essential as predictors of CIN and to long-term survival.","PeriodicalId":320506,"journal":{"name":"Cardiac Cath Lab Director","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127011939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1177/2150133510395102
Molly Szerlip, P. Suryanarayana, U. Luft
Anomalous origin of the left main coronary artery is a rare clinical entity that can present with symptoms across the clinical gamut, from asymptomatic to chest pain and possibly even sudden death. The clinical syndrome varies depending on the course of the aberrant left main. The anterior course where the artery runs between the aorta and the pulmonary artery can lead to compression of the left main, resulting in ischemia and possibly sudden death. In this article, the authors describe a case of a left main arising from the right coronary cusp that took a posterior course. There was a high-grade, proximal left anterior descending artery lesion that was treated with percutaneous intervention after defining the course of the aberrant left main.
{"title":"Anomalous Left Main Coronary Artery From Right Coronary Cusp","authors":"Molly Szerlip, P. Suryanarayana, U. Luft","doi":"10.1177/2150133510395102","DOIUrl":"https://doi.org/10.1177/2150133510395102","url":null,"abstract":"Anomalous origin of the left main coronary artery is a rare clinical entity that can present with symptoms across the clinical gamut, from asymptomatic to chest pain and possibly even sudden death. The clinical syndrome varies depending on the course of the aberrant left main. The anterior course where the artery runs between the aorta and the pulmonary artery can lead to compression of the left main, resulting in ischemia and possibly sudden death. In this article, the authors describe a case of a left main arising from the right coronary cusp that took a posterior course. There was a high-grade, proximal left anterior descending artery lesion that was treated with percutaneous intervention after defining the course of the aberrant left main.","PeriodicalId":320506,"journal":{"name":"Cardiac Cath Lab Director","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129846860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1177/2150133510395572
D. Macklin
The elimination of catheter-related bloodstream infections (CR-BSI) requires meticulous intravenous (IV) catheter care. There are three different types of needlefree connectors and one intraluminal protection device that require different care regimens, including the correct usage of disinfectants, flushing techniques, and clamping sequences. The nurse must be able to identify which connector is in use and select the appropriate care. This care must be followed not only in the inpatient unit by the bedside nurse but also in areas that are providing diagnostic procedures such as the cardiac cath lab. Since bacterial adhesion to the intraluminal catheter wall is the primary building block of a CR-BSI, which may not present until days after initial inoculation, preventing intraluminal fluid pathway contamination is paramount with every access. In addition, many institutions have more than one type of connector available. This complicates the provision of consistent safe care. Split septum, negative mechanical valves, positive pressure mechanical valves, and intraluminal protection devices have specific care and maintenance requirements. This article discusses the different connector types, why each requires special care, how intraluminal fluid pathway contamination can lead to CR-BSI, and how simple nursing care and maintenance practices of connector septum swabbing and catheter flushing by the cardiac cath nurse can help prevent this serious complication.
{"title":"IV Catheter Care and Maintenance Minimizes Catheter-Related Blood Stream Infection","authors":"D. Macklin","doi":"10.1177/2150133510395572","DOIUrl":"https://doi.org/10.1177/2150133510395572","url":null,"abstract":"The elimination of catheter-related bloodstream infections (CR-BSI) requires meticulous intravenous (IV) catheter care. There are three different types of needlefree connectors and one intraluminal protection device that require different care regimens, including the correct usage of disinfectants, flushing techniques, and clamping sequences. The nurse must be able to identify which connector is in use and select the appropriate care. This care must be followed not only in the inpatient unit by the bedside nurse but also in areas that are providing diagnostic procedures such as the cardiac cath lab. Since bacterial adhesion to the intraluminal catheter wall is the primary building block of a CR-BSI, which may not present until days after initial inoculation, preventing intraluminal fluid pathway contamination is paramount with every access. In addition, many institutions have more than one type of connector available. This complicates the provision of consistent safe care. Split septum, negative mechanical valves, positive pressure mechanical valves, and intraluminal protection devices have specific care and maintenance requirements. This article discusses the different connector types, why each requires special care, how intraluminal fluid pathway contamination can lead to CR-BSI, and how simple nursing care and maintenance practices of connector septum swabbing and catheter flushing by the cardiac cath nurse can help prevent this serious complication.","PeriodicalId":320506,"journal":{"name":"Cardiac Cath Lab Director","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128728900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1177/2150133510393496
S. Kanjanauthai, R. Napier, T. Raja, V. Arora
It is still debated whether a transradial approach or a transfemoral approach is better for coronary angiography or percutaneous coronary intervention. This article will provide a focused review on different aspects of the two approaches.
{"title":"Transradial Versus Transfemoral Approach in Coronary Angiography and Intervention","authors":"S. Kanjanauthai, R. Napier, T. Raja, V. Arora","doi":"10.1177/2150133510393496","DOIUrl":"https://doi.org/10.1177/2150133510393496","url":null,"abstract":"It is still debated whether a transradial approach or a transfemoral approach is better for coronary angiography or percutaneous coronary intervention. This article will provide a focused review on different aspects of the two approaches.","PeriodicalId":320506,"journal":{"name":"Cardiac Cath Lab Director","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132586820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-02-01DOI: 10.1177/2150133510391244
J. Robins
With the focus on radiation dose to patients becoming more prevalent in the past few months, steps need to be taken to ensure the safe use of fluoroscopy for patients coming to the cardiovascular lab for procedures that are becoming more and more complex. Technology exists within newer imaging systems that allows providers to establish benchmarks with respect to patient dose and therefore create protocols that will automatically trigger quality review of patients who receive a relatively high dose.
{"title":"Patient Dose Benchmarking","authors":"J. Robins","doi":"10.1177/2150133510391244","DOIUrl":"https://doi.org/10.1177/2150133510391244","url":null,"abstract":"With the focus on radiation dose to patients becoming more prevalent in the past few months, steps need to be taken to ensure the safe use of fluoroscopy for patients coming to the cardiovascular lab for procedures that are becoming more and more complex. Technology exists within newer imaging systems that allows providers to establish benchmarks with respect to patient dose and therefore create protocols that will automatically trigger quality review of patients who receive a relatively high dose.","PeriodicalId":320506,"journal":{"name":"Cardiac Cath Lab Director","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125515881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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