The cardiac catheterization laboratory has undergone major changes in the last decade. It is a much more sophisticated environment where a gradual shift in emphasis from a diagnostic laboratory to a therapeutic environment is occurring. As the risk of both diagnostic and interventional procedures has declined, there has been liberalization in the types of patients who may safely have procedures performed in both outpatient settings and in laboratories without cardiovascular surgical backup. The influence of peripheral vascular and structural heart intervention has also required a change in focus for many laboratories and has given rise to the hybrid cardiac catheterization facility. The advances in percutaneous therapies for structural heart disease are just now beginning to impact both the adult and pediatric catheterization laboratory. Some of the routine practices in many laboratories are being questioned. For instance, the committee no longer suggests a protime be obtained before a procedure, unless an abnormality is anticipated. Overnight NPO orders should be replaced with shorter-term fasting as hydration is important. Acetylcysteine is no longer recommended to reduce contrast nephropathy. QA is a focus of this report, and its importance is mounting as it becomes harder to justify minimum volume requirements for both the operator and the laboratory. The importance of national databases to provide benchmarks is emphasized. Radiation safety has also entered into the discussion more prominently as patients and regulators have expressed concern regarding the amount of medical radiation the public receives. Measures of the amount of radiation exposure should be a routine part of the cardiac catheterization report.
All Science Journal Classification (ASJC) codes
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine