Cath lab

German cardiac catheterization laboratory (2004)

A catheterization laboratory or cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to support the catheterization procedure. A catheter is inserted into a large artery, and various wires and devices can be inserted through the body via the catheter which is inside the artery. The artery most used is the femoral artery.However, the femoral artery is associated with local complication in up to 3% of patients^{[citation needed]} and hence, more interventional physicians are moving towards the radial (wrist) artery, as an alternative site. Disadvantages of the radial artery include small vessel caliber and a different "learning curve" for physicians used to the femoral (groin) access.

Most catheterization laboratories are "single plane" facilities, those that have a single X-ray generator source and an image intensifier. Older cath labs used cine film to record the information obtained, but since 2000, most new facilities are digital. The latest digital cath labs are biplane (have two X-ray sources) and digital, flat panel labs.

Biplane laboratories achieve two separate planes of view with the same injection and thus save time and limit contrast dye, limiting kidney damage in susceptible patients

Catheterisation laboratories in the UK are staffed by a multidisciplinary team including a Physician (normally either a cardiologist or radiologist), an Anaesthetist, a Cardiac Physiologist, a Nurse and a Radiographer.

Cardiac Procedures:

A number of cardiac diagnostic and therapeutic procedures can be performed in a catheterisation laboraory. These typically include angiograms, percutaneous coronary interventions, closure of some congenital heart defects, treatment of stenotic heart valves, and pacemaker implantations. Many modern cath labs have facilities for performing electrophysiological studies, wherein catheters and wires passed into the heart through blood vessels are used in diagnosing and treating arrhythmias. Most Cath lab procedures are performed under local anesthesia. General anesthesia may often be necessary in small children in whom longer procedure times are anticipated.

A coronary angiography is performed when the physician suspects the existence of coronary artery disease, a condition characterised by significant stenoses in the coronary arteries of the heart. The procedure is typically performed through the femoral(groin) artery or the radial (wrist) artery. Pre-shaped catheters are passed through the arterial access under fluoroscopic guidance and used to cannulate the openings (ostia) of the coronary arteries. Small quantities of a radiographic contrast medium ('dye') are injected into the coronary arteries through the catheters. The dye passes through the coronary arteries into the coronary venous circulation. During its passage, which typically takes a few cardiac cycles, the anatomy of the coronary arterial tree can be visualized under fluoroscopy due to the radio-opacity of the dye. The X-ray tube is rotated so as to provide specific views (projections) to enable complete visualization of the coronary arterial tree.