Catheterization laboratory
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A catheterization laboratory or cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualise the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.
Equipment
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.
A typical 'Cath Lab' will consist of:
- Patient Couch
- A floor or ceiling mounted Image intensifier C-Arm
- Set of viewing monitors
- Realtime ECG/Blood pressure/Oxygen Saturation measurements with softward to record and measure these when needed
- Injector Pump used for imaging the Left Ventricle or Aorta
- X-ray software for the recording and playback of the Flouroscopy runs acquired during the procedure
- Diagnostic Catheters
- Guide catheters
- Guidewires
- Angioplasty balloons
- Stents (drug eluting and bare metal)
- Sheaths
- Closure devices
- General nursing supplies
- Defibrilator
- Drugs
- Recovery bays
- Reporting station
- Scrub area
Staff
Catheterization 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.
Procedures
"Cardiac catheterization" is a general term for a group of procedures that are performed using this method, such as coronary angiography, as well as left ventricle angiography. Once the catheter is in place, it can be used to perform a number of procedures including angioplasty, PCI (percutaneous coronary intervention) angiography, balloon septostomy, and an Electrophysiology study or Catheter ablation.
A list of procedures carried out in a Cath Lab include:
- Coronary Angiography or Coronary catheterization
- Coronary Angioplasty or PCI
- Closure of some congenital heart defect
- Treatment of stenotic heart valves
- Permanent and temporary pacemaker implantations
- Electrophysiological studies such as AV node ablation
- Rotablation of heavily Calcified vessles
- Lt and Rt Sided pressure studies
Projections
Any combination of the following views are used in visualising the Coronary Arteries:
- PA (Postero-antero)
- RAO (Right Anterior Oblique)
- RAO CRANIAL
- PA CRANIAL
- LAO CRANIAL
- LAO (Left Anterior Oblique)
- LAO CAUDAL (or 'spider' view)
- PA CAUDAL
- RAO CAUDAL
As a general rule, cranial views are best used to demonstrate the Left Anterior Descending Artey or 'LAD', and caudal views are best used to demonstrate the Circumflex Artery.