system process to prepare you and your staff for the ... · system process to prepare you and your...

System Process to Prepare You and Your Staff for the Management of Cath Lab Disasters

Craig J. Beavers, PharmD, FAHA, AACC, BCCP, BCPS-AQ Cardiology, CACP

Cardiovascular Clinical Pharmacy Coordinator, Gill Heart Institute University of Kentucky Healthcare

Adjunct Assistant Professor, University of Kentucky College of Pharmacy

SCAI 2019 Scientific Sessions

Las Vegas, NV

May 20th, 2019

Twitter Handle: @beaverspharmd

Disclosures

• I have no disclosures related to this presentation.

Objectives

• To review systems processes to prepare your catheterization laboratory for complications.

Systems Process to Prepare You and Your Staff for the Management of Cath Lab Disasters

Systems Process to Prepare You and Your Staff for the Management of Cath Lab DisastersSeptember 20, 2016By: Craig J. Beavers, PharmD, BCCP, FAHA, AACC and Jayant Bagai, MD, FSCAI

•Success is where preparation and opportunity meet.

-Bobby Unser

Case

•A 61-year old patient with past medical history of known ischemic heart disease was admitted for elective PCI to left circumflex artery chronic total occlusion.

Case

• A 61-year old patient with past medical history of known ischemic heart disease was admitted for elective PCI to left circumflex artery chronic total occlusion.

• Diagnostic angiography showed diffuse calcified occlusion extending from the proximal to distal left circumflex with Renthrop classification grade II collaterals from the diagonals filling up the obtuse marginal branches (OM).

Case

•Procedure:

•6-French extra-back up guider and micro-catheter support, attempts were made to with:

• soft hydrophilic wire

• intermediate tapered tip wire

• stiff wire

•With stiff wire, lesion was crossed with tip in OM2

Case • Procedure:

• Exchanged to soft wire and placed second wire in the distal left circumflex.

• Multiple balloon inflations/dilations at various sites from proximal left circumflex to OM2

• Placement of 2.5x38mm drug-eluting stent from proximal left circumflex to Om2 branch

• Heparin used in the case

Case

Type III Coronary Artery Perforation of Obtuse Marginal Branch with Contrast Extravasation into the Pericardium

How confident are you in YOUR WHOLE staff’s knowledge and skill in regards to efficient protamine use?

A) Very confident

B) Somewhat confident

C) Maybe confident

D) Not confident at all

E) Help! https://scai.confex.com/scai/2019/audiencepoll/ask.cgi?password=742171&Entryid=1323&EntryTable=Paper&Questionid=3#ask

https://scai.confex.com/scai/2019/audiencepoll/ask.cgi?password=742171&Entryid=1323&EntryTable=Paper&Questionid=3#ask

Coronary Perforations

•Estimated rate of occurrence of 0.2-0.5%

• Select risk factors:• Female patients • Calcified lesions• CTO PCI• Over-sized balloon/stent

•High in-patient mortality (average rate of 10%)

Cathet. Cardiovasc. Intervent. 89: 966-973.

Staff Response to Coronary Perforation

• Stop and reverse anticoagulation, if able

• Calls for support (staff or code team)

• Call for STAT ECHO

• Obtain needed supplies or equipment • Pericardiocentesis kit, covered stent coils, IABP


Cath Lab Emergency Management Processes Application

•Core Phases•Prevention •Mitigation •Preparedness •Response •Recovery

Cathet. Cardiovasc. Intervent. 89: 973-975

Cath Lab Emergency Management Processes Application

•Core Phases•Prevention •Mitigation •Preparedness •Response •Recovery


PCI Complication Checklist: Coronary Perforation

•Preparedness:•Outline equipment and procedures needed

• Identify and stock needed and stents and coils

• Protamine/Reversal agents available and how to dose/mix

• Training with all procedures, supplies, or medications needed Cathet. Cardiovasc. Intervent. 89: 973-975

PCI Complication Checklist: Coronary Perforation

•Response:• Stop and reverse anticoagulation, if able

• Calls for support (staff or code team)

• Call for STAT ECHO

• Obtain needed supplies or equipment: pericardiocentesis kit, covered stent coils, IABP


Who Has a Complications Checklist?

A) We do!

B) We need one!




Examples of Other Disasters


Best Practices

• Run Mock Drills (refer to SCAI 2016 Best Practices Documents for Core Elements)

• Define roles of team

• Protocols to identify high risk patients

• Post-procedure de-brief after complications

• Host morbidity and mortality conference, benchmark data

Who Routinely Runs Mock Drills?

A) We do!

B) We plan to start!

C) We probably should!




Systems Process to Prepare You and Your Staff for the Management of Cath Lab Disasters

Systems Process to Prepare You and Your Staff for the Management of Cath Lab DisastersSeptember 20, 2016By: Craig J. Beavers, PharmD, BCCP, FAHA, AACC and Jayant Bagai, MD, FSCAI

System Process to Prepare You and Your Staff for the Management of Cath Lab Disasters

Craig J. Beavers, PharmD, FAHA, AACC, BCCP, BCPS-AQ Cardiology, CACP

Cardiovascular Clinical Pharmacy Coordinator, Gill Heart Institute University of Kentucky Healthcare

Adjunct Assistant Professor, University of Kentucky College of Pharmacy

SCAI 2019 Scientific Sessions

Las Vegas, NV

May 20th, 2019

Twitter Handle: @beaverspharmd