Minimising failures in cardiac cath lab

Cardiac cath labs are highly technically evolved area in hospitals. Meeta Ruparel writes on combating problems in cardiac cath lab

Staff working in cath labs come across many problematic issues in their day to day operations of the department. A few of the areas are a) medical/ clinical procedural failures, b)inappropriate stress management systems for the staff, c)downtime/ failure of critical medical equipment in the cath lab, d)technology failure: power failures, unavailability of other engineering support systems like adequate light, HVAC, communication and transport systems, etc, e)problems arising due to unavailability of critical supplies and f)inappropriate waste disposal systems / environment control, etc. I would elaborate a few important points.

Clinical failures

An intensivist/a clinical practitioner in cath lab can best address this issue. However, there are many problems due to medications induced (problems due to allergies etc), sudden call of surgery for the patient under angiography/angioplasty and the emergency protocols to be followed under such last minute calls as per need of the hour, etc

Burnouts and stress is a common health hazard experienced by critical/ cardiac care nurses and other staff working in ICUs, OT, cath lab, and other such critical care units of a hospital

In this article, I would discuss on possible engineering failures in cath labs and precautionary measures that can be implemented to prevent such failures. These issues can also be correlated with other critical care departments of a hospital and similar protocols can be designed and followed appropriately.

Potential system failures and steps to minimise such failures

A downtime/failure of critical medical equipment in the cath lab

Cath lab is a highly medical electronic intensive set-up and comprises many medical equipment that are in continuous use for critical diagnosis and treatment

Failure/ long downtime of any one of these equipment makes the unit dysfunctional or inadequately functional. This invariably causes many hindrances in the effective functioning of the unit. In situations like this what should one do is a question that needs immediate answer for smooth functioning.

Some of the major equipment failures

• Unable to perform clinical diagnosis like EP studies, vital parameters like blood pressure, ECG, etc, due to non-functioning of vital sign monitors, electro physiology equipment, etc
• Sudden failure of defibrillators, external pacemakers; effecting towards untimely care during life threatening situations
• Inability to perform catheterisation due to radiology system failures or Injector failure
• Improper functional ability of medical gas compressors, infusion pumps, etc resulting in inability to provide necessary suctioning/ respiratory care or infusion of medications retrospectively

Preventive measures

• Maintain regular check and calibration of the equipment
• Incorporate alternative/ standby in case of critical equipment like defibrillators, pacemakers, vital sign monitors, etc
• Incorporate manual blood pressure meters, thermometers, manual blood, saline/ glucose and medicine infusing sets, etc
• Incase of radiology system failure; ensure ability of the system to be transferred to portable fluoroscopy system for immediate attention, if necessary
• A constant check needs to be ensured for the proper functioning of the injector. Because failure of the same might result in sudden shutting down / postponement of the case
• Best suggestion would be to station an experienced bio-medical engineer in the cath lab/unit at all times, to look into such major failures immediately
• Train staff to report to the bio medical department of the hospital for any error or dysfunctioning of any of the equipment, immediately
• Train nurses for manual infusion of medications, administration of appropriate CPR & other respiratory therapies
• Insure proper storage of back-up cylinders, syringes and other critical supplies, etc
• Close interdepartmental relations need to be maintained between the cath lab and other departments of the hospital viz: pharmacy, stores, engineering department, CSSD, pathology lab, OT, etc

Failures of other engineering systems

Some support engineering system failures

• Power failure / inadequate back up of generator, leading to inability to use electrical and electronic equipment
• Improper air conditioning systems (unable to control temperature/ humidity, improper functioning of venting systems, etc), resulting in uncomfortable ambience (working as well as for patients)
• Improper; waste disposal systems, sterilising systems, water supply & air handling systems, leading to nosochomial infections
• Inadequate light supply, thereby effecting proper execution of protocols
• Traffic jams (patient flow, supplies flow, waste flow, staff flow, etc) due to inappropriate transport systems (elevator failure, etc) ú Failure of security & fire alarm systems, communication systems (like telephones, EPABX, etc) and local network systems (like computers). Such failures result in improper information & data transfer, inability to communicate emergency calls, many a times leading to uncompromisable hazards

Steps to prevent/minimise such failures

Again the initial protocols remain the same for all engineering services; in addition the following can be implemented:

• Maintain regular check of the systems
• Incorporate alternative/ standby.
• Train staff to report to the engineering department of the hospital for any error or dysfunctioning of any of the systems, immediately
• For communication failures possibly implement a two-way radio systems for emergencies to ensure timely call of physicians, surgeons and required medical staff.
• Train staff for smooth handling of supplies, patients, waste, etc in case of transport system failures
• Train staff for proper evacuation of patients and staff in case of fire and other such hazards and ensure effective safety management protocols
• Incorporate storage of blankets, portable heaters, fans, etc in case of failures in air conditioning systems
• In case of failure in CSSD systems, water supply systems, waste disposal systems or air handling systems, train staff for ensuring good manual waste disposal systems, minimise wastes, minimise use of water (wherever possible), use more disposable instruments and other disposable supplies to ensure use of sterile products in advent of sterilising system failures.

The author is biomed engineer with Aum Meditech. Email:meeta@meditecindia.com, meetaruparel@hotmail.com