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Technologies ASCs Need to Add Cardiology Administrators weigh in BY ROBERT KURTZ
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started working in a hospital heart catheterization lab. “Now these advancements are helping support the migration of inpatient cardiac proce- dures to ASCs,” says Kubaiko, regional director of operations for Azura Vascu- lar Care and National Cardiovascular Partners in Edina, Minnesota. At the top of Kubaiko’s list of essential technologies for cardiology ASCs is a ceiling-mounted cath lab system. “This provides the best imag- ing possible,” she says. “The better the detail of the images, the better the phy- sician can visualize blockages.” For Manhattan Specialists Center in Manhattan, Kansas, a C-arm is cur- rently its main piece of imaging equip- ment, says Administrator Tiffany Zach- ary. “It allows us to produce excellent images for our interventionalist—an important tool when making the best decisions in managing our patients. He can then see exactly where he is plac- ing that catheter, which helps ensure he is going to the correct vessels.” Zachary’s ASC will soon add a ceiling-mounted imaging system in a second operating room that is cur- rently under development. “When we opened the ASC, coronary procedures were not approved for ASCs like they are now,” she says. “The C-arm we have is not good for such procedures, like heart catheterizations. The ceiling- mounted unit has a smaller detector that provides much better detail of the smaller heart vessels so we can begin doing stents and balloons in the heart.” The C-arm and ceiling-mounted unit both include an important fea- ture: an integrated hemodynamics sys- tem. This permits users to monitor a patient’s electrocardiogram, blood
nnovative technology drew Traci Kubaiko to the cardiology spe- cialty more than 20 years ago when she
pressure and other vitals. “When our physician goes into a patient with a Swan-Ganz catheter, for example, the system will provide detailed pressure measurements,” Zachary says. To assess lesions, Kubaiko says her cardiologists often rely on frac- tional flow reserve (FFR) and instan- taneous wave-free ratio, also referred to as instant flow reserve (iFR). “This is a pressure wire that is put across the lesion. FFR and iFR can tell us if the pressure gradient across the lesion is great enough to warrant a stent.” Zachary points to intravenous ultra- sound (IVUS) as another critical tool. The IVUS takes an ultrasound into the patient’s vessels, helping reveal mor- phology and identify types of lesions and other vessel and lesion character- istics. Use of IVUS provides confi- dence to Manhattan Specialists Cen- ter’s physician owner, Zachary says. “There were times when he did not think he would end up stenting a ves- sel, but once he went in with IVUS,
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he determined it needed to be stented. And vice versa.”
Laser treatment, atherectomy and thrombectomy devices further sup- port ancillary procedures at Manhat- tan Specialists Center, Zachary says. “We are introducing shockwave ther- apy with intravascular lithotripsy, a novel technology in managing heavily calcified arteries. We have the option of several atherectomy devices, which break up and remove the plaque in the vessels. With a narrower stenosis, it is much easier to place a stent. The thrombectomy devices help to remove blood clots rather than plaque.” When outfitting a cardiovascular ASC, do not forget to address the need for “bailout” equipment, as well as pol- icies and procedures, for emergencies, Kubaiko advises. This might include covered stents for helping seal up per- forations, balloon pumps, a temporary pacemaker and a fully stocked crash cart. “You hope you never use any of it, but you must keep it on hand.”
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