Does your hospital do heart caths, but does not do CABG's?

  1. What's your opinion? Do you think it is safe to do heart caths on patients without a stand-by back-up surgery team available if you have complications?

    There's good $$$ in it for the cardiologists. Anyone know what the going rate is for a heart cath?
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  2. 17 Comments

  3. by   Katnip
    The hospital I'm going to work in and have done my ED rotation in does heart caths. They do not have open-heart surgical facitilies.

    People who need open heart if the cath does not go well, get shipped down the street a few blocks away.
  4. by   VickyRN
    I used to work in a hospital that did caths AND had the capacity to do open heart surgery in house. We frequently had patients transferred to us who had caths in the outlying hospital "simply" for diagnostic purposes, then came to us for yet another cath--this time for interventions. Besides the safety factor (what IF something major goes wrong with the patient on the table?)--it seemed incredibly inconsiderate to the patient and wasteful to go through the cath at one place and then have the cath with us, for the intervention (stent, etc).
  5. by   Chttynurs
    I agree with VickyRN. I work in a hospital full time that does caths and heart surgery, which makes sense. I also work in a hospital--per diem--that does caths and doesn't have the capacity to do CABG. It does seem inconsiderate if the patient ends up needing an intervention and needs to be shipped somewhere else. Nothing against the hospital that I work per diem in, but if my family member is told they should have a cardiac cath, I'll be sure they go to a hospital that can do interventions and does surgery if needed!!
  6. by   zambezi
    I work in a hospital that does both caths with intervention and heart surgery...we have another hospital a few miles away that does diagnostic caths...can't remember if they also do interventions...lately they have been trying to ship most patients with chest pain/ekg changes right to us as their will probably be an intervention...our docs are on staff at both hospitals...we also have another hospital about one and a half hours away that does caths but no surgery....we get patients transferred from there relatively frequently...
  7. by   Tweety
    We do caths, but not CABGs, which is weird. I'm pretty sure the hospital next door where the CABGs are done always has a cardiac surgeon on call 24hours and we have an agreement with them. (It's a children's hospital. So when adults have CABGs they come to us after being in critical care for a day. Strange relationship).

    I agree, it's important to have some plan available in emergencies.
  8. by   P_RN
    How about freestanding Cardiology centers? There is one that is about 1 1/2 mi (downtown) from 3 hospitals. They do almost everything including caths there. They have an excellent reputation, but sometimes things go wrong really rapidly don't they?
  9. by   Chttynurs
    Things CAN go wrong VERY quickly!! I've heard a code in the cath lab more than once! I'm not sure if this is the law everywhere, but around here, interventions absolutely can not be done in facilities that can't perform cardiac surgery. We're supposed to be getting one of those free standing facilities in my town that does cardiac caths also, diagnostic of course. I just can't imagine having it done unless it's in a facility that can actually do an intervention if it's needed while they're already in there. If a person has a cath done in a facility that can't perform intervention, can the sheaths remain in the patient for transport to another facility? I don't know much about that aspect of the whole deal, I'm assuming they can't be transported with sheaths in. But it would at least make things easier!!
  10. by   cookie22039
    I work for a medium size hospital and we do caths here but we do not have any cardiac back up and the nearest hospital that does have a cardiac surgery team is about 30 miles away. CRAZY!!!!!!!!! I am amazed that they will do this here and not have any other back up, but they do and they do it just about every day. My father in law is having one next week here at the hospital I work at and I have tried everything I know to get them to go on downtown to have it done, but they just won't you know how that goes. Anyway, I agree they should have cardiac surgery available, and it is very unfair to the pt to have to do another cath to do any stent, ect.
  11. by   Cath Lab RN
    I have worked in a cath lab for almost nine years. We do diagnostics only at this point. It is a community hospital and we monitor our pt. population. If we feel that the patinet is a high risk we send to an interventional facility for cath and possible plasty. Hospitals have been doing both diagnostic and interventions without CABG available for many years. At a recent conference I was at a cardiac surgeon was saying that in the beginning CABG staff was standing by for diagnositic cath then went to standby for interventions as they learned how safe the procedures were. Now interventional cardiologists are taking high risk patients to the cath lab because they are TOO HIGH RISK for the surgeons to take to surgery. We are coming 360 degrees. As far as codes in a cath lab... I don't know about your facilities but in mine you are standing shoulder to shoulder with some of the finest MDs, you are literally standing next to your pt. should they arrest (many times because for time of arrest to resuscitation is so short a percordial thumb will be enough) and these docs and staff are all excellent. Our nursing staff are former ICU/CCU RNs all staff is ACLS certified (yes even our x-ray techs) so EVERYONE is monitoring the pt. at all times. I wouldn't work out side a cath lab. Hope this helps answer some of your questions and concerns.
  12. by   nursenatalie
    Get this, at a local hospital they do heart caths in a mobile trailer a couple days a week, 30 miles from the nearest hospital that can perform CABG. While this trailer conveniently parks next to the helipad...wouldnt it be a little too little too late if something was ruptured? Scary...
  13. by   Ted
    The only thing our happy little . . . really little. . . hospital does surgically for the heart is place pace-makers.

    We used to "ship" our cardiac customers who needed catheterization to our sister hospital. Unfortunately, they don't do CABG's or any open heart surgery. Since out hospital has been fortunate to have hired a cardiologist, he's been re-thinking this strategy. Now we send our cardiac customers to a hospital an hour's drive farther than our sister hospital.

    But the more distant hospital does open heart surgery including CABG's.
  14. by   CCL"Babe"
    The cath lab I work in has OR back up. Thank God we don't need it very often, but in the years I've been there we have rushed patients to the OR, just from diagnostic procedures.
    Cathlabrn is correct. We now are doing very risky procedures on patients we would have sent to the OR before. The equipment and technology is advancing rapidly.
    I still wouldn't want to work in a lab that didn't have OR back up. Even though I miss the ER, I wouldn't want to work anywhere else.

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