MI: when to go to cath lab

[dingbiscuit]

I work at a small community hospital on a PCU. Our hospital has a cath lab and CV surgeon. We see patients on a regular basis that present with positive cardiac enzymes and abnormal EKG. I work night shift and our cath lab is only open during the day with someone on call at all times. The only time I have seen them open the cath lab at night is for patient presenting in ER with a STEMI. I have taken care of plenty of patients with acute MI that we put on hep. gtt and nitro, etc.. till the cath lab opens in the am. Just curious if it is like this at other hospitals or if most do caths 24/7.

[Virgo_RN, BSN, RN]

I work in a PCU in a major medical center that serves a large portion of the state. Your protocols are the same as ours. People with STEMI need immediate reperfusion because STEMI usually involves complete occlusion of a coronary artery, whereas NSTEMI usually involves transient thrombosis or incomplete occlusion, so Nitro, LMWH, GP IIb/IIIa inhibitors are appropriate. They will usually have a coronary angiogram, but it can wait until the cath lab opens in the morning.

[al7139, ASN, RN]

Hi,

Our hospital is the same way. A STEMI is emergent, and our hospital's time goal is 90 minutes to cath and reopen the occluded artery. For this reason, we always have a cardiologist and cath lab techs on call 24-7. If the MI is a Non STEMI, it depends on the time of the day. After hours, they will usually be put on nitro and/or LMWH and be cathed the next day with close observation in ICU until the procedure the next AM. This has to do with perfusion. A STEMI is the most damaging MI a patient can have, because if the MI occurs in the anterior wall (associated with the Left anterior descending artery), they are likely to experience left sided heart failure and ventricular dysrhythmias due to the necrosed tissue that cannot be repaired. This is why your staff is called in in the middle of the night to cath this patient. All other MI's, while potentially fatal as well, are not as emergent, because even if tissue death occurs, it is not as widespread and the heart can compensate for it.

Amy

[Spatialized]

If someone develops a STEMI while on the floor, we can call in the cath lab team who are on-call 24-7. We've had a couple of times where the patient comes through the ER with mild symptoms and they are being admitted for observation, then start to extend in a bad way. Our typical protocol is to contact the cardiologist and they can decide to activate the cath lab if they feel it is warranted. Usually we're only calling them for new ST elevation and/or large jumps in cardiac enzymes. Sometimes they'll have us treat conservatively with nitro, heparin, Gp IIb/IIIA inhibitors, beat blockers (if appropriate) and morphine. Others they're in the cath lab in 45 minutes.

Tom