Cardiac Catheterization Lab
Lancaster General Health’s Cardiac Cath Lab performs more than 4,500 diagnostic catheterizations and 1,400 interventional procedures annually.
Procedures that help provide information about your heart and/or lungs, the blood vessels that feed these organs as well as your heart valves and the aorta. This information helps your doctors make decisions regarding your care and treatment.
Left Heart Catheterization and Coronary Angiography (LHCC’s)
A sheath (short tube) is inserted into the artery in your leg or wrist through which a flexible catheter is advanced to your heart. X-ray dye is then injected through the catheter to visualize your coronary arteries and check for blockages. Pictures are also taken to determine the strength of your heart muscle.
Right and Left Coronary Heart Catheterization and Coronary Angiography (RLHCC’s)
In addition to the above procedure, a sheath will be inserted into the vein in your leg and a catheter advanced to your lungs. This allows us to measure pressures in your heart and lungs.
In addition to visual analysis several procedures can be used to assist your physician in determining the severity of any blockages found in your coronary arteries including ultrasound and flow measurements to assess pressure gradients.
Pulmonary Arteriogram (PA Gram)
Pictures of the arteries in your lungs are taken utilizing a catheter. This catheter is inserted into a vein in your leg or neck and advanced to your lungs. X-ray dye is then injected through the catheter to check for blood clots.
If your physician suspects you might have poor blood flow to your legs images of the blood vessels in your legs can be obtained in a specially equipped procedure room. Much like a heart cath, x-ray dye will be injected though a small catheter directly into the blood vessels of your lower extremities to assess for narrowing or blockages.
If you doctor suspects the cause of your high blood pressure might be due to Renal Artery Stenosis he may take pictures of your renal arteries to assess for narrowing. A small catheter is inserted through the artery in your leg and x-ray dye is injected directly into the Renal Artery.
Interventional procedures are used to correct problems in your heart that are discovered during one of the diagnostic procedures mentioned above.
Percutaneous Coronary Intervention (PCI)
When a blockage is found in one or more of your coronary arteries, your doctor has several options for fixing the blockage(s). The majority of blockages can be fixed using one or more of the following methods. However, in some instances, your doctor may refer you to our highly regarded team of cardiac surgeons, the Cardiothoracic Surgeons of Lancaster. They are the exclusive providers of cardiac surgery to Lancaster General Health.
Balloon Angioplasty (PTCA)
During Balloon Angioplasty, a tiny balloon on the tip of a catheter is advanced into your coronary artery and across the blockage. The balloon is then inflated, compressing the blockage against the artery wall.
Coronary Stent Implantation
A coronary stent is a small metal tube, much like the spring in a pen, which is mounted on an angioplasty balloon. The stent and balloon are advanced across a blockage. Once in position, the balloon is inflated, implanting the stent into the wall of the artery. Stents act as a scaffolding to hold the artery open. Most of the stents we use are coated with a drug that helps prevent scar tissue from forming inside the stent.
Rotational Atherectomy (PTRA)
When a blockage is very hard, due to calcium buildup on the inside of the artery, a diamond-tipped drill is used to reduce the blockage.
When a coronary artery contains clot, several devices can be used to remove this clot and restore blood flow to your heart.
If x-ray pictures are not enough to diagnose a problem in your arteries, an ultrasound catheter can be advanced to obtain images from inside your artery.
There may be options available, at the discretion of your cardiologist, which could be used to fix holes in the septum of your heart.
Vena Cava Filter
This is a metal filter that is placed in a major vein returning to your heart to prevent blood clots from entering your lungs. In time, any clots that are trapped in the filter simply dissolve.
When a blockage is found in one or more of the blood vessels feeding your legs, your doctor has several options for fixing the blockage(s). Much like fixing blockages of the heart vessels, your doctor can use angioplasty balloons, stents, thrombectomy and laser to open blockages in the blood vessels in your legs
Renal Artery Stenting
If your doctor diagnoses Renal Artery Stenosis to be the cause of your high blood pressure he might opt to place a stent in the Renal Artery. A Renal stent is a small metal tube, much like the spring in a pen, which is mounted on an angioplasty balloon. The stent and balloon are advanced across a blockage. Once in position, the balloon is inflated.
What to Expect
If you are scheduled for an outpatient catheterization, you will park in the James Street parking garage. Exit the garage on the 2nd Floor and you will be directed to the Heart Center Registration Area. Here your personal health and insurance information will be reviewed for accuracy.
You will then be escorted to our Cath Lab Holding Area where you will be weighed and placed in a private room. If you require a Chest X-ray prior to your procedure you will be escorted to and from the Radiology Department by one of our staff members. If you need blood work done prior to your procedure, a phlebotomist will come to your room to draw blood samples. You will change into a gown, be assessed by your nurse and have an IV started. Your nurse will ask you an extensive list of questions and review your current medication regimen. If you are already admitted to a hospital bed prior to your heart catheterization, you will skip the pre-registration process and be brought directly to our holding area.
Our Holding area is a starting point for many different cardiology patients managed by several different cardiology groups.
When it is time for your procedure, one of our staff members will transport you from the Holding Area into the Cath Lab suite. Once you are in the Cath Lab suite, our staff will transfer you to our procedure table using a sliding board. You will notice that the temperature of the room is very cool. However warm blankets will be provided for your comfort. You will be hooked up to our monitors and a staff member will begin preparing your groin or wrist for the procedure. If a groin approach is planned to be used, a loin cloth will be placed to maintain modesty while a staff member shaves your right and left groin area with an electric razor. Generally, we only use the right side groin. However, we prepare both sides in case we need to enter through the left side. Once the planned access site is prepped, staff members will place several blue sterile drapes on top of you. We ask you to please not reach on top of the drapes. When we are finished preparing the sterile field and equipment, your cardiologist will be notified.
When the cardiologist begins, he or she will put firm pressure on your groin or wrist while feeling for your pulse. Following this, the area will be injected with a local anesthetic that will sting for a small period of time. After the initial anesthetic you should not feel sharp pain. If you do feel pain, please let us know. We have plenty of medications that can help comfort you. When the area has been numbed, we will gain access to your femoral or radial artery and insert a sheath approximately the size of a coffee stirrer. This sheath acts as a one way valve allowing us to exchange our catheters in and out of your artery without blood loss occurring. After the sheath is inserted, the hard part is over. You will not feel our catheters traveling to your heart because there are no nerve endings inside your arteries.
Generally, the first picture that we take visualizes the main pumping chamber of your heart. With this picture, you may feel a hot flash from head to toe. It may also make you a little nauseated, create a metallic taste in your mouth, and/or make you feel like you urinated. You will not have urinated. It is just a feeling you get from the x-ray dye. These are normal sensations and will go away in approximately one minute.
We will also take pictures of your coronary arteries. During these pictures, your cardiologist may ask you to take a deep breath and hold it for a few seconds. Throughout the procedure, the cameras will be rotating around you as we obtain images from several different angles. You may watch the pictures on our television screen; but, at times your view may be blocked by our rotating cameras. We can show you your pictures and explain them to you when the procedure is over.
The length of your procedure may vary. If the pictures show us that there is not a blockage, we will put you back on your bed and return you to the Holding Area. Once in the Holding Area, we will monitor your vital signs and remove the sheath(s) when appropriate. After the sheath is removed, you will have bed rest based on your cardiologist’s order, and then be discharged. Although the procedure is relatively short in duration, please plan on spending the entire day with us.
If the pictures confirm that you do have a blockage, your cardiologist may attempt to open it, if clinically appropriate. From your perspective opening a blockage is similar to the diagnostic portion of the test. We may place an additional sheath in your groin and we will place you on oxygen. You may notice some chest pain when we inflate our balloon(s) and/or stent(s). This chest pain may last for approximately one minute; although, you may have a dull ache in your chest for several hours after the procedure. This is called stretch pain and occurs when we stretch the wall of your artery. This pain will slowly resolve after your procedure.
Fixing a coronary artery is unique for each person and procedure times will vary. During the procedure, we will give you blood thinners. The sheaths in your leg may have to remain in place until the blood thinners wear off. This may take a few hours. Several hours of bed rest may follow the removal of your sheath(s). With an interventional procedure, you might need to spend at least one night in the hospital. Most patients are discharged the following day.
Where will my family wait while I am in the procedure room?
During your procedure, family and friends will be directed to our Skylight Information and Waiting Center on the second floor. They will check in at the front desk and receive a pager. At the end of the procedure, our staff members will call the Information and Waiting Center, who will locate and escort your family and friends to the Cath Lab. Your cardiologist will explain the results of the procedure with you and your family and friends.
What if I have allergies?
You will be asked about your allergies multiple times before your procedure. If you are allergic to X-ray dye, iodine, or shell fish, you will be given additional medications to prevent an allergic reaction.
Why do staff members wear lead, and how much radiation will I receive during my procedure?
Scientists and medical doctors, using numerous clinical study results, have determined that the amount of radiation dose you will receive is safe. Your risk is minimal. Our staff members work in the radiation all day; so, they need to protect themselves by wearing lead and using shields when possible.
What should I do in preparation for my procedure?
Arrange transportation to and from the hospital, bring a current medication and allergy list, and any necessities you may want should you be admitted to the hospital. If you require CPAP at night while sleeping we suggest you bring your unit with you.