What are the basic equipments in a cathlab?

What are the basic equipments in a cathlab?

Cardiac catheterization laboratory is often called as cathlab in short. Cathlab is the place where invasive cardiac procedures like right and left heart catheterization, angiography, angioplasty, implantation of cardiac implantable electronic devices, electrophysiology study and ablation procedures are done. When the number of procedures is more, there could be subdivision into interventional cardiology and electrophysiology labs as each require different additional equipment as complexity of procedures increase. This discussion is on a basic cathlab which is seen in most invasive setups.

Cathlab being an X-ray related procedure room, radiation protection is important for all staff as well as patients, following the ALARA principle: “as low as reasonably achievable”. This means avoiding radiation that does not have direct benefit to you, even if it is a small dose. Cathlab enclosure has a good radiation shielding to avoid exposure to those outside the cathlab. Walls and doors will have coating of radiation absorbing material of requisite thickness. External view glasses into the cathlab will be made of lead glass to ensure radiation protection.

Devices for personal protection of staff include lead aprons, lead goggles, thyroid shield etc. In addition, specific shields may be used for patients when needed. Within the cathlab there are lead glasses to shield the operator from scatter radiation coming from the patient and lead sheets below the patient table in front of the X-ray tube. Both these are near the operator because other staff will be located further away and will get less radiation by the inverse square law. Lead glass screen can be repositioned as per the operator’s convenience.

X-ray equipment is mounted on a C-arm which can rotate in two planes to allow different angulated views. In the image the flat panel detector situated above the patient table is shown, while the X-ray source below the patient table is hidden by the lead shield. Both these move together when the technician operates the C-arm from the control console. Patient table can also be moved to get the region of interest while imaging in the centre of the image. This movement is known as panning, can be done either by the operator or technician. Table can also be locked to avoid unexpected movements while doing procedures like skin puncture.

In the system shown here the movement rails are mounted on the roof. There are also systems with rails for some equipment mounted on the floor as well. Foot switches are there to control the X-ray source to decide whether you want the low radiation continuous imaging usually called fluoro mode or the short cine runs of high radiation for high contrast images. The system usually gives a different audio alert while on cine mode. A roof mounted spotlight gives illumination at the external procedure site for skin puncture and device introduction.

An array of monitors is also roof mounted here. It can be moved closer to the operator when needed. One will be live fluoro, another can be used as a roadmap with a previous frozen image. Third monitor will show the pressure tracings and ECG. Continuous monitoring of ECG and catheter tip pressure are essential to ensure patient safety. An additional defibrillator monitor will also be there with defibrillator paddles kept with electrode jelly for immediate defibrillation if needed.

A pressure injector is used to inject radiocontrast for left ventriculography and aortography at graded speed, which is adjustable as per need. Infusion pumps, resuscitation tray, medication tray, racks for catheters and devices are other things not shown in this image. When electrophysiology procedures are done, electrophysiology recorder, stimulator and ablators are additionally needed. Other devices for interventional cardiology procedures are intravascular ultrasound console and optical coherence imaging console. A portable echo machine is also at hand when needed. Some procedures need transesophageal echocardiography as well.