Interventional nursing perspective on seting up of a coronary rotational atherectomy service: First-year experiences and lessons learnt

Background: Coronary Rotational Atherectomy (CRA) is a complex intervention to treat heavily calcified coronary atherosclerosis. We began performing CRA at Middlemore Hospital in August 2012. We discuss our experiences in setting up this service. Methods/Results: Patient safety was our priority, and we approached the issue with values of teamwork, communication and methodical preparation. Training in CRA was provided to laboratory staff by local experts. Access to a CRA simulator gave the staff good insight into procedure mechanics. A few senior nurses were nominated to learn and become familiar with the equipment and to scrub for procedures, in order to quickly develop the skill base. A single cardiologist is responsible for patient selection, case review, planning, and communicating to laboratory staff. The operator is made responsible for informed consent. We decided the first procedures would be performed electively, and we obtained outside experts to support and supervise the first procedures. We devised algorithms to guide equipment checks before and during the procedure. During procedures all lab staff are assigned roles, and all are strongly encouraged to communicate regarding progress, concerns, or complications. Familiarity with the procedure, equipment, and having assigned roles enables efficient running of the operation. Quality assurance of CRA procedures is provided through cardiology peer review, clinical auditing, team debriefing, morbidity and mortality review. Conclusion: We have had a successful first year performing CRA procedures at Middlemore Hospital, with good patient outcomes and low complication rate. CSANZ NZ AbstractsHeart, Lung and CirculationVol. 23Preview Full-Text PDF