13. Device therapy in secondary hospital (without a cath lab): Feasibility, logistics and outcome

• Main Author: A. Jelani
• Format: Article
• Language: English
• Published: Saudi Heart Association 2016-07-01
• Series: Journal of the Saudi Heart Association
• Online Access: http://www.sciencedirect.com/science/article/pii/S1016731516300355

Device therapy for conduction abnormalities, heart failure, primary or secondary SCD preventions is under delivered to requiring patients. Most of these devices are implanted at tertiary care centers in major cities of most countries. This makes the availability of these guideline guided therapies to a very small percentage of needy patients. Implant of such devices at a secondary hospital (without a cardiac cath lab) with training of previously novice hospital staff and available resources as well as support of the industry is an alternative and very viable option to have such important therapy delivered to requiring patients. The usage of simple-readily available-C-arm in operating theatre (OR) or the interventional radiology suite can be utilized for this purpose. OR nursing staff and radiology technicians can be trained –with help of nursing education department– to help in such procedures over a relatively short period. Technical support utilized from the vendors representatives is an alternative to face the lack of EP technicians in local or international market. The follow up of these patients in OPD can be organized with help of the vendors on regular basis under supervision of trained cardiologist/s. This model can help establish device therapy service at a secondary hospital without huge expenditure on infrastructure or facing the lack of recruitment of specialized technical support that is difficult to find –especially for smaller cities–. We present our experience at a 250 bed secondary hospital, with a relatively small cardiac unit (3 consultants, 5 hospitalists, 10 cardiac ECG/Echo techs) and no cath lab of introduction of this service with the help of nursing education department and vendors supplying these devices as well as OR and radiology departments. Training of radiology technicians and OR nursing staff on the basic procedural support with few in-service demonstration helped prepare adequate staff helping during implant procedures. Requirement of technical support from the vendor –as a condition for purchase of devices– during the implant and follow up clinics helped overcome the lack of EP technicians. After implant of more than 100 different devices (pacemakers, AICD and BiV-AICD) the process became much smoother and easier. A total of 106 procedures (including insertion of PPM, AICD, BiV-AICD and loop recorders, battery change, etc.) were carried out from the start of the program. The immediate complication rate was 6.6% (2 pneumothorax, 1 CS dissection, 1 hematoma, 1 lead dislodgement, 1 lidocaine toxicity, 1 PEA) with no mortality. 1.8% (2 patients) required intubation during the procedure (lidocaine toxicity, PEA). No device infection related to procedure (upto 6 months) was noticed. Device implant programs can be established with relatively low cost for institutions without cardiac cath lab. In an era of controlling the spiraling costs of medical care, cutting the cost while delivering the guideline guided therapy to needy patients is possible. Our experience can be replicated with success at other smaller centers facing similar challenges.