Click CathSpeak: what your interventional cardiologist may really be saying
By Barry D. Kussman, MBBCh, FFA (SA)
Boston Children’s Hospital
All cardiac catheterizations involve definite risk, with some complications being non-specific and others exclusive to the procedure being performed. It is a mistake to underestimate the importance of good communication between the interventional cardiologist and the anesthesia team, nursing staff and catheterization technicians for the prevention and management of critical events.
However, information is sometimes conveyed by the cardiologist to the anesthesiologist in an indirect manner. Because our program trains many interventional cardiologists who go on to practice at different institutions in the USA and internationally, I thought that a primer on some ‘cath-lab’ terminology would be useful to those anesthesiologists practicing in this ‘hostile’ environment.
This primer is based on my (and colleagues who wish to remain anonymous) experience over the years and is intended to be useful (i.e. preempt the need to practice your PALS skills), humorous and non-judgmental to any specific interventional cardiologist.
I have placed in italics what the cardiologist says, and in normal text what is often meant:
- Can you put the patient on oxygen? I have injected air into the vascular system.
- The device, coil, etc. is displaced. There is a foreign body embolus.
- There is extravasation of contrast. There is a tear in the vessel or conduit.
- To the assistant, “Show me the conduit again.” A tear in the conduit is strongly suspected.
- Can we call for an echo? I have perforated the heart and suspect an acute pericardial effusion.
- Is there any blood in the endotracheal tube? I have torn a pulmonary artery.
- Can you give the patient lasix? The patient is in pulmonary edema.
- There is angiographic improvement (following a vessel dilatation). There is no change in the pressure gradient or clinical improvement.
- There is clot in the aortic root. Prepare for acute coronary artery occlusion.
- The patient did not like it (the intervention). The cardiac output was not adequate to sustain life.
- This (intervention) is going to make the patient sick. Prepare for a cardiac arrest.
- We had temporary pulselessness. The patient had a cardiac arrest.
- Does this patient have a Foley? This catheterization will go on for another 5 hours.
- Can somebody move the arms up? You are about to get hit in the kneecap with the lateral camera.
- The low arterial saturation is not due to pulmonary vein desaturation. For once we can’t blame the low saturation on your poor ventilation.
- Start dopamine! The blood pressure is heading towards the single digits.
- Does this patient have a unit bed? You will not be able to extubate this patient.
- This patient does not need a unit bed. This patient is likely to require at least 8 hours of extreme vigilance in the PACU.
- Do we have consent for this? Off-label use of cutting balloon or device.
- What did you just give this patient? I don’t accept that my catheter caused the hemodynamic instability.
- How much volume have you given? The left atrial pressure is 32 mmHg.
- The ETT is too high. Are you still listening to me?
- Who is the surgeon on call? I have caused damage which I cannot fix.
- Are you happy with the blood pressure? There is no blood pressure.
- Although the SVC saturation is 20%, the good news is that the CVP is higher. Call for ECMO.
- Call for ECMO. This is the finest example of direct communication which you should NOT ignore!
