Page 49 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
276
#0085
COST OF A STANDARDIZED APPROACH TO MANAGEMENT OF PULSE LOSS FOLLOWING PEDIATRIC CARDIAC CATHETERIZATION
Wendy Whiteside, Je rey Anderson, Christina M. Metcalf, Betsy Newkirk, Christine Combs, Janene Allen, Karen Minsterman, Bryan H. Goldstein
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Background: Pulse loss is a known complication of pediatric cardiac catheterization. A standardized approach to the diagnosis and man- agement of post-catheterization arterial thrombosis has been shown to result in thrombus resolution in the majority of patients. The cost burden of this practice has not been reported previously and may be a perceived barrier to utilization of a clinical practice guideline (CPG) for post-catheterization pulse loss.
Methods: Single center data collected prospectively for quality improvement e orts was reviewed retrospectively. Beginning in 5/2013, all patients with post-catheterization pulse loss, identi ed by clinical pulse exam 1-2 hours after sheath removal, were managed according to an institutional CPG. The CPG included initial evaluation by lower extremity Doppler ultrasound, prompt initiation of anti-co- agulation using low-molecular weight heparin (LMWH), and serial re-evaluation by clinical exam, Doppler ultrasound and anti-Xa levels until thrombus resolution or until 12 weeks of therapy had been com- pleted. Charges for protocol related items: CPG follow-up visits, diag- nostic imaging, medication and laboratory testing were collected.
Results: From 5/2013- 2/2016, post-catheterization pulse loss occurred in 64 cases (61 patients) with a median age of 105 days (IQR 67, 154) and weight of 5.2 kg (4.3, 6.2). Incidence of pulse loss in cases with arterial access was 4.5%. By 12 weeks, restoration of pulse occurred in 92.3% of patients. Median charge per patient for CPG-related care was $2,672 ($1,587, $4,087) with the largest contri- bution coming from lower extremity ultrasound. Patients received a mean of 3±2 ultrasounds for a median radiology charge of $2,344. Pharmacy charges were minimal, with median duration of LMWH therapy of 7 days (1,23) and median charge of $82 ($25, $371). For patients with restoration of pulse prior to hospital discharge (£1 day of LMWH), median charge was $1,583 ($801, $1837). One patient on protocol was noted incidentally to have a pseudoaneurysm at 1-week follow-up, for which therapeutic thrombin injection was performed by interventional radiology. There were no bleeding events or other complications. Social burdens of chronic LMWH administration, clini- cal and laboratory visits for monitoring, and the nancial implications of lost work/school time were not evaluated.
Conclusions: Implementation of a CPG for management of post-cath- eterization pulse loss results in a high-rate of pulse restoration (92%) with only modest associated charges.
#0086
COMBINED IMPACT OF A RADIATION REDUCTION INITIATIVE AND NEXT GENERATION ANGIOGRAPHIC IMAGING SYSTEM ON RADIATION DOSE IN A CONGENITAL CARDIAC CATHETERIZATION LABORATORY
Wendy Whiteside, Konstatin Averin, Russel Hirsch, Karen Minsterman, Ross Schierling, Barbara Bear, Michael Harris, Bryan H. Goldstein
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Background: ALARA (As Low As Reasonably Achievable) princi- ples dictate best practice using the lowest possible radiation dose. Radiation reduction has been a particular focus of the congenital cardiac catheterization laboratory due to increased radiation sus- ceptibility in children and frequent need for repeat procedures. We sought to assess the incremental impact of a radiation reduction ini- tiative and subsequent acquisition of a next generation angiographic imaging system on radiation dose.
Methods: Beginning in 2014, a radiation reduction initiative was devel- oped to emphasize radiation reduction within our program. This e ort included equipment settings and practice changes to promote radi- ation lowering techniques. Subsequently, a capital upgrade to a next generation angiographic imaging system (Philips AlluraClarity) was installed in 1/2016. Single center radiation data collected prospectively for quality improvement purposes was reviewed retrospectively. The impact of these dose changes was assessed via longitudinal tracking of mean Air Kerma across the same 4 catheterization providers.
Results: From 1/2014 through 8/2016, 2083 catheterization proce- dures were performed at our institution. At baseline, mean Air Kerma per case was 229±476 mGy. Following initial modi cations to default frame rates and ALARA-guided practice changes, we saw a 25% reduction in mean Air Kerma per case to 173±348 mGy. The instal- lation of a next generation imaging system combined with further changes to default imaging settings generated an additional 57% reduction in mean dose per case. After 7 months with next gener- ation equipment, mean Air Kerma per case was 49±80 mGy, a 79% reduction in dose from baseline. From 1/2014-12/2015, there were on average 5 high exposure cases (>2000 mGy) per 6-month period. Over the 7 months since equipment upgrade, there has been only one high exposure case despite similar average uoroscopy time per case and an unchanged case-mix.
Conclusions: Changes in catheterization lab culture, practice habits, and equipment settings are e ective in reducing radiation dose, but the availability of next generation imaging equipment allows for expo- nential dose decrease. These combined approaches result in a nearly 80% reduction in radiation dose for congenital cardiac patients.
#0087
FEASIBILITY AND VALIDITY OF PRINTING 3D HEART MODELS FROM ROTATIONAL ANGIOGRAPHY
Saar Danon, Manoj Parimi, John Buelter, Vignan Thanugundla, Sri Condoor, Wilson King
Saint Louis University, Saint Louis, MO, USA
Background: Rotational angiography (RA) has proven to be an excel- lent adjunctive method for evaluating congenital disease (CHD) in the cardiac cath lab, permitting acquisition of 3D datasets with excel- lent spatial resolution. This technique has not been routinely imple- mented for 3D printing. We describe our case series of models printed from RA and validate our technique.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306