Week 3: A day in the cath lab

Last week I got to watch two cases in the cath lab. There were a few particularly cool things about this experience.

1) I got to scrub in both times.

I'd never done this before, and I found it a lot trickier than I had anticipated. Making sure your fingertips don't get any drips from the rest of your arm is tougher than it sounds (this is because your fingers are supposed to be the absolute cleanest part, so you don't want to rinse your whole forearm and then have the water from your elbows drip down to your hands...makes sense). Lots of maneuvering at the sink was involved, and then making sure no part of you touches anything that's not also sterile requires careful attention. This is particularly true when you're putting the gown on, which involves holding part of the folded gown, letting the rest of it drop, and putting your arms through simultaneously while spreading your arms out wide to maneuver the gown up your arms. Anyway, I'm sure I'd eventually get used to it, but it was definitely a learning experience in paying attention to detail. I think the hardest part was resisting the urge to scratch any itch on my face, which happened a lot with the mask I was wearing. I wore one with a splash guard to protect my eyes, so there was even less ventilation around my face. I was also wearing a 30 lb lead apron (lead collar, vest, and skirt) to protect from radiation, plus scrubs, the gown and a hair hat. I have a newfound respect for surgeons and interventionalists who perform hours upon hours of procedures at a time while standing with all that gear on. It's not easy, and I was only on my feet for about 2 hours at a time.

2) Because I scrubbed in, I got to stand close to the table and see things.

It was absolutely incredible to watch the interventionalists snake catheters up the femoral artery and into the heart, and I still don't understand how they knew where they were in the heart. The screens that they look at project X-ray images that show where the catheter is, but none of the soft tissues (i.e., the heart, veins and arteries) show up. The only time I could make any sense of how they knew where they were was when they injected contrast (the dye), which darkened whatever area the catheter was in. So besides the simple act of maneuvering the catheter, I thought the coolest part was watching them balloon a stenosed (narrowed) pulmonary valve (the valve between the right ventricle and the pulmonary artery). This is called a balloon valvuloplasty. For whatever reason the leaflets of the valve were closing too tightly, so they used a little balloon at the end of a catheter to stretch them out. That way the right ventricle doesn't have to work so hard to pump blood to the lungs because the pathway between the two is wider.

3) More puzzle solving was involved, which I always find interesting.

I found it very cool how they used various bits of information to get a full picture of what was going on in the heart so they could select the appropriate treatment. For example, some of the catheters have pressure transducers at the end to take pressures from various parts in the heart, which the interventionalists use to gather information and make diagnoses. So, for the narrowed pulmonary valve case, they measured the pressure gradient between the right ventricle and the pulmonary artery and found that the pressure in the RV was a great deal higher than it should've been compared to the pressure in the PA. This is a sign of pulmonary valve stenosis because the right ventricle must work extra hard to pump blood through the very narrow opening, which causes the pressure to be higher than it normally would be. I'm sure this is an overly simplified explanation, but even understanding such a tiny amount was exciting.

So, I spent a day in the cath lab, and I'll get to observe in the operating room later this week. I'm thrilled with how much I'm getting to see, and I can't believe I'm already in my fourth of five weeks. Trying to soak it all up :)