Anaesthetic Machine and Equipment check:
The primary PCI's generally go in to Lab B and there is an anaesthetic machine, a cart with drugs, airway , IV access and infusion equipment with a separate vascular access cart kept there.
THE ANAESTHETIC MACHINE WILL HAVE TO BE CHECKED AND THE CHECK LOGGED-IN IN EVERY SHIFT (I.E TWICE IN A TWENTY FOUR HOUR PERIOD). IT IS THE RESPONSIBILITY OF THE SHO ON THAT SHIFT TO DO THIS.
We suggest to do this towards the end of night shift and day shift ( before handover) so that you could avoid the radiation exposure during the normal working hours when they are doing cases in the cath.labs. The ODA's on-call will come down with you to check and ensure that the trolleys are restocked and to change the circuits etc. We have asked the cath. lab management to educate their staff not to tamper with the anaesthetic equipment ( Please identify and report this to the cath. lab charge nurse whenever this happens). We have splitters for the wall gas supply so that they don't have to unplug the anaesthetic machine to use their equipment
Please note that all the cath. labs have the standardised trust crash trolleys with airway equipments currently.
Drugs:
We suggest that the SHO's on each shift should check, draw-up and properly label drugs to be used for emergency induction and intubation. They should be kept sterile and stored in a drug fridge. They should not be left in for more than 12 hours and with proper labelling. The drug fridge in cath lab B will be ideal for this purpose, but it is unfortunaly broken and awaiting replacement. (8/2015) So we can use the main drug fridge in theatres as an interim arrangement. Suggestions are welcome as to the list of the drugs to be drawn-up and ready before we finalise a list. (contact Prasad)
Please note that the main drug storage area ( and the drugs fridge) in the cath. labs is currently located in a room between cath. labs B and A. ( while the lab D is being refurbished). One of the cath. lab nurses carry the keys for this each shift.
Other equipments:
There are syringe pumps in all cath. labs. Portable monitor and portable ventilators are currently kept in theatre storage cupboard.There is the possibility of having a dedicated portable ventilator for cath. lab. use. The cath. lab can provide you with patient trolleys and oxygen cylinders. There is a difficult airway trolley in the area outside staff room in the EP labs ( you will need access to enter EP labs - If you haven't got it already, Enda can help you if you give her your ID card no. - Please ensure you do this). Please do not use the drawer-lock system on this trolleys as they can get stuck locked easily. So leave them open all the times. There is a glidescope inside EP lab 1.
Main storage:
There is a main storage cupboard in the corridor in cath. labs for anaesthetic drugs and equipment. All the ODA's should have the access code for it. If any of the ODA's don't have access, they should contact Danny to get it.
Transport to GICU:
In case of GICU admission, trainees are advised that they liaise with GICU early, to get the bed, monitoring, ventilator and infusions organised. If a delay is expected the patients could be transferred to one of the theatre anaesthetic rooms and cared for safely until the ICU bed is ready or extubated if appropriate.
Radiation protection: These precautions ( lead apron and thyroid shield) should be observed all the times( even in emergencies) and the radiographers can challenge you otherwise.