Index
Ep Defined | Getting Started | Working in the EP Lab
Right Atrium | Right Ventricle | Left Atrium | Left Ventricule | Cardiac Conduction | Cardiac Cell Properties | Action Potential | Sympathetic or Not | Med Page
Electrograms Defined | Recording Modes | Electrode Spacing | Filters | EGM Interpretation | Arrhythmia Analysis
The Physical Lab | Tools of the Trade
Setting Up | Catheter Placement | Baseline Measurement | SNRT | Conduction Study | Arrhythmia Induction | Pacing Protocols | Ablation | Tilt Table | Secrets to Success
Bradycardia | Atrial Tach | Atrial Flutter | Atrial Fibrillation | AVNRT | AVRT | Ventricular Tachycardia
Surface ECG's | Intracardiac Questions | Med Challenge | Advanced

The Physical Lab - Layout of the Lab

A Question of Space....

For those looking to design an EP lab, you must consider what is needed for procedures performed in these rooms. Too often I have seen labs designed by administration without input from those who use the labs. This section will try to address some of the considerations that should be applied when designing a lab that will be utilized for cardiac electrophysiology procedures. By learning from the mistakes of the past and keeping an eye on what may be coming in the future it is possible to design a functional lab without going overboard on the budget.

Equipment Needs

         First and foremost, the equipment required for a lab will determine most of the design requirements for an EP Lab. The following items should be considered essential, non-negotiable items for the lab. Each of the items listed are discussed in detail on additional pages located elsewhere in this site. The information provided here will focus on considerations that should be kept in mind when selecting the items. Additional information about the item discussed may be accessed by clicking on the item name.

  • Fluoroscopy / Cine: Fluoro has been a basic component of electrophysiology labs from the onset. When considering which system to purchase, keep in mind the following items;
    • Single or Biplane: For a ped's lab, the decreased radiation exposure provided by a biplane system is essential. For adult labs, the biplane provides less function and takes up a good deal of space. My recommendation would be to go with a single plane system for adult labs.
    • Fluoro Boom / Monitor Mount: Most fluoro systems come with a fluoro boom that holds the monitors which display information collected during the procedure. A minimum of six different monitors are usually required. Ideally, the display of each of these monitors should allow for easy switching to facilitate the needs of different cases. Switching the displays should be able to be performed without unplugging cables and moving them to different monitors. Computer controlled input provides the optimal solution. The ideal system will have enough monitors to show the following;
      • Live fluoro image
      • Frozen / Replay fluoro
      • Live EP Recording System data
      • Review EP Recording System data
      • EP Mapping System
      • Ultrasound
    • The fluoro boom with the monitors must be able to be positioned on either side of the fluoro table.
    • Fluoro Table: There is little option here with the exception of patient weight. It is advisable to have a table with a weight limit that allows for most patients to be handled. I recently worked a case with a patient that weighed close to 450 poungs. It is better to be able to accomodate these patients than have to refer them to an alternate facility.
  • EP Recording System: There are at least three good EP Recording Systems available on the market today. They all have similar functionality and all perform very well with case documentation. When considering these systems, look at integration with alternate pieces of equipment in the lab. Which system will provide the highest degree of integration? Also look at support of the system. Which vendor will provide the best support for the system once it is purchased? The final consideration is ease of use. Which system will include education that will help you staff learn the system? What about long term support? Which vendor has the best support system for their equipment?
  • Cardiac Stimulator: Many companies provide Cardiac Stimulators that are integrated with their recording systems. This allows for bundled deals that help keep costs down. This, along with user preference, should be considered when selecting one of these devices.
  • EP Mapping System: Two primary mapping systems exist for customers today. When selecting which of these to purchase, the considerations mentioned under EP Recording Systems also apply. Integration and support are the most important considerations to keep in mind. Once those items are evaluated, consider what unique options one system offers over the other. Consider what new features have been added over the years as well as what functions do each provide that meet the needs of your lab. Finally, ease of use and user preference should also be given serious consideration.
  • RF Generators: Because this is a smaller and less expensive item, it is often included in a packaged deal. Before blindly saying yes, take a moment and ask your friends from other EP labs for an evaluation of any generator you are considering. How does it hold up to regular use in the lab? How often are there problems with it? It is always a good idea to check on any equipment by asking others who have used it.
  • Intracardiac Ultrasound:Trans-esophageal echo along with intracardiac echo are newer additions to the lab. Both play a vital role in a large EP environment. Here, image quality is a prime consideration. Currently, many EP programs rely upon staff from the ultrasound department to bring the equipment and operate it when trans-esophageal ultrasound is utilized. Intracardiac ultrasound is often supported by an industry rep. Availability of support should be another consideration when considering which ultrasound system to go with. Ideally, one system that can perform both TEE and ICE would meet the labs needs. To date, I have not seen a lab with this setup.
  • Storage for Catheters, Sheaths & Cables: The closer the items are to the lab, the better off you will be. Do not store items used during procedures down the hall in a small room. The more often staff exit and enter the room during a procedure, the greater the chance of introducing infectious agents. If storage will serve for multiple labs, then a common storage area that is not accessible to the general staff works best. Abbott Northwestern Medical Center, in Minneapolis Minnesota uses an excellent setup. Items used during every procedure are stored in the lab. For items that are used less frequently, they have four labs that each have access to a common area. This area is off limit to those who are not wearing scrub attire. To get an item that is not stored in the lab requires a few seconds and does not require the staff to pass through areas where attire is not regulated, thus reducing the possibility of introducing infectious agents.

The Control Room

           The purpose of the control room is to provide a workspace where staff may sit and operate the equipment without wearing lead. In many facilites, the control room also acts as a buffer zone between the corridors outside the lab and the lab itself. The control room should also provide easy access to equipment storage. This allows for a free hand in the control room to get an item that is needed for the procedure when that staff in the lab are occupied. With these thoughts in mind, we can provide some stipulations for the control room;

          It should be large enough to allow three people to sit. One at the caridac stimulator, one at the recording system and one at the mapping system. In many situations, one of these people will provide double duty and run more than one piece of equipment. Some labs will also have the RF generator present in the control room. The operator of the stimulator or recording system will often run the RF generator during procedures.

          The control room should be placed in a location that provides the best view for EP procedures. Often this is behind the physician with a good view of the patient. This allows the control room staff to act as a second set of eyes during the procedures. Access between the control room and the lab should provide minimal obstruction. Some labs have a door between the two rooms while many have the control room built as part of the lab. I have found this second option to be a good workable design. The area is shielded from radiation yet offers easy access to the main room. This approach may also minimize the need for microphones and allow good communication without shouting between the two rooms.

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