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The Physical Lab - The Cable Connundrum

What solutions are available to deal with the myriad of cables used in the lab....

          This section discusses some of the ways to deal with the numerous cables that are used to connect various devices in the EP Lab. If you are looking for infomration on the cables used to hook up the EP catheters, please review the Catheters and Cables area.

          One thing that is consistant in every EP Lab is that every piece of equipment requires cables to connect. There are cables that connect to the patient, cables to connect to power, cables that connect to amplifiers, cables that drape across the floor, cables that hang from the ceilings and cables that get tied up in knots the moment you are not looking!!  While these cables are necessary, they can be problematic.

          A number of creative options have been explored by different labs trying to address the cable problem. This includes everything from hanging cables from the ceiling to running them through conduits under the floor. I have had the opportunity to look at a few of these options and will offer some pro's and con's of some of the methods I have seen utilized.

Fixed to the Floor

          The most commonly used technique in dealing with cables is the tried and true technique of drapping them across the floor. With the sheer number of cables found in most EP labs, this is the most commonly used technique.  While this is the easiest method, it has it's share of problems.  The foremost problem is that with the cables on the ground, it is difficult to move equipment around without running over the cables. While the cables are built to withstand wear and tear, you can cause damage to any cable when you run over it with something like an intracardiac ultrasound machine.  Of course this can be avoided with the up and over technique, though this may not work with shorter cables.  

          Another risk with cables on the floor is the possability of someone tripping over one of them.  This usually results in the offending cable being disconnected and/or broken.  Note that catching your foot and tripping over a fiber optic cable is almost a guarenteed break of either the cable or the adapter where it hooks into whatever piece of equipment it is attached to.  Fiber optic cables are the most fragile connectors in the lab and you should always make sure you have at least one extra at all times.  This can make the difference between being able to complete a case and having to tell the patient they will have to come back another day.

          Along with the potential for damage to a cable, there is also the very real possability that someone in the lab could sustain a significant injury from tripping over a cable.  A number of labs I have been in have come up with methods of dealing with cables on the floor.  The easiest of these techniques is to use tape to secure the cables.  A couple of pieces of strong tape applied in strategic locations can hold those pesky cables in place and possibly prevent a fall.  While this makes it difficult to move the cables when a new piece of equipment is needed, most cables will withstand being run over if they are secured and the weight is not left directly on top of it.  The negative aspect of this is the tape leaves adhesive on the cables which tends to coat them with a sticky residue that picks up every piece of dirt it comes in contact with.  If you do use tape, be sure to wipe the cables down with alchohol swabs after the procedure is over.

          Another technique that works well for cables on the floor is a cord cover. On the left side of this page there are links to a couple of companies that make such products.  The entry listed as Medical Cable Covers has a number of options for controlling cables that are specifically designed for the medical environment.  This site is definately worth looking at if you are trying to find some way of dealing with wayward wires. Using a cable cover offers a couple of advantages to the tape approach. The primary consideration is that it protects both the cable and the staff.  A cable cover makes it almost impossible to trip over and, depending upon the stregnth of the cover you get, will even allow heavy equipment to roll over the cables without damaging them.

High Wire

          Some labs will look for a solution that does not require the staff to place tape of protective covers each time they do a case. One rather innovative lab used wire fasteners to attach some of their cables to the wall. One end of the cables were left coiled on a cable mount near where their cardiac mapping system was normally placed when in use. From their, they were affixed to the wall at ceiling level and then run along the top of the wall until the cables were close to where the amplifier was routinely positioned. Three clips carried the cables across the ceiling where they were attached to a retractable cord spooler with a drop down cord that hung just above head level. When the cables needed to be connected, the staff would simply reach up, pull the cord coil down from the ceiling, uncoil it and connect it. This provided an inexpensive, yet rather effective method of controlling some of the wires in the lab.

Out of Sight....

          ...does not necessariy mean out of mind. This is something to consider if you are contemplating running your cables through conduit under the floor.  This is a technique I have witnessed in a few facilites that were considering building new EP labs.  During the planning stages, it was suggested that running some of the cables for equipment that was used periodically under the floor would be a good alternative to stringing them across the floor.This initially seemed like a good idea. However, when you stop and think about it, there are some points that should be considered before choosing this option.

          First of all, the reason it is easy to place cables in conduit under the floor when you are building a new lab is that the floor isn't there to impede your access. Once the construction is completed, the cables are now safe and secure under the floor. Now if you have to replace them, it will require having someone come in to run new wire through the conduit after taking the old wire out. Doesn't sound too difficult. Let's just shut down the lab for half a day and pay an electrician good money to run that new wire.

          The next thing to consider is that when you run a cable under the floor, you are increasing the number of both the cables and cable connections used. Let me provide you with an example of how this works. A facility that I would periodically visit used the EnSite Cardiac Mapping System. This system has two carts. The first cart contains the amplifiers and is usually placed near the bedside. The second cart is where the operator sits and is usually placed back in the control room, or at least a good distance from the table. This set up requires both a fiber optic and a Cat 5 cable to be run between the two system components. So this facility was faced with a cable conundrum!!

          A new EP lab was under design and they made the decision to run conduit under the floor. The EnSite carts were always placed in the same position in the room so wall or floor plugs could be placed at appropriate locations. So now, instead of one cable with two connections, they had one cable running from the first cart to the wall (1 cable, 2 connections), a second cable under the floor and a third cable (with 2 more connections) running from the floor plate under the table to the second cart. In short, they tripled the number of cables and doubled the number of connections. In short, they increased the number of things that could go wrong. Eventrually, they did have a problem that was traced to the fiber optic cable under the floor. Due to the busy schedule in the lab, it was not fixed for several months. During this time, the cables returned to their standard position on the floor.

I still think that under the floor is a good place for cables to run. They are safe and out of harms way. It would be Ideal to have an in floor conduit system that was easily accessible. The link for the Cable Conduit System above is the closest thing I could find to a cable solution that allowed relatively easy access.  It would be interesting to hear if any labs have utilized a system like this. If you know of a lab that has used a system like this, let me know.

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