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 - Storage Solutions

Storage Solutions

          Another significant problem that many EP labs face is the need for more storage.  In this environment, there are three primary storage areas that are essential to smooth operation of the lab. The first of these is In Room Storage, items that need to be kept close at hand or are specific to the operation of items found in that room. The there is what I term Common Storage, or areas where items that are common to all the labs are kept. The final storage area is one for larger pieces of mobile equipment. If an EP program has designed an environment that provides efficient storage that meets these three needs, it will promote a productive work area.

In Room Storage

          When I first started working in a cath lab, most of the equipment we used was stored in the lab itself. As cardiac programs have grown, the amount of tools available for use in the lab has also increased. At the same time, labs are getting larger and space comes at a premium price. To meet these changing needs, many labs have moved much of their supplies out of the room and into a common storage area. The items that are still stored in the room now fall into one of two categories; items that are specific to equipment found in the room, or items that may be needed on an immediate basis.  None of the items that fall into these groups require a huge amount of space and thus the amount of storage needed in each lab has dropped substantially. This shift in storage locations has allowed for more flexible utilization of the space inside the lab.

Common Storage

          Another factor that has contributed to the shift to a common storage area is the growth in individual EP programs. A few years back, EP programs with one lab were the norm. As EP has expanded, it is not uncommon to see programs with multiple labs. I have been numerous facilities that have 2-4 EP labs and have even been in one facility that had 10 dedicated EP labs. Building programs on this scale does require a shift in planning. It is just not feasable to store duplicate inventories in each lab. So, to keep costs under control, many facilities have moved towards common storage areas.

          One very efficient design that I have seen utilized in a number of facilities is the "core" approach. This setup utilizes an area that is central to all the EP labs and is easily accessed from each room. Standard equipment and devices that may be used in any EP procedure are often kept in the core area. When the staff are setting up any of the labs, they can retrieve whatever items are needed for the procedure type they are preparing to do. This area would include all introducers, sheaths, catheters, guidewires, pacemakers, ICD's and other similar tools that might be used on a case, but would not be needed on an emergency basis. This core area also acts as a place for staff to meet and discuss operational matters such as schedules, call rotations and case assignments.

Mobile Equipment Storage

          As technology has advance the science used in cardiac electrophysiology, it has allowed the development of numerous new pieces of equipment that have changed how EP is performed. In many cases, this new equipment falls into a specialty niche and is not used on every case. In these situations, the equipment is brought into the room if it is pertinent to the procedure being performed. When not in use, this equipment needs to be stored in a safe location that allows realtively easy access. Intra cardiac ultrasound and cardiac mapping systems fall into this category. When being utilized, easy access to these systems is essential, yet when they are not in use, a place is needed to store this equipment.

         Storage of this type really isn't difficult to create. All you really need is a good sized room where the various carts can be stored. The main question is where to locate this room. Ideally, equipment of this type should not be moved very often. While most of these systems are on carts with wheels, very few of them are designed to be moved around on a regular basis.  If it possible to find a semi-permanent place for them, it is preferrable to do so. Barring that, a storeroom in very close proximity will often work. One design that seemed to work well was a store room between two labs with large doors for easy access.

          Many facilities that I have visited have one or two rooms dedicated to specialty type procedures. In this situation, a cardiac mapping system is placed in a lab that is used primarily for the more advanced procedures. This works best if there a two or more rooms available. Using an approach like this allows the facility to minimize the number of times this equipment needs to be moved.

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