Walk through of the cardiac cath lab at West Middlesex Hospital

Hi Dr. Nijjar. Hi. You're going to walk us through your cath lab here at West Middlesex? Yeah, absolutely. Let's bring you through. Okay, so this is our cardiac cath lab here at West Middlesex Hospital, which is part of Chelsea Westminster NHS Trust. This is a state-of-the-art cath lab that was purpose-built for the treatment of patients who have angina, tightness in the chest or breathlessness when they walk or exert themselves and we're looking for coronary artery disease. And I'll just talk you through what's in this room because it can be quite frightening when you're thinking about having a procedure like this and so it can be intimidating if you've never been in the environment. This room is awfully cold and that's because the x-ray equipment needs the room to be of a certain temperature. We see here we have an x-ray table and this is a specially design table that allows x-rays to penetrate through the table and this is an x-ray machine or an image intensifier as we refer to it and this is a mobile arm that moves around and what would typically happen is a patient will come into their cath lab and they will be asked to move from their chair or their bed onto a table like this. This table is fairly firm so you have to expect a little bit of discomfort from being on a very hard table and then we will typically do the procedure through the hand. So the patient's arm will be placed here, usually on a soft squidgy supportive thing like this, and we will then cover you with a drape, a blue surgical drape that is sterile. Once we've done that, we will put local anaesthetic into the hand and then pass a tube into the artery, and then through that tube, allow pathogens to travel up the arm, around the aortic arch, into the aorta and allow us to see the heart arteries on x-ray. When we do x-ray, this camera system moves around and changes different angles and it will often come very close and sometimes we ask the patient to turn their head left or right and sometimes the x-ray camera can come in really, really close and it can be a little frightening when this comes close but be reassured that it's driven by a person who knows what they're doing and it alarms and will not hit you so that's important for you to know. And we will see the pictures here on this very large screen and it allows us to be able to look at the heart arteries whilst we're doing the procedure as we're giving small amounts of dye into the vessel. We tend to be standing here and we have this shield that's protecting us from the radiation and you'll notice that I'm wearing this slightly unusual looking uniform, this is actually made of lead and this is to protect me from the x-rays. We're doing these procedures day in and day out and so it's important to protect us from the radiation. And you'll have a member of staff here as a radiographer and often there'll be another member of staff in the control room, will be a physiologist and there'll also be often a nurse, maybe two nurses who are contributing to the case. Now if we're doing an angiogram that can be a very quick procedure and that can take usually from once we've got the tube in maybe 10 minutes, maybe 15 depending on the complexity of the case. If we have to go on and perform angioplasty then it may add another hour say onto the case depending on the complexity. If it's very complicated it may be longer, if it's more simple it may be shorter than that. Now when we're calling for equipment we will hear us say lots of different things, we'll ask for different balloons and different stents and I'll just show you now that some of the equipment that we tend to use so you can see here in this cupboard over here a large number of different scents and balloons and there's a lot of different equipment and we often call out for different sizes and different kit and we gauge the size of the balloons and scents that we need based on your requirements and what we think will work best in that situation and sometimes we have to modify our plans and it really requires us to think on our feet.