Perspective:

The following are 10 points to remember about this Expert Consensus Document on Cardiac Catheterization Laboratory Standards:

1. The cardiac catheterization laboratory has undergone major changes in the last decade. It is a much more sophisticated environment where a gradual shift in emphasis from a diagnostic laboratory to a therapeutic environment is occurring.

2. The influence of peripheral vascular and structural heart intervention has required a change in focus for many laboratories, and has given rise to the hybrid cardiac catheterization facility.

3. Quality indicators for a cardiac catheterization laboratory should include structural, patient care, system-specific, guideline-driven, and cost-related items.

4. Establishing an appropriate oversight quality assurance/quality improvement process is more important than focusing on minimal volumes.

5. It is recommended that both the training and practice activity associated with structural heart disease intervention be concentrated among a limited number of laboratories and operators with a particular interest in these procedures.

6. An overnight, a nothing by mouth (NPO) order, is not always in the best interest of the patient; fasting should be no more than 2 hours after clear liquids or 6 hours after a light meal. Hydration should be considered an important component prior to contrast administration.

7. A laboratory director is a prerequisite for all laboratories, and should be an experienced (generally >5 years) interventionalist, board-certified, and familiar, if not proficient, with the various procedures and technical equipment being used in the laboratory.

8. All members of the cardiac catheterization team must have Basic Life Support certification in cardiopulmonary resuscitation (CPR) techniques, and the committee strongly urges certification in advanced cardiac life support as well.

9. An understanding of X-ray image formation and basic radiation safety principles allows for the understanding of means to limit exposure to both the patient and operator.

10. All pediatric catheterizations should have a director responsible for all aspects of the laboratory operation, similar to the adult laboratory. Attending physicians should be board-certified in pediatrics and at least board-eligible in pediatric cardiology.