• Start-up capital. The main piece of equipment you'll need is a
fixed C-arm designed specifically for cardiac procedures that
mounts to the floor or the ceiling. The operating table for cardiac
procedures has a radiolucent surface and is designed to allow for
360-degree views of the coronary vessels when the C-arm rotates
around the patient. You'll also want to consider purchasing an ultra-
sound machine, micro-puncture needles and an assortment of
sheaths, guidewires and stents. In total, these items could cost
upward of $1 million. Pacemakers and defibrillators typically are
delivered to facilities on consignment by the manufacturers, so there
are no upfront costs to maintain an inventory of those devices.
• Big footprint. An interventional cardiovascular suite consists of a
procedure room, an equipment room and a control room. The proce-
dural space must be larger than a traditional OR — large enough to
comfortably house the C-arm, the radiolucent table and ancillary
equipment. Although square footage varies from facility to facility, you
basically need the space of two standard operating rooms to make
one fixed interventional suite.
• Emergency equipment. While emergent events are rare, they do
occur and you must be prepared to manage them. Be sure to have
a dedicated crash cart that will be kept in the cardiovascular inter-
ventional suite. You should also have available an intra-aortic bal-
loon pump (IABP), pericardiocentesis kit, temporary pacemaker
and, if possible, covered coronary stents.
An IABP is a therapeutic device used to reduce the workload of the
heart. For instance, if there is a critical blockage, the IABP can be
used to augment blood flow to the extremities as well as to coronary
arteries. Pericardiocentesis kits are used to treat symptomatic pericar-
dial effusion or cardiac tamponade by aspirating fluid from the peri-
cardial space. This can occur during angioplasty, or during pacemaker
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