and defibrillator implants, with incidental lead perforation, typically
through the right ventricle of the heart.
Covered stents are sometimes used when there is an arterial dis-
section or perforation. While there may be times when only a bal-
loon is needed to treat the dissection, a covered stent could be used
to treat major complications that require immediate attention. The
size of the vessel and the location of the damage determines the
need for a covered stent, non-covered stent or a simple balloon
angioplasty.
• Patient selection. Prevention is the best form of emergency pre-
paredness, and that starts with a precise list of guidelines for patient
admission criteria. Cardiovascular patients often are of advanced
age, have multiple comorbidities and may be more vulnerable than
your typical same-day surgery patient. Before procedures, cardiovas-
cular patients should undergo stringent pre-procedure testing, have
lab work drawn and obtain medical clearance. When they arrive at
the facility, they must be carefully reassessed and again determined
to be a candidate for an outpatient procedure. These are elective
procedures, so even slight changes in the patient's status might
mean they shouldn't be treated on that particular day.
While adding cardiovascular cases is definitely doable, launching the
service line is uniquely challenging and can be complicated. It's impor-
tant to carefully consider the required staffing, space and equipment
needs, and proceed with caution.
OSM
Ms. Bemis (kbemis@ncplp.com) is the chief clinical officer for National
Cardiovascular Partners and Azura Vascular Care, two divisions of
Fresenius Medical Care of North America, which operates dozens of ambula-
tory surgery centers and outpatient facilities in the U.S.
Business Advisor
BA
1 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 0
