Cath Lab Design: Room Size, Lead Shielding & MEP Requirements

Heart disease is one of the leading causes of death in Pakistan, and the cardiac catheterisation laboratory, or cath lab, has become one of the most valuable departments a hospital can offer. It is where coronary angiography, angioplasty and stenting, pacemaker implantation and many other minimally invasive procedures are performed. For patients having a heart attack, a well-run cath lab can be the difference between full recovery and permanent heart damage.

A cath lab is also one of the most demanding rooms to design and build. It combines the imaging and radiation requirements of radiology, the infection control standards of an operation theatre, and the power, IT and structural demands of heavy, sensitive equipment. This guide explains cath lab design in practical terms: room sizes, layout, radiation shielding, HVAC, electrical and structural requirements, supporting spaces, and the mistakes that cause delays and cost overruns.

🏢 About Hospital Design Hub

Hospital Design Hub is a specialist hospital design and construction company, established in 2000 and focused on healthcare infrastructure: design, construction, consultancy and project management, and the renovation and maintenance of hospital facilities. With more than 50 successfully completed projects, our team has worked on healthcare facilities across Pakistan, including projects such as LDMC, MCH Islamkot, King Edward Medical University / Mayo Hospital, and UOL Hospital Lahore.

Cardiac facilities are among the most technically demanding projects we deliver. Our architects and engineers coordinate equipment vendors, shielding, structure, HVAC and power so the cath lab works reliably from day one.

❤️ What Happens in a Cath Lab?

In a cath lab, cardiologists insert thin catheters through an artery or vein (usually in the wrist or groin) and guide them to the heart using live X-ray imaging called fluoroscopy. Common procedures include:

• Coronary angiography: imaging the coronary arteries to find blockages.
• Angioplasty and stenting (PCI): opening blocked arteries, including emergency treatment of heart attacks (primary PCI).
• Pacemaker and ICD implantation.
• Electrophysiology studies and ablation in specialised labs.
• Peripheral and neuro-interventional procedures in multipurpose or hybrid labs.
• Structural heart procedures such as valve interventions in advanced centres.

Because procedures can become emergencies at any moment, the cath lab must be designed to allow immediate escalation: resuscitation, ventilation, and in some cases conversion to open surgery.

📐 Cath Lab Suite: Rooms and Sizes

Indicative sizes for planning. Final dimensions depend on the specific equipment chosen, which should be confirmed with the vendor’s site planning drawings before design is finalised.

📷 Equipment-Driven Design

More than almost any other room, the cath lab is designed around its equipment. Different manufacturers have different requirements for room size, ceiling height, ceiling rails, floor loading, cable trenches, power supply and cooling. The design team should obtain the vendor’s site planning guide early and design to it.

Ceiling Height and Support

Ceiling-mounted C-arms, monitor booms, radiation shields and surgical lights hang from a steel support grid fixed to the structural slab above. This grid must be designed by a structural engineer to carry the equipment loads without vibration or deflection. A clear ceiling height of roughly 3 metres or more is commonly required, with extra void above for the support structure and services. This is one reason cath labs are much easier to fit into new buildings than into existing ones with low floor-to-floor heights.

Floor Requirements

Floor-mounted systems and patient tables are heavy and must be anchored to a level, strong slab. Cable ducts or trenches may be needed between the procedure room, control room and equipment room. The floor finish should be seamless, antistatic where specified, and easy to clean.

☢️ Radiation Shielding for the Cath Lab

Cath labs have long fluoroscopy times and high workloads, so radiation protection is critical for staff and for people in neighbouring areas. Walls, doors, the control room window, and often the floor and ceiling must be shielded based on a calculation by a qualified professional. Commonly, lead-lined walls and doors and lead-glass windows are used.

Inside the room, staff protection comes from ceiling-suspended lead acrylic screens, table-mounted lead curtains, mobile shields and personal protective equipment. The room layout should leave space for these shields to move freely without clashing with other equipment. Like all radiation facilities in Pakistan, the cath lab must meet the requirements of the Pakistan Nuclear Regulatory Authority (PNRA). Read our detailed guide to radiation shielding and PNRA approval.

❄️ HVAC and Infection Control

Many cath lab procedures involve implanting devices such as stents, pacemakers and valves, so infection control is essential. Cath labs are typically designed with ventilation standards similar to operating theatres:

• Positive pressure relative to adjacent corridors.
• High-efficiency filtration, with HEPA filtration commonly specified, especially for hybrid labs and device implantation.
• High air change rates, often around 15–20 or more per hour depending on the standard adopted.
• Controlled temperature and humidity for staff comfort (staff wear heavy lead aprons) and equipment performance.
• Separate cooling for the equipment room, because imaging electronics generate significant heat and must be kept within the manufacturer’s range 24 hours a day.

International references such as ASHRAE ventilation standards and FGI Guidelines are widely used for design criteria. See our page on HVAC and climate control systems.

⚡ Electrical, IT and Medical Gases

• Dedicated power supply: the imaging system typically requires its own feeder of specified capacity and quality.
• Backup power: connection to the essential supply and UPS for the imaging chain and critical equipment, so that a procedure is never interrupted mid-way by an outage.
• Earthing and power quality: clean earthing and protection against voltage fluctuations, which are common in Pakistan and can damage sensitive electronics.
• IT and PACS: network connections for image storage, reporting and viewing in the CCU and wards.
• Medical gases: oxygen, medical air and vacuum at the patient position, often from a ceiling pendant, plus anaesthetic gas scavenging where general anaesthesia is used.
• Lighting: dimmable lighting for viewing monitors, plus examination or surgical lighting for access sites and hybrid procedures.

📍 Where to Locate the Cath Lab

For heart attack patients, time is muscle. International guidance for primary PCI focuses on minimising the time from the patient’s arrival to reopening the blocked artery. The hospital’s layout has a direct effect on this:

For a broader view of cardiac facility planning, see our guides to cardiac hospital design and ICU design standards.

⚖️ Standard Cath Lab vs Hybrid Operating Room

✅ Pros and Cons of Adding a Cath Lab to Your Hospital

⚠️ Common Cath Lab Design and Construction Mistakes

1. Designing before selecting equipment: leading to redesign when vendor requirements arrive.
2. Insufficient ceiling height or no space for the ceiling support grid.
3. No dedicated cooling for the equipment room, causing system shutdowns in summer.
4. Weak power quality protection, leading to expensive electronic failures.
5. Shielding gaps at door frames, penetrations and control room windows.
6. Too few prep and recovery bays, limiting the number of procedures per day.
7. Poor location far from ER and CCU, delaying emergency treatment.

🛠️ How Hospital Design Hub Delivers Cath Labs

1. Service planning: procedure types, expected volumes, emergency coverage and growth.
2. Vendor coordination: integrating the chosen system’s site planning requirements into the design.
3. Integrated design: architecture, structure (ceiling grid and floor), shielding coordination, HVAC, electrical, IT and medical gases.
4. Construction: shielding inspection, ceiling support installation to tolerance, clean-room finishes.
5. Commissioning: HVAC validation, power testing, radiation survey coordination and handover.

Explore our MEP services and operation theatre design.

💰 What Drives the Cost of a Cath Lab Project?

The imaging system itself is the largest single item, but the building works around it are significant and often underestimated. The main cost drivers are:

A realistic budget always includes the building works, not just the equipment quotation. Owners who budget only for the machine often find the project stalls when shielding, HVAC and power upgrades are priced.

👩‍⚕️ Designing for the Cath Lab Team

A cath lab is staffed by interventional cardiologists, nurses, radiographers or cardiac technologists, and often an anaesthetist. The design should support their work and wellbeing:

• Lead apron storage: proper hanging racks near the entrance, because folding damages the lead lining.
• Comfortable temperatures: staff wear heavy aprons for hours; slightly cooler room settings reduce fatigue.
• Clear communication: intercom between procedure and control rooms, and visible monitors for everyone at the table.
• Reporting room: a quiet space near the lab for reviewing images and writing reports.
• On-call rest room: for teams covering 24/7 primary PCI services.
• Efficient stock management: clean store close to the procedure room with secure storage for high-value stents and devices.

🔁 Adding a Cath Lab to an Existing Hospital

Many hospitals in Pakistan add a cath lab years after opening. This is possible, but it requires careful planning:

1. Site survey: measure floor-to-floor heights, check slab thickness and structure, and identify what is above and below the proposed room.
2. Services capacity check: confirm electrical capacity, generator and UPS headroom, HVAC plant capacity and medical gas supply.
3. Route planning: confirm the equipment can be delivered into the room through doors, corridors or openings.
4. Phased works: isolate the work zone with dust barriers and plan noisy work around clinical schedules.
5. Commissioning: complete HVAC validation, radiation survey and equipment acceptance before the first patient.

With good planning, a retrofit cath lab can be delivered without disrupting the rest of the hospital. Read more about renovation in operational facilities.

❓ Frequently Asked Questions

How big should a cath lab procedure room be?

A typical cath lab procedure room is roughly 50–70 square metres, with hybrid operating rooms larger. The exact size depends on the equipment chosen and the procedures planned.

Does a cath lab need radiation shielding?

Yes. Cath labs use fluoroscopy for long periods, so walls, doors, windows and often floors and ceilings need shielding designed by a qualified professional, and the facility must meet PNRA requirements.

What ceiling height does a cath lab need?

Ceiling-mounted systems commonly need a clear ceiling height of around 3 metres or more, plus void space above for the structural support grid and services, depending on the vendor.

What HVAC is required for a cath lab?

Cath labs are usually designed to operating-theatre-like standards: positive pressure, high-efficiency or HEPA filtration, high air change rates and controlled temperature and humidity, plus dedicated cooling for the equipment room.

Where should the cath lab be located in a hospital?

Close to the emergency department and CCU, with a direct route and bed lift access, so heart attack patients can be treated as quickly as possible.

What is the difference between a cath lab and a hybrid OR?

A cath lab is designed mainly for catheter-based procedures. A hybrid OR combines cath lab imaging with a full surgical operating theatre, allowing open surgery and interventions in the same room.

Can a cath lab be installed in an existing hospital building?

Often yes, but floor-to-floor height, structural capacity, shielding, HVAC and power must all be checked first. Low ceilings are a common obstacle in older buildings.

How many recovery bays does a cath lab need?

It depends on procedure volume and length of stay, but several prep and recovery bays per lab are usually needed to keep the lab running efficiently throughout the day.