Cath Lab Digest Email Discussion Group

Question 1: Defibrillation by non-nursing staff? How does your hospital policy on defibrillation address non-nursing personnel in the cath lab? Are your rad techs or resp therapists allowed to defibrillate if they are ACLS certified? Is that a department policy or covered under a hospital policy? Question 2: Emergency cases after hours? Other than an acute MIs, what are considered emergency cases after normal operating hours? Do you have specific criteria, and do your interventionalists follow them? Group Members Respond to… Question 1: Defibrillation by non-nursing staff? Have ACLS; can defib All cath lab staff are ACLS in our lab. therefore everyone can defibrillate. Larry Sneed, BS, RCP Coordinator, Cath Lab Alamance Regional Medical Center sneelarr@armc.com Not an issue This is an interesting question. It has never come up in our lab. It may not be an issue for us since we staff 2 RNS in the lab (along with a scrub tech and a rad tech). carletta@weirtonmedical.com Rad techs w/ ACLS Currently our rad techs who are ACLS certified can defibrillate. This is a hospital policy. t9261@epix.net RNs & techs have ACLS All nurses and technologists are ACLS certified, and are certified and recertified annually. This policy is an administrative-approved policy. Chuck Williams, Cath Lab Emory University Hospital, Atlanta, GA CharlesWilliams@mail.weber.edu Education is key With proper education, anyone can perform routine procedures in a cath lab setting. Lay people are currently being trained to perform emergency defibrillation in public places; I can’t think of a better place for teamwork in education, training and support than the cath lab. In my previous labs, all staff were REQUIRED to test and pass on defibrillation procedures in order to assure instant access for the patient to this lifesaving mode. JCha602066@aol.com All w/ ACLS can defib All personnel is ACLS certified in both labs in which I work...if you cannot obtain it within 6mos of your hire date then you cannot work in the labs. All ACLS personnel can defibrillate at both places I work. At one hospital we have RNs and RTs. The other employs RNs, RTs, and CVTs. They are covered under hospital policies. Kevin Rich, BS, RN, RCIS MDs direct but we have done without The techs are allowed to defibrillate in the lab, under direct physician direction. We all know how to defibrillate, are ACLS-certified, and would (and have) without a physician present. In the EP lab, the third person in the room is responsible for running the second defib unit during testing. Connie csgehin@yahoo.com Skills checklist The dept policy allows any clinical staff to defibrillate if they have passed the skills checklist. CVTs are new to our lab and one has now completed ACLS. The other has done the skills checklist and would defibrillate under direction of physician. The rest of the staff has ACLS. Marcia Todkill, RN Methodist Medical Center Oak Ridge, TN todkill@att.net Circulator defibs All of the staff in our labs have received their ACLS. Any new personnel that comes on board will take the ACLS course within a year of coming to the cath lab. Any rad tech or nurse can defib. a patient. We generally have a standing policy that the circulator will defib a patient while the recorder will bag the patient. Meds are given by either a nurse or rad tech. The only thing we can not do is intubate a patient, which is done by an RT. Charlene Houston Winchester Medical Center Winchester, VA ACLS = Ok to defib All cath lab personnel are ACLS certified, and can therefore perform defibrillation. Alex, Alex.Holmes@tenethealth.com Only RNs Only RNs defib patients, but anyone can hook up an AED in the hospital. Gordon Reichard, Gordon.Reichard@stvin.org Group Members’ Responses to … Question 2: Emergency Cases After Hours? Other than an acute MIs, what are considered emergency cases after normal operating hours? Do you have specific criteria, and do your interventionalists follow them? Physician can declare The ST elevated MI is most emergent. However, if the physician deems it necessary and calls it an emergency we will do it. We have done pacemakers as emergencies, usually due to the fact that the thresholds were high and the position too unstable for the patient to go to the floor. We have also placed ICDs and done EP studies due to the patient’s condition. We do temporary pacemakers, pericardiocentesis as well. Our interventionalists will do as directed by the physicians within their group who manage the patients that would come in through the ER. We always have an interventionalist on call, however, that may not be the same person that is on call for the hospital. Connie, csgehin@yahoo.com Try facilities w/ emergency cardiac program I believe criteria exist that define what an emergency is for cath labs either through the ACC or some of the high-profile, high-volume labs. It usually has to do with ECG changes, Troponin levels, etc. Places with Emergency Cardiac ER programs have excellent criteria. Perhaps try contacting them. JCha602066@aol.com 5 classified as emergencies What is considered an emergency other than acute MIs: a. Acute post PCI closures. b. Intra-aortic balloon insertions on cardiogenic shock patients, which may not be caused by an acute MI. c. Emergency Swan-Ganz catheter placements that can not be placed bedside. d. Organ donor patients who have been medically declared brain dead. Chuck Williams, Cath Lab, Emory University Hospital, Atlanta, GA CharlesWilliams@mail.weber.edu MD directs We have no guidelines for what is considered an emergency. If the physician considers it an emergency that is what it is. Marcia Todkill, RN, Methodist Medical Center, Oak Ridge, TN todkill@att.net

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