May 2009 Society of Invasive Cardiovascular Professionals (SICP) News

SICP Chapter Spotlight: North Carolina Chapter

By Michelle Eggleston with contributions from Chris Jolly The SICP has several established and developing chapters across the country. Chapters offer networking opportunities and grassroots advocacy opportunities for current issues in the invasive cardiovascular profession. They also offer a great way to keep members up-to-date on ongoing membership developments. Belonging to a chapter is an excellent way to become more involved in your professional society, advocating and promoting the invasive cardiovascular profession. The North Carolina (NC) SICP chapter disbanded for a short time, but with the leadership and initiative of Chris Jolly and Jessica McCarver, they have undertaken the task of re-initiating the NCSICP chapter. Jolly and McCarver organized a meeting to reintroduce the NC chapter to area professionals with the goal of building a strong foundation by increasing interest and ultimately membership in the NCSICP chapter. The meeting was held at the Marriott SouthPark in Charlotte, NC, on March 7, 2009. Aside from reintroducing the NC chapter, Chris and Jessica also wanted to provide an educational opportunity for technologists in the area. It was expressed by several technologists in the area that while more and more hospitals and medical centers are requiring RCIS registry as a condition of employment, there was not a high level of local support or opportunities for obtaining CEUs in this area. With this concern in mind, Jolly and McCarver invited Abbott Vascular to sponsor a half-day educational opportunity, offering 3.0 CEU credits to those who attended the meeting and educational session. Twenty-six people attended the chapter meeting, a good turnout, considering the somewhat short period of time to market the program. In attendance were interventional and diagnostic cath lab personnel from several counties surrounding Charlotte, as well as students from the cardiovascular technology program at Central Piedmont Community College, also based in Charlotte. Chris felt the meeting was a success, commenting, “We were able to reintroduce the NCSICP chapter and provide 3.0 CEUs in one afternoon. It was a great start and there is still much work to be done. A few people became members of the SICP and two have pledged their assistance for future events within the NCSICP. We would like to increase involvement around the state to assist in planning and implementing other educational opportunities like this one, and market them to everyone across the state, with the eventual goal of holding a statewide meeting in the near future.” The current goals for the NC chapter are to reactivate the chapter and increase membership statewide, assist with the organization and implementation of 3-5 educational events a year across the state of NC and eventually hold a large, state-wide meeting to include presentations, elections and meaningful planning of future events. If anyone is interested in assisting with organizing educational events, please contact Chris at chris.jolly@cpcc.edu. Presently, the NCSICP chapter leadership consists of Chris Jolly and Jessica McCarver, both acting as co-chairs. They are looking to enlist others to assume some of the responsibilities they now share in hopes of electing individuals for other leadership positions such as chair-elect, treasurer and secretary for the chapter. Anyone interested in getting involved should contact Chris Jolly at chris.jolly@cpcc.edu or Jessica McCarver at jmccarver@carolina.rr.com. _____________________________

Ask the SICP

Kenneth A. Gorski, RN, RCIS, FSICP SICP Standards Committee Co-Chair Q: We are having a little disagreement with a new physician about manual hold times during brachial sheath pulls. Do you have any guidelines that you use or recommend? (There’s no hope of a cut down or radial approach in our near future.) Whatever insight you have will be appreciated. A: Brachial arterial sheath removal is even a stickier subject than femoral sheath removal. I can find absolutely nothing in the literature that touches on the subject. Here is the specific technique I recommend: 1.Assess vital signs, radial pulses and access site. 2.Palpate brachial pulse approximately above the skin entry site. 3.Clean the site of any blood prior to removal. 4.Aspirate the sheath sidearm (to remove potential clots which may have formed within the sheath). 5.Remove the sheath and apply enough direct downward pressure to control bleeding and maintain a radial pulse for minimum of 10 minutes or until hemostasis is achieved. Like femoral sheath removal, avoid “milking” the sheath when removing the catheter, which could potentially strip out clots which may have formed inside. It is important to palpate the distal (radial) pulse while maintaining brachial artery pressure; prolonged complete occlusion of the pulse may risk thrombosing the forearm. After hemostasis is achieved, clean the puncture site with iodine or chlorhexidine (unless a topical hemostasis pad was used) then and apply a dry sterile dressing per your institution protocol. I prefer to cover with a 2 x 2 pad and clear dressing, and then some rolled-up gauze and a strip of an elastic bandage. The arm should be secured on a board and kept straight for a minimum of 2 hours. The dressing may be removed the following morning, and the patient instructed to keep the puncture site covered by a bandage for 3 days. Recommendations may vary with physician, but upon discharge, the patient should be advised not to lift anything > 5 lbs until the following day. Any heavy lifting/strenuous activity (such as weight training, tennis, bowling with the affected arm) should be avoided for 48 hours. _____________________________

Malignant Hyperthermia

James A. Lincoln, RCIS SICP Advocacy Committee Chair Malignant hyperthermia (MH) is a rare, life-threatening condition that is triggered by exposure to certain drugs used for general anesthesia, (specifically all volatile anesthetics), nearly all gas anesthetics and the neuromuscular blocking agent succinylcholine. In susceptible individuals, these drugs can induce a drastic and uncontrolled increase in skeletal muscle oxidative metabolism which overwhelms the body’s capacity to supply oxygen, remove carbon dioxide and regulate body temperature, eventually leading to circulatory collapse and death if not treated quickly. Look for these key symptoms: •Muscle rigidity •Unexplained ventricular arrythmias •Rise in end title CO2 •Rise in potassium late •Rise in creatinine kinase (CK) late •Rise in core temperature late Susceptibility to MH is often an inherited disorder, for which there are at least 6 genetic loci of interest. It is usually unmasked by anesthesia or when a family member develops the symptoms. There is no simple, straightforward test to diagnose the condition. When MH develops during a procedure, treatment with dantroline sodium is usually initiated; dantrolene and the avoidance of anesthesia in susceptible people have markedly reduced the mortality from this condition. The Caffeine Halothane Contracture Test (CHCT), a test performed on freshly biopsied muscle, is the “gold standard” for diagnosis of MH. It can be performed only in roughly 30 centers worldwide, eight of which are located in the United States and Canada. The patient must travel to one of these sites for the test because the test must be completed within hours after muscle is removed. The size of the muscle needed for testing is about the size of a dime and usually taken from the thigh. The cost for the CHCT biopsy is roughly $6,000 and is covered by most insurance companies. MH is a rare disorder and important knowledge for those who work in the cardiac catheterization lab. I had no knowledge of it in the first 12 years of my employment in the lab and suspect many fellow professionals haven’t heard of it either. We had a patient at my facility that had triple-vessel disease and was referred for a coronary artery bypass graft (CABG) evaluation. The surgeon raised the suspicion of this disorder while discussing family history during his interview. Fortunately, there was a testing site close enough to us that we could transfer our patient for the CHCT testing, which came back positive for the disorder. We subsequently performed a staged multi-vessel angioplasty on this patient with an excellent outcome. My encounter with this case leads me to believe that we should incorporate this question during our H+P, especially on the patients that are at a high risk for intubation in the lab. We often use succinylcholine as a paralytic agent in this situation and want to be prepared in the event our patients start to exhibit these symptoms while in our care. Check with your hospital pharmacy to be sure that the dantroline sodium is easily and readily accessible for cath lab staff, and have your pharmacist do an in-service. Please visit the Malignant Hyperthermia Association of the United States for more information at https://medical.mhaus.org _____________________________

CCI Is Looking for People Who Ask the Right Questions

Contribute to the cardiac catheterization profession by becoming an item writer for the Cardiovascular Credentialing International (CCI) registered cardiovascular invasive specialist (RCIS) exam. CCI depends on credentialed professionals’ knowledge and expertise. As our RCIS credential continues to grow, we recognize that its success relies on a constant flow of new questions (or “items”) for our certification exams. If you are a current RCIS and a subject matter expert, we invite you to become an item writer. As a CCI item writer, you assist in molding the cardiovascular invasive profession. To be considered as an item writer, please submit a copy of your curriculum vitae. Contact Jerel Noel at (919) 863-9489 or jnoel@cci-online.org with any questions.

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