What Do You Think?

Pressure Tubing Open?
I am a critical care nurse by background. For years, I have learned through the American Association of Critical Care Nurses (AACN) that pressure tubing should never be left open to air, only to zero the lines. In my cath lab, we leave the white caps on the transducer set, which have holes in them, while performing a cath. This goes against my 7 years of training in ICU about pressure tubing. So, my questions are as follows: What is the best practice for use of these pressure lines? Should we be closing this system off completely to the air during a cath? We seem to have a lot of problems with normal saline dripping on our monitoring equipment, which is not good for the cables. Thank you!

Jennifer Stankowski, RN
Email: tankoja@dxandtx.com
Cc: cathlabdigest@aol.com

Cardiology Physician Extender Questions & Contacts
1. Are readers interested in attending an educational symposium presenting high-quality advanced board review programs for advanced level physician specialists who work within radiology-based or cardiology-based medical imaging departments?
The advanced level physician specialists would include nurse practitioners, physician assistants, radiology practitioner assistants, radiologist assistants, radiologic technologists who work in cardiovascular settings and have a desire to take the advanced ARRT examinations for Vascular Interventional studies (VI) and Cardiac Interventional studies (CI), cardiovascular technologists who are Registered Cardiovascular Invasive Specialists (RCISs) and other board-certified allied health professionals, who work in invasive and interventional cardiology settings, hold the CCI RCIS credential and /or have a desire to take the CCI RCIS exam or the new CCI EP Examination. The program would also be open to students and graduates who have to take board examinations that deal with medical imaging, patient assessment, pathophysiology, medical and surgical disease processes, etc.

2. How many readers who meet the descriptions listed above would be interested in helping develop a societal organization that would be in alliance with international certification credentialing organizations and would offer certification processes for an Advanced Level Cardiology Physician Specialist or an Advanced Level Radiology Physician Specialist?

We have the opportunity to develop the largest board review course that has ever been offered for those who have professional desires to function at advanced levels, especially in cardiac cath labs as well as radiology settings. Our goal is to offer a program which will not only satisfy the needs of advanced level physician specialists, but will establish unity amongst our valuable peers, the nurse practitioners and physician assistants. Those who have an interest, please contact the persons listed below as soon as possible. We need to have as much information from our readers no later then February 29, 2008 at midnight.

Jeff Davis, RCIS, RRT,
Director, Cardiovascular
Technology Program,
Edison College, Ft Myers, Florida at jdavis@edison.edu.
Chuck Williams, BS, RPA-RA, RT(CV)(CI), RCIS, FSICP at codywms@msn.com

No. of Peripheral IVs
How many peripheral IVs are inserted prior to catheterization procedures? We have always placed two, but some in our lab feel it is not necessary, and others feel it is. We were hoping to get some feedback from other hospitals. Thank you!

Jena Canavan RN, CCRN
Invasive Cardiology Educator
Email: jcanavan@notes.cc.sunysb.edu
Cc: cathlabdigest@aol.com

Normal Caths & Standard Ambulation Times
How does your institution handle the following items?
1) Do you track normal cardiac cath numbers? If so, how? If yes, what is the criteria in place that defines a normal cardiac cath (i.e., no blockages greater than 15% in any major artery greater than 2mm diameter)?
2) What are the standard ambulation times after a diagnostic cath using 5 or 6 Fr sheaths, when the patient has not received heparin. How long do you keep patients on bedrest after hemostasis is achieved? (Manual holds only, no devices used for closure.) For those responding to this question, do you know of any studies or articles/research that supports this ambulation time?
Thank you!
Annie Ruppert
Email: Annie.Ruppert@sharp.com
Cc: cathlabdigest@aol.com

Data on Pre/Post Beds per CCL
I am looking for data or research that supports the number of pre/post beds per cath lab. Are there any guidelines on recommendations ratios?
Thanks for your help.
Melissa A. Muller
Cardiovascular Service Line
Administrator, Bronson
Methodist Hospital, Kalamazoo, MI
Email: mullerm@bronsonhg.org
Cc: cathlabdigest@aol.com

Ambulation, T&S Questions
1. Does anyone ambulate patients to the lab (elective outpatients only)? Do they have criteria to assist with the decision to wheel or walk?
2. Do other labs require a type and screen on all patients pre-procedure? Is there a specific subset of criteria for T&S requirements? Thank you!
Terry Leonard, Unit Educator,
Invasive Cardiology, Stony Brook Univer. Medical Center
Email: tleonard@ notes.cc.sunysb.edu
Cc: cathlabdigest@aol.com

Medication Errors
I was wondering if anyone knows of any studies on medication errors in the cath lab and statistics involving the errors (i.e., nurses vs. techs, intervention vs. diagnostic). I was wondering who commits the most errors and during what situations the errors are committed. I feel this would help the lab where I work with calling attention to some areas where we may not always look (not that we have many errors at all). We have a lot of relatively young staff and we may be looking at cross-training techs to give medications down the road. If you have heard of any studies or know of where I may be able to find this information, I would greatly appreciate it. Thank you,

Mark Baker, MICP, RCIS
Email: cathtech99@yahoo.com
Cc: cathlabdigest@aol.com

ACT Check Prior to Sheath Pull
Our cath lab is currently reviewing and writing policies and procedures. We are currently reviewing standards for pulling arterial sheaths when heparin has been given as a bolus prior to a diagnostic procedure or during a peripheral intervention. Currently, there is no practice in place to check an ACT unless the physician orders it. Our Policy and Procedure Committee wants to implement a policy for checking an ACT prior to pulling the sheath.
What is your department’s policy/ practice, and what level of the ACT is deemed safe for patients? Thank you!
Mike LeGal, RN, BSN, CCRN
Cardiovascular Lab, Kaiser Sunnyside Hospital and Medical Center, Clackamas, Oregon
Email: Michael.R.Legal@kp.org
Cc: cathlabdigest@aol.com

Screening Criteria
We are a small rural hospital with one diagnostic cath lab and two cardiologists. We have been unable to locate any up-to-date screening criteria (the most recent American College of Cardiology guidelines are dated 2001). What criteria would you recommend that we follow to screen our patients (inpatients and outpatients)? We do not offer bypass or interventional procedures. The closest facility is 30 minutes away. Thank you for your help.
Cheryl J. Harrell, RN and Lori A. McMahon, RN,
Provena United Samaritans Medical Center
Email: Cheryl.Harrell@provena.org
Cc: cathlabdigest@aol.com

RCIS Mandatory?
We are thinking of making it mandatory for our staff to be RCIS-certified. Are there labs that have done this? What was your process to implement change?
Anonymous Email: cathlabdigest@aol.com