What Do You Think?

Can you help your fellow professionals with the following NEW questions?

Fully Cross-Trained Our lab currently has a fully cross-trained staff. Paramedics, RTRs and RCISs are competency trained to give medication and sedation, and the RNs scrub. We keep a full rotation in all three positions (record, circulate, then scrub). Are there other facilities that operate the same way in the state of Illinois? If not in this state, what states, and are they struggling with Magnet status and JCAHO regulations? Stacey Prentis Email: Stacey.Prentis@advocatehealth.com cc: cathlabdigest@aol.com Pacemaker Lead Removal Requesting any information you have on guidelines and protocols. Thank you! Email: cathlabdigest@aol.com Ethical Question re: Inventory Interventional Volumes Is it legal/ethical to sell inventory data of medical devices to manufacturers? Cath labs are always concerned about on-hand inventory, but manufacturers would also want to have this information as well (find out when they need to have a sales person visit or what a competitor has stocked). Thank you! Tor Steiner Email: ths103@psu.edu cc: cathlabdigest@aol.com RCIS: Clinical Ladder Does anyone have a clinical ladder for RCIS? I think it's a good question and would serve to advance our credential and practice if we had a model to work with that could be implemented in different hospitals. Thanks for your time and attention. Jason Wilson Email: Hrtfixr7@yahoo.com cc: cathlabdigest@aol.com CAS Database Programs Are there any database programs for collecting information on Carotid Artery Stenting besides ACC-NCDR? Our facilities are looking into the possibility that CMS may require participation in a national database. It would be nice to look at more than one program. Hope you can help Marcia M. Todkill, BSN RN Endovascular Registry Coordinator Covenant Health Organizational Effectiveness/Clinical Outcomes Email: mtodkill@CovHlth.com cc: cathlabdigest@aol.com ____________________________________________________________________

Ongoing Questions

Cervical and Lumbar Damage from Lead Aprons: Do you as a cath lab professional suffer from cervical and/or lumbar disc damage? My suspicion is that wearing the lead as often and for as long as we do, that the weight is causing a significant percent of our professionals’ to suffer lifetime damage! Bob Basile Email: bobstero@ptd.net Cc: cathlabdigest@aol.com It is crucial that hospitals take these facts or suspicions into account when ordering leads for staff. Each staff member should be allowed the choice of ultra-light protection. We in the cath lab have the greatest risks, more so than most other health care providers. As well, our department is a good source of income to the hospital. It would behoove any hospital to take into account the heavy weight and extensive wear by their staff. Ultra-light is the way to go. Since our hospital bought me the ultra-light, I have less back and neck pain after a long day. The older leads would cause pain after one good case. The cost may be a bit more, but it is worth it. Perhaps measurements of the cervical spacing and noting of bulges in the cervical discs would be helpful in determining the weight over time factor. Susan B. Steadman, MSN NW Medical Center Margate, Florida Email: JWS7345@aol.com Cc: cathlabdigest@aol.com I have been in the cath lab for 20 years. I have severe cervical disc pain requiring ESIs and chronic use of NSAIDs. I have frequent pain in my shoulders and arms with some numbness from time to time. I have had a CMC arthroplasty of my left thumb for degenerative changes (attributed to manual pressure to arteriotomy sites). Anonymous by request Yes, after 10 years I can no longer wear lead. I have damage to my brachial-cervical nerves, which also limits what type of nursing I can do now. Anonymous by request Implant Guidelines: I need some information regarding cath labs doing implants, i.e., permanent pacemakers (PPMs) and automatic implantable cardioverter defibrillators (AICDs). 1. Are your labs separate from the OR? 2. If separate, do you require head, face and shoe covers for all cases or just specified cases such as interventions and implants? 3. If standards are different for these cases, what are your room cleaning standards for the labs? Post case cleaning and terminal cleaning 1x per week? State differences, please. Thank you! Steve Gressmire RT(R)(CV) ARRT, AAMA, ACP Cardiology Services Director Northwest Mississippi Regional Medical Center Clarksdale, MS Email: Steve.Gressmire@nwmrmc.hma-corp.com Cc: cathlabdigest@aol.com Our labs are separate from the OR. The electrophysiology lab has mandatory requirements of all-surgical attire for implants or any cut-down procedure. The cath lab, regardless of interventions, has shoe covers, hat, and masks available, but these are not mandatory due to a percutaneous approach. The staff performs a general clean between each exam (mopping floors, spraying tables, emptying garbage) then we have a full terminal clean every night. Our lab staff also details once a week. Stacey Prentis Email: Stacey.Prentis@advocatehealth.com Cc: cathlabdigest@aol.com Our electrophysiology lab is located separately from the OR. We use a close approximation to OR standards for the implants. We require surgical hats for all personnel and the patient. We require all personnel that enter the room, once the tray is opened, to wear masks. Those personnel that wear their shoes outside of the cath lab are required to wear shoe covers. If your shoes stay within the facility, then that is not a concern. Our cleaning involves cleaning up the floors and countertops between cases, mopping as needed, and removing trash. The room is thoroughly cleaned by housekeeping every night after the cases are done for the night. This includes moving equipment. If we notice that the room is particularly dusty, we will wipe down the equipment on down days. We have also looked at the air exchanges. These have been set to OR standards. Connie Email: csgehin@yahoo.com Cc: cathlabdigest@aol.com We do pacemaker and ICD implants in a cath lab separate from the OR. We require scrubs, hat, shoe covers, and mask for all of these procedures, but not all procedures done in that room, and not for stocking supplies, etc., when no procedures are underway. Terminal cleaning is done once a week, and the room is cleaned and mopped between cases. It will be interesting to see if there is a standard! Good question! Judy S. Parham Email: jparham@armc.org Cc: cathlabdigest@aol.com 1. Labs are separate from the OR. 2. Head, face, and shoe covers are required for PPM and the person scrubbing for all cases. 3. PPM cleaning is just like the OR cases. All other cases are cleaned for soiled areas and the table is cleaned. Environmental cleans each night. Larry Sneed, BS, RCP Manager, Cath Lab Alamance Regional Med. Center Email: sneelarr@armc.com Cc: cathlabdigest@aol.com We do our permanent pacemakers, AICD implants and EP studies in the cath lab, separate from the OR. We require hats, masks, and shoe covers on all implants, (pacemakers and AICD implants). There is no in-and-out of personnel during the case, so that the door to the room is not opening during the procedure. We do not have different cleaning standards. We do not set up a tray until the patient is in the room, prepped and draped. Annie Ruppert, RN Email: Annie.Ruppert@sharp.com Cc: cathlabdigest@aol.com 1. Our cath lab is separate from the OR. 2. For cardiac caths, masks and hats are required for those scrubbed in. For implants, ALL personnel in the room must wear the same shielding. 3. Room cleaning after each case is done by CCL staff, and nightly cleaning is done by housekeeping. We do terminal cleaning prior to implants, and after dirty patients. Anonymous by request Regarding the implantation of PPMs and AICDs in our lab, the room is treated as a OR suite even though we are a separate entity from the OR. The room is washed down before the case. Everyone, and I mean "EVERYONE," wears an OR bonnet or a cap, shoe covers, and face masks. Our lab is staffed with RT(R)s and RNs. Either one can scrub the chest after they have been proctored. They have to scrub and wear a gown and sterile gloves while doing this part of the procedure. Mostly RTs scrub for the actual implantation with the physician, but some RNs are now getting in on the action. Cardiac interventions and implants are treated differently. PPMs and ACIDs are treated as a surgical procedure and interventions (PTCA, stents, Rotoblator, etc.) are treated like a regular cath, since all of our regular heart caths are scheduled as a heart cath +/-, so if an intervention is needed it can be done at the same time. All labs are terminally cleaned each night and regular mopping between cases is done when needed. Jeffrey L. Mefford, RT(R), RCIS Cardiac Cath Lab Central Baptist Hospital Cardiac and Vascular Institute Lexington, KY Email: j.mefford@insightbb.com Cc: cathlabdigest@aol.com Mount Clemens General is operating the same as Central Baptist Hospital (above), with the exception of us having RNFAs (Registered Nurse First Assistant) available when they are not doing CABG. The physicians love it because they are skilled in closing the pockets. Judith Filthaut Email: JudithF@mcgh.org Cc: cathlabdigest@aol.com We are separate from the OR. Everyone in the room is required to wear head and face covers when doing an ‘open’ case, i.e., PPM and AICDs. Head cover is required for everyone in the room, regardless of the type of case. Masks are used by scrub personnel during ‘non-open’ cases. Shoe covers are highly encouraged when scrubbed but not required for all personnel. For any open case, a terminal clean is done prior to the case. Cath and intervention processes are to clean back table, table, II, lead shields, and the floor between each case with an approved cleaner. Kevin Rich, BS, RN, RCIS Email: ldrich3@comcast.net Cc: cathlabdigest@aol.com 1. Our cath labs are separate from the OR and other departments. 2. Masks and hair covers are required for all sterile cases. Staff wears shoes which are kept in the department. 3. We have a housekeeping protocol for cleaning the labs between cases and once a week. Once a week, all surfaces, including walls, are cleaned using hospital detergent. Yelena Barclay Email: Yelena.Ba@bgh.co.th Cc: cathlabdigest@aol.com Our EP rooms are separate from the cath labs. Full surgical attire is required. After all, the implantation is general surgery. Any person directly assisting the physician is required to scrub their hands for 20 minutes. The rooms are surgically cleaned between all cases, as specified in our approved policies and procedures. Infected pockets, along with infected leads, can occur if any aspect of the implantation is jeopardized by inappropriate sterile technique. Chuck Williams RPA-RA, RT(R)(CV)(CI), RCIS Emory University Hospital Atlanta, GA Email: rpainga@yahoo.com Cc: cathlabdigest@aol.com

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