What Do You Think?

Can you help your fellow professionals with the following NEW questions? 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 Cath Lab Interventional Volumes I am interested in teaching hospitals doing over 2000 interventions a year. What are your 2004 versus 2005 (estimated or actual) interventional numbers for both coronary and peripheral cases? Thank you, Michael Milyo RN Clinical Educator Sones Cleveland Clinic Cardiac Catheterization Lab The Cleveland Clinic Cleveland, Ohio Email: milyom@ccf.org cc: cathlabdigest@aol.com ______________________________________________________________ Loose Hair and Infection Control In the September 2005 issue of Cath Lab Digest there was an article by Dave Droll (Clipping Versus Shaving: Who Wins in the End? Infection Risk and Hair Removal Guidelines) addressing clipping versus shaving in groin prep and infection control issues. The area I am hoping to address is mentioned in the last paragraph the loose hair that is moving about after the groin prep and the whole new set of contamination issues. I am employed at a large cath lab and our volume is approx. 45 cases per day. The groin shave prep is done in the holding area with an electric razor. The hair is then taped to aid in removal. The problem is that we are finding the hair in several places within our holding area and I am concerned re: the infection control issues that are not being addressed. Do you have any comments/suggestions for researching this idea? Thank you for your time in addressing this concern. Mary Quincey RN BSN Email: mquincey1@yahoo.com Cc: cathlabdigest@hotmail.com As long as any of the hair is removed from the sterile field, you should be fine. I have yet to see a contamination/infection from a hair in the cath lab. As far as clipping vs. shaving I have seen no difference in our infection rates at either of the hospitals I have worked at. The biggest factor is to keep the site clean (betadine or your choice) then maintain that field with diligence. Kevin Rich, BS, RN, RCIS Email: ldrich3@comcast.net Cc: cathlabdigest@hotmail.com When hair is removed from a patient, the area should be cleaned before the next patient is placed in the area. Loose hair anywhere in a patient care area is considered a contaminate. We use tape to remove the loose hair from the groin area and we have the same issues. Most of hair clippings occur in our preparatory area. In emergent cases, we have to clip in the procedure room. Either place, hair can become airborne and is considered dirty. Chuck Williams, BS, RPA, RT (R)(CV)(CI), RCIS, CPFT, CCT Emory University Hospital Atlanta, GA Email: rpainga@yahoo.com Sheath Pulls and BP Limits I was wondering if you had any information on sheath pulls and BP limits. We are having an issue in our lab regarding the systolic and diastolic limits as to when to pull or not. If you have any information, I would greatly appreciate it. Thank you, Heather Stover CVT Email: stoverh@bronsonhg.org Cc: cathlabdigest@aol.com Most MDs that I work with prefer to have the systolic 150 or less and diastolic 80 or less. Kevin Rich, BS, RN, RCIS Email: ldrich3@comcast.net Sheaths should not be pulled if systolic or diastolic hypertension exists. Removal with elevated a BP leads to prolonged manual pressure, prolonged FemoStop usage, and possibly large hematomas. If the BP is elevated, I always ask the attending cardiologist if we can give an IV anti-hypertensive medication, such as Lopressor, hydralazine, or VasoTec. Many times I have used sublingual nitroglycerin. Whatever is used, the vital signs need to be monitored at least q 3 minutes. The BP could fall dramatically in some patients with any one of the medications, so I prefer a least 3-minute BP checks. Chuck Williams, BS, RPA, RT (R)(CV)(CI), RCIS, CPFT, CCT Emory University Hospital Atlanta, GA Email: rpainga@yahoo.com Bispectral Index (BIS) Monitoring During Pacer Insertion What credentials if any, are necessary to use this during a pacemaker procedure? I am a nurse new to the cath lab and am concerned that this is getting into the anesthesia arena and that I may not be licensed for BIS monitoring. Anonymous Email: cathlabdigest@aol.com I want to thank your "What Do You Think?" reader for asking about the BIS monitoring during pacemaker insertion. BIS is used in cases of sedation and general anesthesia for help in dealing with the depth of awareness, and although it can be used in sedation cases, I personally think this is another monitor that might better be suited for those who feel comfortable with the use of sedation and anesthetic medications. As an anesthesiologist and internist, my suggestion would be to leave this monitor to those administering sedation and anesthesia. Sincerely, Robert J. Rogers, MD, FACP Cedars Sinai Medical Center Department of Anesthesiology Los Angeles, CA Email: Robert.Rogers@cshs.org Expired Supplies I am inquiring if anyone knows of an organization that accepts old and expired devices (i.e., catheters, stents, etc.) for redistribution to more needy areas of the world. It seems such a shame to just discard once-valuable commodities. If you have any information, please feel free to contact me. Thank you for your time. Don Heinisch Email: dcind@enter.net Cc: Donald.Heinisch@triadhospitals.com Cc: cathlabdigest@aol.com REMEDY is an organization dedicated to recovering medical supplies and medical equipment for use in underdeveloped countries. They have methods in place and offer a packaged program to ease the transition from current practices to recovering these supplies for use. Please contact remedy@yale.edu for more information. I am using their contacts to ship expired supplies to areas of the world that need and use them. TLSmith Email: radcathone@yahoo.com Cath Lab Procedure Write Up We are required to write up procedures during the catheterization procedures performed in the cath lab to provide physicians with the information needed to prepare their formal reports. Are other hospitals also doing this? If so, I would appreciate any suggestions or standard requirements that other centers use. Please send me any samples of this that your center can provide. Anonymous Email: cathlabdigest@aol.com We use the MacLab System with a workstation. When the patients are discharged, it compiles data in a ready for chart format. If the physician so chooses, he may also computerize his own cath report at the workstation. Ours does not use this feature, but it is available. 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 Measuring Productivity Do you calculate staffing productivity? Do you calculate room productivity? If so, at what point do you determine the need for another procedure room? What criteria did your cath lab use? If your cath lab measures these things, how do you benchmark comparison data? Thank you in advance for any information you can provide. Marcia Vermilye, MSA, BS, RN Director of Cardiovascular Services La Porte Hospital and Health Services, La Porte, IN Email: M.Vermilye@lph.org Cc: cathlabdigest@aol.com We use a system called Kronos. Based on the pre-selected numbers put into the system, it calculates the number of procedure weights against number of FTEs and number of hours worked. So, if our procedure totals are 38, our paid hours earned are 55, paid hours used are 40 for that day. We have to do enough procedures to cover our 40 hours for that day to come out ahead or in excess of 100%. This is also calculated towards adjusted patient day for that day. If we fall short, then we have to reduce hours left in the pay period in order to keep productivity in the acceptable range, above 90%. If I can help further, do not hesitate to contact me. 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 Documenting Data Are there any cath labs that REQUIRE a minimal amount of charting during a procedure? For example, at Erlanger Health System, we document times for introducing and removing sheaths, wires, catheters, balloons, stents, lead wires, pacemakers and ICDs. We also document times for wire exchanges, PCI balloon inflations and where those inflations are done. Some of this data is necessary for the NCDR-ACC database. Thank you for any help you can provide. Craig Cummings, RCIS Email: Craig.Cummings@erlanger.org Cc: cathlabdigest@aol.com We are now living in an era that requires more paperwork. Our lab’s monitoring/data collection system is the GE Mac Lab IT. From the time the patient arrives for their procedure(s), it is all entered into a report that is printed out at the end of the procedure. It includes pre-procedural data: staff, time the patient arrives, scheduled case time, H&P, labs, consents, pulses, allergies, IVs , referring physicians, pre conscious sedation scale (pain level if present), time out (patient, procedure, site confirmation with MD in room and staff), smoking habits, family history CAD Christine J. Reoch RCIS reochris2000@comcast.net

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