What Do You Think?

Left upper arm discomfort after a PCI Have any of you noticed swelling of the upper extremities on patients who have had prolonged cuff blood pressure monitoring during and after PCIs? One of our cardiologists had a patient who complained of left upper arm discomfort after a PCI. Swelling of the upper extremity was observed. I was asked about this, and mentioned that I had noticed bruising on the medial areas of the distal humoral areas on patients who had come to the cath lab after being on heparin drips and/or GP IIb/IIIas overnight. Some literature has mentioned patients with swelling and petechia from prolonged cuff blood pressure monitoring that is done frequently. Chuck Williams, RPA, RT, RCIS Atlanta, Georgia Email: rpainga@yahoo.com cc: cathlabdigest@hotmail.com Three zones in the CCL? I am an RN from Florida, and my specialty is surgery. Currently I live in Thailand, and work in Bangkok Hospital as a nursing consultant. My primary job is to educate the staff and help them to implement international standards. My biggest project involves the cardiac catheterization lab, so I am dealing with the same problems. I am currently working on a dress code policy for a cath lab department. This is a new hospital with fairly new staff. I am an experienced O.R. nurse, and think that the dress code should not be any different than in the main O.R. due to infection control and aseptic technique issues. My question is the following: Can the cath lab department be divided into three areas (restricted, semi-restricted, nonrestricted)? Can somebody recommend some references? Yelena Barclay Email: Yelena.Ba@bgh.co.th Cc: cathlabdigest@hotmail.com Use of pressurized normal saline? How many cath labs use pressurized normal saline instead of heparin art line flush bags (2 USP heparin units/ML) when connecting to a sheath/IABP/Swan? Brian Crosby, RCIS, RN, BSN HealthPark Medical Center Email: brian.crosby@leememorial.org cc: cathlabdigest@hotmail.com Bispectral index (BIS) monitoring during pacer insertion What credentials, if any, are necessary to use the BIS during a pacemaker procedure? I am a nurse new to the cath lab, and am concerned that this is getting into the anesthesia arena for which I may not be licensed. Anonymous by request Email: cathlabdigest@hotmail.com Share your door-to-balloon timing? We are evaluating our door-to-balloon time, so I wanted to see what other labs are doing. 1. What is your door-to-balloon time? 2. Do you track all AMIs? 3. Do you still have an in-house RN to handle sheath-pulling and acute patients? 4. How many are on the call team? 5. What is their expected response time? Julie Baran, RN, BSN Clinical Manager Adult and Pediatric Invasive Cardiology Memorial Hermann Hospital Email: julie_baran@mhhs.org cc: cathlabdigest@hotmail.com Ergonomics and moving patients I have been a RN in the cath lab for the last three years. I worked for 20 years in the O.R. where I am CNOR-certified. I have a concern with patient safety and employee injury from the practice our facility uses for transferring patients to and from the carrier to the catheterization table. Our method involves pulling the patient over by using the carrier sheet (possibly causing skin friction and shearing injury to the patient). Anywhere from 3 to 4 people pull patients without using a roller (a transferring device I have seen used in the O.R.). We do have a long board (which is more difficult to use because of its size); I have seen it used twice during the last three years. The board is awkward to use and I had no idea how to use it until I had been in the cath lab for a year. I am trying to gather information for our department regarding employee health in terms of back injuries as a result of transferring patients from carriers to the catheterization table using this method. Barbara Forest Email: bforest2003@wmconnect.com cc: cathlabdigest@hotmail.com Can you help your fellow professionals with the following NEW questions? Cath lab procedure 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 me. Anonymous Email: cathlabdigest@hotmail.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 Email: cathlabdigest@hotmail.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 NCDUR-ACC database. One of our physicians is requesting that we don't document all of this, stating that our cath lab documents more than any cath lab he knows of. I thought this forum would be a quick way to get a qualified answer for him. Craig Cummings, RCIS Email: Craig.Cummings@erlanger.org cc: cathlabdigest@hotmail.com Units of service Is there a standard for units of service for cath lab procedures in measuring productivity and FTEs, or is this set by each institution? Anonymous Email: cathlabdigest@hotmail.com

NULL