What Do You Think? Multiple new and ongoing questions from readers.Your responses are welcome!

ORTs in the Cath Lab I have recently been given the nurse manager position in our cath lab. Staffing is currently the front-running issue needing to be resolved. Our hospital administration is asking that we consider using operating room technicians (ORTs) in the scrub position. Can you tell me what your community standard is; if your facility uses ORTs and/or direct me to where I would find information on the industry standards related to utilizing ORTs in the cath lab? Any and all help will be greatly appreciated. Sandy Peterson, RN Stockton, California Email: S.Peterson at dameronhospital.org Cc: cathlabdigest at aol.com

Infection Control Guidelines I am writing to see if anyone is enforcing the 2005 Infection Control Guidelines for cardiac cath labs published by the SCAI, which include the use of masks during procedures. Thank you! Tami Burns Email: tburns at harrisonmedical.org Cc: cathlabdigest at aol.com

Questions with Answers

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 at ptd.net Cc: cathlabdigest at aol.com

I started working in the cath lab in March of 1998, at the age of 25. Within that first year, I began to have pains in my neck, like when you have slept wrong. There were times that I could not even go to work, because I could not turn my neck. Over the years, it began happening at least once a month. There were times when I would get up in the morning, stretch and instantly feel the muscles in my shoulder area tighten up. I went to the doctor and he diagnosed it as stress because I didn’t actually have pain in my spine; it was always in my shoulder area. There was one weekend in particular when I remember having sharp pains shoot down my arms, but I still didn't go back to the doctor. My director and manager at the time had both had neck surgery already, and I think I was afraid of what I would find out.

In August of 2005, about 5:00 a.m. one Saturday morning, I heard a pop in my neck while sleeping. The pop woke me up and I instantly felt pain. That following week, I went to that same doctor, and he ordered an MRI on my cervical spine. At C4-C5 and C5-C6 I had herniated discs, and at C6-C7, I had a bulging disc. I underwent physical therapy and I was doing a lot better. But this past July, I had my second child and after carrying her diaper bag around and going back to work, I have started having a little more pain. It has not gotten as bad as it was previously. When I have problems, I get my Massage Mouse that I purchased on Ebay, and use it on the area that is hurting me the most. That tends to help a lot. My husband makes fun of me because at 34, I am falling apart. Sonja Druell, RT(R), Texas Email: sonjadruell at sbcglobal.net Cc: cathlabdigest at aol.com

Sandbags for MC Does your cath lab routinely employ sandbags following manual compression for sheath removal? How long do you leave the sandbags on? Are sandbags utilized for all manual sheath removals or is it sheath-size dependent? Michele Kosinski, RN, MSN, CCRN, CEN Nurse Manager, Cath Lab St. Joseph’s Hospital Health Center, Syracuse, New York Email: Michele.kosinski at sjhsyr.org Cc: cathlabdigest at aol.com

Our cath lab typically does not use sand bags. We have found that they are an easy excuse to not do routine groin checks. They are also uncomfortable for the patients. Our adverse events have decreased and our patient satisfaction has increased by using AngioSeal VIP in interventional cases. If you will read the AngioSeal VIP IFU, you will discover that it is indicated for IIB and IIIA inhibited patients with a ACT of 299.6 +/- 85 seconds. I hope this helps. Best regards, Tim M., RN, BSN Email: tmtulmn at cox.net Cc: cathlabdigest at aol.com

Days On Call Per Month My hospital has 2 heart labs and 1 specials lab. There is a total of 5 RNs and/or RTs that take call daily. During a month’s period, we average 9–10 days of call per team member. What is the typical number of days on-call for RNs/RTs per month? Do you have a policy regarding the maximum number of days a team member, either RN or RT is allowed to take on-call, per month? Thank you! Theresa Billington, RN Staff Nurse, Cath Lab Lake Hospital System Willoughby, Ohio Email: Tmb54669 at aol.com Cc: cathlabdigest at aol.com

In my previous job, there were only 2 RTs, both taking call one week at a time. Therefore, I was on call at least 14 days per month. I then moved to a much larger hospital, with a larger staff base. I now take one call day per week, and one full weekend every 8–9 weeks. We do not have a policy regarding the maximum number of call days we can take. In fact, we have several staff members (RT, RN, and CVT) that pick up additional call for co-workers for the extra money.

My advice to anyone who feels overwhelmed by their call schedule is to move to a larger hospital where there are more staff members that take call. Dee C, RT

Our lab, at Kaiser Permanente in San Rafael, CA, is a newly constructed lab that has been open almost 1 year. We are a combined IR/Cath lab with 3 RTs and 6 nurses. Due to the state requirement that a RT pan the table, on average, for each 6-week schedule, I will have 25+ days (evenings from 4:30 pm – 8:00 am or weekends from 8:00 am – 24 hours). Working 40 hours a week, you can imagine that it seems like I live here sometimes. We have performed over 300 diagnostic cases this last year, but only do scheduled caths 2 days a week. The other 3 days are for IR procedures. We are available for emergent ST-elevation type caths, with a 30-minute response time, and have performed over 30 PCI cases to date, from simple stent placement to complex lesions and balloon pump insertions. James Stokes, RT(R), CRT Novato, California Email: jimstokesrt at gmail.com Cc: cathlabdigest at aol.com