Email Discussion Group: New Year, New Questions

Currently Under Discussion: R2 Pads Does anyone routinely position the R2 pads under fluroscopy so that they are placed exactly over the heart? R. Sparrow, RN We do not use flouroscopy to position the pads directly over the heart. However, during our EP cases, we prefer the pads to be in an anterior-posterior position. We are a pediatric facility but we almost exclusively use anterior-posterior pads. We use the Zoll radioluscent pads for adults and the Medtronic physio-control radioluscent pads for children under 15 kg. L. Payne, RN In the full service EP lab where I work, we do not routinely use fluoroscopy to position the rescue pads. All of our patients receive a set for all procedures other than a loop recorder implant, even device changeouts because lead damage and subsequent replacement is possible. This relatively new approach was brought to us by a physician who at one time was depicted in a cartoon drawing with the pads adhered to each of his buttocks because he was so adamant about fluoroscopic positioning. By the way, we are using bi-phasic equipment and have not experienced external defibrillation or pacing failure. J. James, RN No. Ours are positioned on the left lateral chest nipple line and posteriorly to the right of the spine below the scapula. Anonymous Propofol for Moderate Sedation Our lab is looking for policies/procedures/guidelines on using IV Propofol (bolus and/or drip) for our longer EP procedures. Does anyone have any information that can help? Randy Shaffer Our own hospital policy does not cover the nurses using Propofol drips for conscious sedation at this time. This med falls beyond the criteria for MODERATE sedation. If there are institutions out there that do this with their nurses, I would be happy, curious and interested to see how they've implemented their P&P. R. Pecana We have been using a Precedex for our longer cases. This allows us to use less Versed and Fentanyl. It's a little tricky to get used to initially. We have been using it for our atrial fibrillation cases and has worked wonders. G. Cusworth, RN At my facility, anesthesiologists cover for all EP and Cath procedures. This is so the RN and technician can dedicate time to managing the patient and getting the needed equipment. M. Sayre, RCIS/EP Currently, at St. Peter's Hospital in Albany, New York, only the anesthesia department can administer Diprivan for OR procedures, and when they are with us for ICD implants, NIPS, and cardioversions. The critical care areas are the only patient care area that have a policy for sedating the patients with Diprivan, when the patient is on a ventilator. It is not within our scope of practice in New York State, as RNs in the EP lab, to use Diprivan; only CRNAs, under the anesthesiologists, may administer Diprivan. Our quality assurance liason did extension literature review and inquiries regarding the topic of discussion. K. Kaczmarek, RN We do not currently use this, but our doc would love to have it. I would like to see a policy also. M. Perez, RN, MS There is at least one article written by a group of GI physicians supporting the use of trained non-anesthesia personnel (RNs in this case) to provide Propofol sedation. There are nursing articles about the use of Propofol in ICUs for sedation of patients who are intubated and who are already in the care of nurses. R. Kidd, RN