Email Discussion Group: December 2007<br />

New Questions: EP Lab Work Schedule Our EP lab will be going to 8-hour shifts, 5 days a week in a couple of months. This is a decision that is widely unpopular with our nurses and techs. I am wondering if any other EP labs work 8-hour shifts (all 7-3:30) 5 days a week, and if so, what has been your experience with this scheduling format? Any pros, cons, suggestions? Lee Henry, RN (To reply to this question, please type Work Schedule in your subject line.) DFT Testing in Patients with Low Ejection Fractions (EF) Less than 10-15% Shaking the bushes to see if anyone has any anecdotal data regarding defibrillation threshold testing during implant in patients with a low EF% of 10 or less: initial shock, second shock, third shock, rescue-limiting inductions and testing to one course or multiple courses. Single initial shock with number of joules 10 less than defib max. Dana St. John, RN (To reply to this question, please type DFT Testing in your subject line.) Pocket Closure I am a registered nurse in a fairly new EP lab. The only procedures we currently do are EP studies and AICD/Bi-V AICDs. We have one electrophysiologist on staff. He requested that myself, an RN, and another staff member (an RCIS) learn how to close the pocket. He personally taught each of us how to suture the pocket closed. After approximately 10 months, hospital administration told us we were no longer allowed to perform this task, so we quit. Now, two months later, the RN is being formally reprimanded for working out of her scope of practice. Do rules about this vary from state to state, institution to institution, or is it just plain wrong for anyone besides the MD to close the pocket? anonymous (To reply to this question, please type Pocket Closure in your subject line.) EP Training I have taken a job in the cath lab. I am an RT, wishing to obtain EP training. Could you please tell me where I could go to get effective training without being away from my children for months? Thanks! Cyndi, Ft. Smith, Arkansas (To reply to this question, please type EP Training in your subject line.) Under Discussion: ACT Guidelines I was just wondering what people are using for ACT guidelines during pulmonary vein isolations. I am also curious as to what ACT machine they are using. Heidi Helmer, RN, BSN (To reply to this question, please type ACT Guidelines in your subject line.) As far as guidelines for ACT readings in pulmonary vein isolations (PVIs), we like to keep the ACT as close to 300 as possible, ± 20 points. To achieve this end, we administer roughly 2,000-3,000 units when the right atrial catheters are inserted, followed by another 4,000-5,000 units post first transseptal puncture and heparin drip started at 1,000 units/hour. Our first ACT is checked roughly 15 minutes after the drip is started. If the ACT is therapeutic, or close to being therapeutic, we will then check another ACT roughly 60 minutes later. If the ACT is lower than we like, we follow the ACT more aggressively, i.e., every 15 minutes until the desired range is achieved. After this, the ACT is checked every hour. The heparin drip is turned off just prior to when the left atrial catheters are returned to the right atrium and the patient is extubated. The ACT machine we use is Hemochron Response (SN #4105). Edmund J. Donovan, Clinical Nurse II, New York Presbyterian Hospital-Columbia We are going to use the Medtronic ACT plus, and some of our doctors have expressed concern regarding the real time ACT that it may delay therapy during ablations. Our current thought is a therapeutic ACT = 250, that s a four-minute wait. name withheld by request EP Exams Has anyone used the online tutorial from HRS and taken the Cardiac Pacing and Defibrillation Exam in the same year? What are your thoughts about the tutorial with regard to passing the exam? How do you feel about the new RCES certification from SICP that was unveiled this year? Has anyone taken this exam? Did the SICP exam appear more difficult than the HRS EP exam, and which exam do you feel is perceived as the more state of the art and respected more by peers and employers? Dana St. John, RN (To reply to this question, please type EP Exams in your subject line.) Antibiotics Our electrophysiologist wants to know what is the standard practice for antibiotics post PM and ICD implants. He currently gives a second dose of IV antibiotics, and no oral antibiotic is given at home. Is it common to send patients home on oral antibiotics? Janice Christian, RN, CCRN (To reply to this question, please type Antibiotics in your subject line.) Wearing Hats and Masks / Bringing Food and Drinks Inside the EP Lab Help! We ve been having major discussions about allowing food and drinks into the EP lab. Also, what is the protocol for wearing hats and masks during ablations? We would like to know what other facilities practices are. What do the policies and procedures read, and what is the actual compliance based on the policies and procedures? Janice Christian, RN, CCRN (To reply to this question, please type Inside the EP Lab in your subject line.) Atrial Fibrillation Ablation We are newly starting to do atrial fibrillation ablations, and I was wondering if anyone could give me examples of their institution s policy on AF ablations? anonymous (To reply to this question, please type AF Ablations in your subject line.) Service for the EP-3i Stimulator At our hospital (E. Wolfson Medical Center), there is an EP-3i Stimulator that needs technical service (we need to buy a key pad). Is there a distributor in Israel? S. Hanan (To reply to this question, please type EP-3i Stimulator in your subject line.) CT Scanner Integration I am currently working with a Toshiba 64-slice CT scanner, and would like more knowledge on the integration with CartoSync. Where can I find more information about CartoSync? Michael J. Moore BSRT, CT (To reply to this question, please type CartoSync in your subject line.) EP Protocols/Procedure Lists We are expanding into EP procedures (i.e., ablations, EP studies, mapping) when our electrophysiology lab opens soon. We would very much appreciate some help with protocols/procedure checklists for EPS, ablations (right atrial and AV nodal), and CRT-D procedures. We are very experienced with caths, interventions, pacer and ICD insertions, but are starting an EP service from scratch. Thanks for your help! Cindy Muto, RN (To reply to this question, please type EP Protocols in your subject line.) NIPS, Cardioversions, Tilt Table Testing How many labs perform NIPS, DCCVs and TTTs? anonymous (To reply to this question, please type NIPS/DCCV/TTT in your subject line.) Readers, we need your help! These questions have yet to be answered: Roles in EP Lab I have two questions. We are having trouble in our lab hopefully you can help me out. We have three labs, and will be getting our fourth. One of our three labs is an EP lab. We have 3 RTs, 1 RN and an EP coordinator, who is also an RN. How do you handle call time, and what is the role of the coordinator? anonymous (To reply to this question, please type Roles in EP Lab in your subject line.) Loop Implant/Explant I was just wondering what some protocols are for loop procedures, particularly explants. I have recently been told that loop explants should take place in a positive pressure room. Any comments on this matter would be appreciated. Edward Muxlow (To reply to this question, please type Loop Implant/Explant in your subject line.)