Email Discussion Group: February 2008

New Questions: Catheter Recycling I have a concern regarding recycling medical catheters. I have been sending catheters to a recycling company for about 10 years. I have always sent the catheter tips in an envelope provided by the company. I have always sent it through secure and insured mail. I have no way of knowing the value of the tips other than based upon the value of the last shipment. The insurance is only valid for the shipment; after it is signed for, the insurance is invalid. Recently, within the last six months, I have not heard from the recycling company, other than the return signed receipt. I am wondering what recourse we have as customers when this happens. I have sent a letter requesting a response as to why I have not received payment for catheter tips. Any suggestions or comments please. anonymous (To reply to this question, please type Catheter Recycling in your subject line.) I also sent catheter tips to a medical recycling company and have not received payment. I have even hounded [the company] on the telephone, and now I have my purchasing department involved. name withheld by request Inventory/Charging Does any lab use technology (bar coding, cabinets, etc.) to help them with their catheter and equipment inventories and charges? What technology, and how well does it work for you? Any input would be helpful. Thanks! Dale R. Beatty, RN (To reply to this question, please type Inventory/Charging in your subject line.) Corvert At our facility and surrounding area hospitals, there has been a debate about the use of Corvert to chemically convert patients from atrial fibrillation to sinus rhythm without the presence of a physician. At our facility, our current practice is to give the drug in the presence of trained professionals. We interpret this as: in the presence of someone who is ACLS certified. We recently had an ACLS-certified professional refuse to give the drug without a physician present. What is the practice at your facility regarding chemical cardioversions? From my own experience, I have worked at the facility for five years and have given the drug several times without a physician present. I do feel comfortable doing this and often help other professionals administer the drug when they are not comfortable giving it. Lisa Decker, RN, BSN, Genesis Medical Center, Davenport, Iowa (To reply to this question, please type Corvert in your subject line.) In our facility, we tend to administer Corvert when the physician is present, but this is only because our physicians are always present. Our policy is as follows: measure baseline QT, administer 1 mg Corvert over ten minutes if warranted, and re-check QT prior to administering the second dose. Most of our nurses are fairly comfortable administering Corvert and have even been called into Cardiac Cath cases to administer it. Because the likelihood of administering Corvert outside of the lab is low, the likelihood of a physician being present is almost 100% at New York Presbyterian. Edmund Donovan, Clinical Nurse II, New York Presbyterian Hospital Line Access and Cath Placement I would love any information supporting EP lab staff line access and cath placement. anonymous (To reply to this question, please type Line Access and Cath Placement 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.) In our lab we have different doctors that like different ACT ranges. One of our doctors keeps his ACTs between 250-300. We take these ACTs every 20 minutes after the initial 3,000 or 5,000 unit bolus of heparin, depending on patient size. Our other doctor prefers an ACT above 350 and most of the time during the case it is greater than 400. In this case we initially give 5,000 units of heparin, wait 20 minutes and give an additional 3,000 units of heparin. Then we check ACT after another 20 minutes. After that, we check ACTs every 15 minutes. We have had some trouble with oozy groins and recently invested in the wedge. This is basically a big roll of gauze in the shape of a half circle wedge that we place over the groin site and then apply pressure dressing tape over the wedge. This is like someone's hand holding gentle but firm pressure over the site until it has stopped oozing. We try to avoid FemoStop as much as possible. We also have to note that the majority of our a-fibs are done under general anesthesia. Patients are taken to a PACU after the procedure where monitoring is more frequent, which also reduces the incidence of groin problems. Lisa Decker, RN, BSN, Genesis Medical Center, Davenport, Iowa 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.) The CartoSync is an older technology from Biosense Webster replaced by CartoMerge. To ensure that you get the best results, the contrast needs to be in the left atrium and pulmonary veins when you scan. So timing is critical. To integrate your CT scan with the software, you need to ensure that you are utilizing the correct file format. The newer 64-slice CT scanners sometimes utilize DVD formats when burning to a disc. Make sure that you are not using a DVD disc. The CartoSync needs the information on a CD. The source image is actually what you need. It is usually the largest file on an image scan. Enter into the CartoSync application load the disc and scan it. Look for the largest file, usually it is greater than 250 MB. Highlighting it will queue it up. Then click the start button in the middle of the screen. Once the file is loaded, open it and close the dialog window. A white cylinder should be on the screen now. Use the transfer function editor, which is the last tool on the right on the tool bar. This allows you to adjust the color, white, and gray scale to your liking. The punch tools will allow you to slice away all of the other anatomy not necessary. If you erase something by mistake, there is an undo feature, so practice and play with it without worry. Dan Medell, RN, RCES, EP Coordinator, Ogden Regional Medical Center 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.) There is no distributor in Israel for EP MedSystems. You may contact EP MedSystems directly at +1(800)361-6464 for technical support and to order replacement parts for your EP-3i Stimulator. David Montgomery, Product Manager - Electronics and Software, EP MedSystems, Inc. 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.) Our staff currently consists of 2 RTs (one is the coordinator) and 1 RN. The coordinator works regularly in the EP lab. None of the EP labs I have worked in require call time for the EP staff. In one EP lab I worked in, we eventually worked out an alternation of days that three of us would stay to complete procedures. The lab I'm in now is very new and we're still working out certain logistics, so no regular schedule is needed for staying late. We work out amongst ourselves if someone needs to be off or if someone is sick. anonymous 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.) Is your EP in its first 12-18 months of operation? The last EP lab I worked in went through several different work schedules before we got settled into consistent procedure volume. We started with 2 RTs, 2 RNs working 8-hour shifts starting at 7:00 am, then varying from there as the EP physician was building business, working out clinic days (2-1/2 days, 1 entire day). Eventually, we ended up with enough staff and consistent volume to support working four 10-hour days. The day off was automatically rotated (Monday this week, Tuesday the next), so that each staff person got a four-day weekend every so many weeks. Currently, I am in a new program in another area. The program is very new and we are working five 8-hour shifts at this time. Hope this helps! anonymous 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.) The best way to answer your question is to refer you to EP Lab Digest s October 2007 issue (https://www.eplabdigest.com/article/7870), where Christopher M. Nelson, RN, RCIS, FSICP, representing Cardiovascular Credentialing International (CCI), was interviewed about CCI's new RCES exam. In short, when asked to compare the RCES exam and the IBHRE EP exam, Mr. Nelson responded "In working with IBHRE, what we have proposed and what they have supported is that the RCES will be seen as an entry level credential, so this exam would be taken first, and then later one would take the IBHRE s advanced practice examination once they ve gained experience in the field". The RCES exam establishes minimum competency for allied professionals working in the specialized field of Electrophysiology. Doug Passey, RCIS, RCES, RCES Exam Chair, Cardiovascular Credentialing International Other Questions for Discussion: 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.) 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.) 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.) 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.)