Email Discussion Group: February Question

New Question: Late Cases and Call How does your lab cover late cases? Do staff do call? How many staff are there per case? Kathleen MacDonald, RN (Readers, to reply to this question, please type Late Cases in your subject line.) We have the call team stay late to cover cases. We have three staff members. name withheld by request Late cases have been a small problem; at this time we do not take call, but we stay until cases are done. This can sometimes cause problems with life outside the EP lab. We are in the process of cross-training a few cath lab folks to help us, but at this time we don't have the volume to justify a call team with only four full-time personnel. I think the question has become (from a business standpoint): can it wait until the next day, or can we get it done today, discharge patient and make more money from the DRG? Douglas Kline, (RT)(R)(CV), Specialty Leader, EP lab Holy Spirit Hospital, Camphill, PA We have five staff members (one 0.8 FTE CVRT, two 0.9 FTE RNs, two 0.5 FTE RNs). One PT RN does late cases (scheduled 7:30am-4pm) every other day. On the days that the one PT RN is off, we rotate late coverage. Everyone else works until approximately 3pm. If the case warrants it, we take turns on who will stay with the late person. We have a good cohesive team, so it works out well. Do staff do call? NO CALL! Monday-Friday, no weekends, no holidays. How many staff are there per case (excluding the MD)? Pacemaker(DDD, VVI, Bi-V)/generator change: 1 CVRT or RN as scrub, 1 circ RN (circs and sedates) ICD (DDD, VVI, Bi-V)/generator change: 1 CVRT or RN as scrub, 1 circ RN in the room (circs and sedates), one RN on standby for ICD test Cardiac caths: 3 staff (one monitor: CVRT or RN, one circ RN to circ and sedate, and one scrub: CVRT or RN) Loop recorder: 1 staff as scrub; generally a straight local case Central lines: 2 staff (all of our RNs scrub/pan under MD supervision for these cases), one in the room for both sedation and non-sedation cases one "runner" TEEs/synchronized CDV: 1 RN to sedate Tilt table study: 1 RN Note: In our lab, only the RNs sedate by moderate sedation, using Fentanyl and Versed IVP for our procedures. We don't pre-med with PO or IM sedation. We rarely use anesthesia. Hope this helps! Marie Fortuno-Shifflett, RN, BSN, GBMC, Department of Invasive Cardiology, Baltimore, MD Under Discussion: Placing Sheaths What about placement of femoral venous and/or arterial sheaths for EP catheters? Also, if non-MDs are placing sheaths, what are their qualifications, and are there protocols for credentialing, etc.? Esther Weiss, RN, MSN, Manager, Cardiac Arrhythmia Center (Readers, to reply to this question, please type Placing Sheaths in your subject line.) We instituted training for venous sheath placement and catheter manipulation. It required several submissions to the hospital before they accepted.  We also developed an extensive training manual that is not in electronic form, but if an institution wants a copy, we could have some made. It is long and has lots of color plates, hence could be a little expensive to duplicate. James McClelland, MD and Mitch Costin, RT, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Eugene, OR Editor's Note: For a copy of this proposal, please contact the editor at:jelrod@hmpcommunications.com.