Email Discussion Group: March 2009

Readers, please take a look at the questions below and let us know if you can help answer any of them.You can respond by emailing us at eplabdigest@hotmail.com or visiting us at www.eplabdigest.com. Remember, when responding to the discussion group, don’t forget to let us know if you would like your name and/or location listed.

New Questions:

Late Cases We have a busy lab, and it seems to us that complicated cases are being added or done even at the later part of the day. I wanted to know if there are any labs out there that have a policy or standard regarding late cases that are being done or added on at a later part of the day, especially complex ones. Do you have a limit or cut-off with your cases per day? If so, may we take a look at your policy regarding this matter? — name withheld by request (To reply to this question, please type “Late Cases” in your subject line.) Patient Care What suggestions can you offer in helping with patient care in the EP lab? For example, how do you help patients relax before an EP procedure? Also, what techniques do you use during procedures to make sure everything goes smoothly? (To reply to this question, please type “Patient Care” in your subject line.) Before a procedure, we have our nurses greet the patient and family and offer a preliminary explanation of what to expect today. All physicians involved in said case meet the patient so as to associate a "face with the voice they will be hearing" and also clarify further what will happen and answer any physician-related questions the patient or their family may have. We explain all facets of the procedure, and explain what to expect post procedure. We assure the patients we will give as much sedation as is hemodynamically allowed, especially prior to Foley insertion in AF procedures (a definite patient dilemma area). Once in the lab, we have an iPod with a fairly good mixture of genres and we ask the patient their preference should they have one. During longer procedures (i.e., AF ablations), we make every effort to keep those in the waiting area "up to date" of their loved one's progress. This has shown to be quite beneficial in overall patient/family satisfaction. During procedures such as AF we keep a visible chart of hourly ACTs, fluid in/out, and monitor esophageal temperature along with arterial blood pressure. During VT ablations we have two Zoll defibrillators on either side of the patient with a nurse at each one during V-stim. Our nurses and doctors have an excellent working relationship and mutually work toward patient safety and comfort. We have a monitor in the room near the bedside, so two nurses are always in the procedure room as well. — Edmund Donovan, Clinical Nurse II, New York Presbyterian Hospital-Columbia EP and the Economy Has your EP lab been affected by this economic downturn? How is your EP lab staff managing? What changes, if any, are being made? (To reply to this question, please type “Economy” in your subject line.) Under Discussion: Abandoned Leads New research reveals that abandoning a nonfunctioning lead in an ICD patient is safe and does not pose a clinically significant risk of complication. This study also suggests that lead extraction should be reserved for cases of system infection or when large numbers of leads have been abandoned. How does your lab handle the practice of abandoning leads? Is lead extraction always performed for lead malfunctions? (To reply to this question, please type “Abandoned Leads” in your subject line.) When a dual-chamber pacemaker has a recalled lead and the patient is pacemaker dependent, the chronic lead will be capped and the new RV lead is advanced near the same access site. A venogram is performed prior to the procedure to ensure the left subclavian vein or the left cephalic vein is patent. If this patient would develop a LBBB and EF — Christine J. Reoch, RCIS