Readers, let us know if you can help provide any information on the questions listed below; if you would like to respond, please email us at eplabdigest@hotmail.com or visit us on the Web at www.eplabdigest.com (click on the email discussion group link). Remember, when posting or responding to the discussion group, please let us know if you would like your name, location, and/or email address listed as well. We look forward to hearing from you!

New Question:

Skills List for Nurses Working in the EP Lab
We are revising our policies and procedures manual, and I wanted to include a skills list for EP nurses. Would you know where I could find this information in order to tailor one for my department?
— Jacqueline Owen, RN/EP Nurse
(To reply to this question, please type “Skills List” in your subject line.)

Under Discussion:

Prerequisites for Transitioning from Cath to EP
As with the excellent description of Lancaster General’s in-house EP training, I’m looking for either competency statements or examples of performance reviews for a new lab. Any input?
— Jerome Leblanc, RCIS
(To reply to this question, please type “From Cath to EP” in your subject line.)

   Our annual competencies are a combination of JCAHO/DOH/Hospital/Departmental requirements. Staff is expected to complete all hospital, DOH and JCAHO competencies annually while departmental competencies can be quarterly, semi-annually, or annually. As an example, our staff is required to close pacemaker/ICD pockets. They participate in a classroom lecture on aseptic technique provided by surgical services and a wound closure lecture provided by our EP tech (who also happens to be a surgical technologist). Next they have classroom lab time with porcine specimens and must demonstrate proper wound closure several times on the specimen for the EP tech/surgical tech. They are then paired with a preceptor in the clinical lab for 30 weeks, functioning in all positions. During this 30 weeks, the new staff member is expected to close at least 50 pockets, with supervision, prior to being signed off by the Medical Director as competent in wound closure. After the Medical Director has signed the staff member as competent, they must have 50 documented wound closures annually to maintain competency. Additionally, our staff is required to validate competency annually on surgical site prep and drape. Many of the departmental competencies have been developed as a result of Performance Improvements.
— Lisha Esbenshade-Smith, EP Internship Educator, Lancaster General Hospital

Table Set-Up
We need some advice in reference to setting tables for diagnostic cases. Do any labs out there have policies or written procedures for gowning and gloving to set tables? The staff at a lab I used to work at just put on gloves to set tables — this went on for 18 years without any infection problems. Now new infection control people from surgery have stated that everyone should mask, gown, and glove. Is there any data out there to support either case?
— Rick Smith, CVT
(To reply to this question, please type “Table Set-Up” in your subject line.)

   Over the past several years we have watched our EP lab fall under the standards practiced by OR. Their guidelines come from the organization AORN (Association of periOperative Registered Nurses) and a book called Standards, Recommended Practices, and Guidelines. We had in the past done the same as the inquiring individual and used sterile gloves to set up. Now we follow standard operating room procedures (pre-clean the room qam, after each case, and also terminally clean the room at the end of the day, cases or not). We make sure that we are gowned, gloved and masked to drape the patient. As far as data to support this position, I am inquiring of our infection control nurse to see if anyone has this info. She will be the one to know, and I will pass her information on. Hope this helps. Succumb to the OR policies — they are the powers that be for the moment.
— Kathy Manfull, RN

Training Classes
I am looking for electrophysiology classes for a radiologic technologist. I hear there is a hospital in Lancaster, Pennsylvania, that may have classes. Does anyone know anything about this? It can be in any eastern state, but Pennsylvania is close to me. I am looking for training classes that are about 2–3 days long. Please list places and contact information.  
— Di Robbins
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   The training education at Lancaster General Hospital, Lancaster, Pennsylvania, is a one-year training program for new employees; 330 hours of didactic/lab education in 22 weeks with the remainder of the time in the clinical lab. We look for motivated individuals who have two years in interventional cardiology, two years in interventional radiology, or two years of recent critical care nursing. Although we use these as guidelines, we have found that the staff member who is highly motivated to learn EP, regardless of credentialed status, is successful in our program. I am not aware of any 2- or 3-day classes offered for EP education.
— Lisha Esbenshade-Smith, EP Internship Educator, Lancaster General Hospital

Device Cases
Recently one of our physicians asked our staff members if we can obtain the training to close the pocket of a pacemaker, ICD, or a Reveal. Currently at our hospital, the only people that can close the pocket are physicians, residents, and First Assistants (FAs). To obtain a First Assistant certification, most places want you to be a current scrub tech or RN with 3+ years experience in the OR. The problem is that in our EP lab, RTs and one scrub tech are the only people that assist with the implant cases. Therefore, we fall out of the RN/ST category as a whole. We are also in a very rural area, so the classes offered are all out of state. What are other EP labs doing for an RT(R) to be able to close the pocket, if your hospital allows it?
— Jonathan Sheets, RT(R)
(To reply to this question, please type “Device Cases” in your subject line.)

   I received training from the suture rep, who called on our EP lab and OR. Most of us who scrubbed implants (RTR, CVT, RCIS) had the option of learning this skill. The rep was able to complete the training in a couple of four-hour evening sessions. After the classes, we were able to start closing under the physicians’ close supervision. Once the physician felt comfortable and we completed the competencies, we were able to close on our own. We had to remain current by doing X number of cases in a year’s time. We also had the full support of the First Assistants. The physicians of course loved it, because they could go on and do their dictating, then move on to the next procedure while we finished up for them.
— Vince Bontempo, CVT

Working in the US: State Licensing
I am a cardiac physiologist (CVT) from the United Kingdom, and am trying to find out about state licensing. Do I need to be licensed to work in the US? There seems to be variance from state to state.
— Stuart Allen, Southampton General Hospital, Southampton, Hants, UK
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   I am not sure what an exercise physiologist is, but there is no license required for an Electrophysiology Technologist, at least not in Pennsylvania. Will you clarify what a Cardiac Physiologist is/does?
— Lisha Esbenshade-Smith, EP Internship Educator, Lancaster General Hospital

Additional Questions For Discussion:

Billing for Transseptal Punctures
I have a question regarding billing for transseptal punctures. Our billing department at New York Hospital states that we cannot bill for a transseptal puncture during an AF ablation because it falls under the category of “access.” This is confusing to me as the cath side can bill for the same procedure under a valvuloplasty. How do other institutions, or do you, bill for this portion of the AF procedure? Thanks.
— Edmund Donovan, RN, CN II, New York Presbyterian Hospital, New York, NY
(To reply to this question, please type “Billing” in your subject line.)

Grounding Pads
We need some advice in reference to the correct placement of the grounding pad for RF ablation. In our lab, we have placed the pad toward the left side of the upper back. Are there alternative sites that can be used for RF ablation?
— Elizabeth Gotay, EP RN
(To reply to this question, please type “Grounding Pads” in your subject line.)

EP Lab Clinical Nurse Specialist
I’m looking for a job description for an EP Lab Nurse Specialist. This would be someone who does all aspects of procedures and also staff education, patient pre- and post-teaching, including post-procedure follow-up.
— David Reynolds, RN/RCIS, Southwest Washington Medical Center, Vancouver, WA
(To reply to this question, please type “Nurse Specialist” in your subject line.)

Stereotaxis Niobe vs. Hansen Sensei
I am interested in opinions from clinicians who have experience using the Stereotaxis Niobe 2 system and Hansen Medical’s Sensei system. Feel free to express any thoughts regarding ease of use, economics, clinical efficacy, procedure speeds, safety, etc. I am especially interested in those clinicians who have performed human procedures using the Hansen system.
— anonymous
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