There are two new questions this month: one is in regards to a check-off list for catheter placement, the second question is about whether or not to purchase a back-up defibrillator. 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 Questions:

Catheter Placement Competency Check-Offs
I would like a job description, and/or competency check-off list for placement of EP catheters during diagnostic studies by allied health professionals. Does any facility out there have a policy or procedure regarding this? If so, I would like a copy!
— Vicki Maestas, ARRT R.T.(R)(T)(CV), CVRT/EP, Banner Baywood Heart Hospital
(To reply to this question, please type “Catheter Placement Check-Off” in your subject line.)

Back-up Defibrillator for EP Lab (Second Defibrillator)
A question that continues to be brought up in our lab is that a second defibrillator is required in case of failure of the primary defibrillator. We have tried to find if this is a standard recommendation, etc. Do you have any insight as to where this information can be located, if it in fact exists?
— Mary Hosler, RN, BSN, Bay Regional Medical Center, Bay City, MI
(To reply to this question, please type “Back-up Defibrillator” in your subject line.)

Under 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 atrial fibrillation (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.)

   Your billing department is correct; the transseptal puncture is considered access and does not have a billable code/charge available to it. On the physician side, you can add modifier 22, which indicates that more work was done.
— Lisa L. Withers, RHIT, CCS, CVIR Coding and Compliance Specialist, Providence St. Peter Hospital, Olympia, WA

Check-Off List for Non-Medical Staff
I would love an outline for non-medical staff skills competency check-off list. More and more across the EP world, line access and catheter placement are being performed by non-medical staff. We have been doing this for 2+ years without one.
— Peter Uluave, RN/EP tech, Salt Lake Regional Medical Center, Salt Lake City, UT
(To reply to this question, please type “Check-Off List” in your subject line.)

   I recently transitioned from a major EP catheter manufacturer to independent consultant. In fact, I just celebrated my 30-year anniversary in EP (four EP labs and two catheter manufacturers). I have trained over 100 EPs in a state-of-the-art animal facility and human cardiovascular registry on various EP topics including transseptal catheterization, cardiac anatomy with emphasis on EP applications, basic and advanced ablation techniques, intravascular and epicardial access (including basic catheter placement techniques), intracardiac ultrasound, and ancillary procedural issues. Would such a "hands-on" practical training program be of value to the non-medical staff as part of a check-off process?
— anonymous

Additional Questions Under Discussion:

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.)

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.)

Working in the United States: 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 United States? There seems to be variance from state to state.
— Stuart Allen, Southampton General Hospital, Southampton, Hants, UK
(To reply to this question, please type “Working in the US” in your subject line.)