There are several new questions this month. Readers, 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:

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.)

NIPS, Cardioversions, Tilt Table Testing
How many labs perform NIPS, DCCV's and TTT's?
— anonymous
(To reply to this question, please type “NIPS/DCCV/TTT” 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.)

EP Protocols/Procedure Lists
We are expanding into EP procedures (i.e., ablations, EP studies, mapping) when our electrophysiology lab opens soon. We would very much appreciate some help with protocols/procedure checklists for EPS, ablations (right atrial and AV nodal), and CRT-D procedures. We are very experienced with caths, interventions, pacer and ICD insertions, but are starting an EP service from scratch. Thanks for your help!
— Cindy Muto, RN
(To reply to this question, please type “EP Protocols” in your subject line.)

Alcohol Septal Ablation
Does anyone have, or are they willing to share, established written procedures for this procedure? In addition, if performing this procedure, do you use ECHO contrast? If so, how is it administered?
— name withheld by request
(To reply to this question, please type “Alcohol Septal Ablation” in your subject line.)

Under Discussion:

ICD Complication Rates
What are the national averages for lead dislodgements for ICDs? Thanks for your help!
— anonymous
(To reply to this question, please type “Complication Rates” in your subject line.)

   If you are submitting data to the ACC-NCDR ICD Registry, they give this benchmark in their report.
   The ACC-NCDR also provides the following areas for benchmarking with the national data registry:
• Cardiac Arrest
• Drug Reaction
• Cardiac Perforation
• Cardiac Valve Injury
• Conduction Block
• Coronary Venous Dissection
• Hematoma-Esophageal
• Lead Dislodgement
• Hemothorax
• Pneumothorax
• Peripheral Nerve Injury
• Peripheral Embolus
• Phlebitis-Superficial
• Phlebitis-Deep
• TIA
• CVA
• MI
• Pericardial Tamponade
• AV Fistula
• Infection to Device
• Death in Lab
   These reports are distributed quarterly with comparison to facilities of your volume and services provided along with national benchmarking. This registry is a mandated registry for institutions that are implanting ICD in all Medicare populations. Hope this helps.
— Pamela Hetrick, RN

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.)