Readers, thanks so much for your participation this year with EP Lab Digest’s Email Discussion Group! As always, there are more questions this month for discussion. If you would like to join in on the discussion, please email us at eplabdigest@hotmail.com or visit us 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:

Roles in EP Lab
I have two questions. We are having trouble in our lab — hopefully you can help me out. We have three labs, and will be getting our fourth. One of our three labs is an EP lab. We have 3 RTs, 1 RN and an EP coordinator, who is also an RN. How do you handle call time, and what is the role of the coordinator?
— anonymous
(To reply to this question, please type “Roles in EP Lab” in your subject line.)

Under Discussion:

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.)

We do have a back-up defibrillator, although in the five years that I have worked in the lab, we have never used the second defibrillator.
— Jackie Carlson, RN, Genesis Medical Center, Davenport, IA

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.)

I’ll send you a PDF copy of Sutter Medical Center’s document “Procedure for Cath Lab: Percutaneous Transluminal Septal Myocardial Ablation” (CATH_PercTrans SeptalAblation.p1.doc.pdf-duplicate-0.pdf).
— Brenda McCulloch, RN, MSN, CNS, Cardiovascular Clinical Nurse Specialist, Sutter Heart Institute, Sacramento, CA
*Editor’s Note: For a copy of this PDF, please email the editor at “jelrod@hmpcommunications.com”

More 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, DCCVs and TTTs?
— 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.)

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.)