Readers, there are lots of new questions for this month’s discussion group. 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 Questions:

Antibiotics
Our electrophysiologist wants to know what is the standard practice for antibiotics post PM and ICD implants. He currently gives a second dose of IV antibiotics, and no oral antibiotic is given at home. Is it common to send patients home on oral antibiotics?
— Janice Christian, RN, CCRN
(To reply to this question, please type “Antibiotics” in your subject line.)

Wearing Hats and Masks / Bringing Food and Drinks Inside the EP Lab
Help! We have been having major discussions about allowing food and drinks into the EP lab. Also, what is the protocol for wearing hats and masks during ablations? We would like to know what other facilities’ practices are. What does the policies and procedures read, and what is the actual compliance based on the policies and procedures?
— Janice Christian, RN, CCRN
(To reply to this question, please type “Inside the EP Lab” in your subject line.)

Atrial Fibrillation Ablation
We are newly starting to do atrial fibrillation ablations, and I was wondering if anyone could give me examples of their institution’s policy on AF ablations?
— anonymous
(To reply to this question, please type “AF Ablations” in your subject line.)

Service for the EP-3i Stimulator
At our hospital (E. Wolfson Medical Center), there is an EP-3i Stimulator that needs technical service (we need to buy a key pad). Is there a distributor in Israel?
— S. Hanan
(To reply to this question, please type “EP-3i Stimulator” in your subject line.)

CT Scanner Integration
I am currently working with a Toshiba 64-slice CT scanner, and would like more knowledge on the integration with CartoSync. Where can I find more information about CartoSync?
— Michael J. Moore BSRT, CT
(To reply to this question, please type “CartoSync” in your subject line.)

Reader Question of the Month:

- EP Exams Has anyone used the online tutorial from HRS and taken the Cardiac Pacing and Defibrillation Exam in the same year? What are your thoughts about the tutorial with regard to passing the exam? Also, how do you feel about the new RCES certification from the SICP that was unveiled this year? Has anyone taken this exam yet? Did the SICP exam appear more difficult than the HRS’ EP exam, and which exam do you feel is perceived as the state of the art and respected more by peers and employers? — Dana St. John, RN (To reply to this question, please type “EP Exams” in your subject line.)

Under Discussion:

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.)

Here is the tilt table test protocol from Mid-America Cardiology (“HUT Clinical Resource Guide.pdf”).
— name withheld by request
*Editor’s Note: For a copy of this PDF, please email the editor at “jelrod@hmpcommunications.com”

I’ve been away for awhile. If you are still interested in EP protocols, contact me and I will be glad to assist you with any needs you may have.
— Dana St. John, RN

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.)

We use Signature Elite ACT monitoring meters.
Our PVIs are bolused with 5000–7000 units of heparin, then we check ACTs q 30 minutes and try to maintain ACTs greater than 300.
— Kelly Williams

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.)

We do NIPS in the EP lab, tilts in the EP lab or the tilt room depending on the need for art line access, and cardioversions are done in the Cath lab recovery area. Hope this helps!
— Alison Swarens, RN, BSN, CCRN, Electrophysiology Program Coordinator

Our lab does perform NIPS. We do not do cardioversions or tilt tables. The defining issue is EP lab availability. The EP docs do not want the EP/Implant labs being utilized by other non-EP docs for cardioversions and tilt table studies. Only EP docs perform NIPS, so we do them in the lab or if another room is available, the EP staff will assist.
— Dana St. John, RN


More Questions:

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.)

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.)

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.)

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.)

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.)