Afib Ablations

Wed, 7/8/09 - 9:29pm
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Two physician groups at our hospital have recently recruited Atrial Fib docs. We do not currently have an Afib program in our EP lab. Plans have been made to purchase ESI mapping system and we use EP Med Systems. Does anyone have suggestions or a guide on how we should go about training our staff? The biggest part of learning is the plan; any help would be appreciated, especially orientation timelines, classes that would be helpful and/or books that could be helpful for the beginner staff. We currently do more simple ablations, aflutter, SVT, WPW, that sort of thing.

Anonymoussays: November 23.2009 at 16:16 pm

I currently work at a facility that does afib ablations. I am a registered nurse.
We use ESI and have EP Med.(we also use carto)
We trained ourselves and have maintained a standard AFib set up, so I cannot guide on training lengths, speak to ESI and EP Med and see what classes they can provide.
Standard AF set up: Patient prep: NAVIX pads, NPO after midnight. The odd case is done under anesthesia.
defib pads on everyone, 12 lead EKG, hemodynamic monitoring, 2 peripheral IV, 20g minimum, one for IV Heparin and one for sedation (we do all fib's under conscious sedation), foley urinary catheter (very long cases) start with a nasal cannula oxygen but have a 100% mask available, grounding pad to right scapula and abdomen.
Table prep: 3-4 sheaths depending on what the doctors want:
minimum of 3, 6Fr for a CS catheter, 2 8Fr, will be exchanged over to transeptal sheaths.
Heparinized saline, contrast, and normal saline for fluid.
2 pressure tubings, transeptal needle, 2 transeptal sheaths(we use the bard Channell FX and they also have great training classes), toray wire.
As far as Pulmonary Vein catheter we use Bard's Orbiter PV and also Biosense Webster's Lasso (both are 20 poles)
The other catheter is an ablation of choice...we use thermocool (Navistar/Carto) and with ESI we use Chilli2.
Expect a long procedure, we do ACT monitoring every 20 minutes, run our ACT's 275-300
Post procedure echo is a standard for us, to R/O effusion...
Sheaths are removed for an ACT of 180 or less, patient is on bedrest minimum 4 hrs after sheath removal, and the patient is admitted to our Interim Coronary Care Unit post procedure.
I hope this is helpful.
My email address is donna_acorn@yahoo.com