Email Discussion Group: September 2007

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.)