Email Discussion Group: March 2008

New Questions: Pause on ECG I want to learn about indications of pacing in patients with ventricular pause more than three seconds according to evidence-based medicine. Is it logical or not to choose >3 seconds? name withheld by request (To reply to this question, please type Pause on ECG in your subject line.) I would refer this individual to the guidelines for permanent pacing that have been established by the American College of Cardiology and the American Heart Association to provide uniform criteria for pacemaker implantation. There are three classes, and those classes are well defined. K. Manfull, RN RCES Exam Have any readers taken the new RCES exam offered by CCI? What are your thoughts on the exam? Was the suggested reading list helpful in your exam preparation? Can you specify any resources to study from in addition to CCI's reading list? Do you have suggestions for preparing for the exam? Many thanks! Toinette Trahan, RT(R) (To reply to this question, please type RCES Exam in your subject line.) In response to your question regarding the RCES exam, I was one of the first 50 individuals to take the pilot test exam and did, in fact, pass. The test was geared as stated to test the newer individual working in the EP lab, and follows the same format as the RCIS exam, so don't expect to see only questions regarding theory and practice of EP. I did not have the benefit of a list of reading material and took it without studying, so I can't help you there. If you have taken the RCIS exam, relook at Wes Todd s program (books or CDs), and keep in mind simplicity this is not an exam to test the more experienced professional. I believe CCI has created this exam as an entry level validation for those new to the EP lab. As an EP professional with 13 years of experience, I found the test to be credible and certainly applicable for the new EP professional. Keep this in mind: if you take the Heart Rhythm Society s EP/AP exam, plan on seeing a whole different program. Be prepared; it s much more difficult! Thanks and good luck! James H. Combs, RCIS, RCES, EMTP Under Discussion: Catheter Recycling I have a concern regarding recycling medical catheters. I have been sending catheters to a recycling company for about 10 years. I have always sent the catheter tips in an envelope provided by the company. I have always sent it through secure and insured mail. I have no way of knowing the value of the tips other than based upon the value of the last shipment. The insurance is only valid for the shipment; after it is signed for, the insurance is invalid. Recently, within the last six months, I have not heard from the recycling company, other than the return signed receipt. I am wondering what recourse we have as customers when this happens. I have sent a letter requesting a response as to why I have not received payment for catheter tips. Any suggestions or comments please. Anonymous (To reply to this question, please type Catheter Recycling in your subject line.) Change your catheter recycling company. I can recommend several companies that will itemize the entire exchange rate for what platinum amounts were obtained from the catheter tips sent in and your return in dollars and cents. You can pick which company you like better for the service and monetary return. We use our recycled monies for the education fund for the cath and EP labs; that way there is no conflict of interest with corporate compliance. Dana St. John, RN Line Access and Cath Placement I would love any information supporting EP lab staff line access and cath placement. Anonymous (To reply to this question, please type Line Access and Cath Placement in your subject line.) We have established a process for training and approving allied professionals (RCIS, RN) for venous sheath insertion via a policy proctored by an EP physician and approved by the hospital s Cardiology Department. Of the two physicians that perform EP procedures, one is on board and one is not. We also had proposals for catheter placement that did not pass, nor did skin closure of implant surgery. Dana St. John, RN Pocket Closure I am a registered nurse in a fairly new EP lab. The only procedures we currently do are EP studies and AICD/Bi-V AICDs. We have one electrophysiologist on staff. He requested that myself, an RN, and another staff member (an RCIS) learn how to close the pocket. He personally taught each of us how to suture the pocket closed. After approximately 10 months, hospital administration told us we were no longer allowed to perform this task, so we quit. Now, two months later, the RN is being formally reprimanded for working out of her "scope" of practice. Do rules about this vary from state to state, institution to institution, or is it just plain wrong for anyone besides the MD to close the pocket? Anonymous (To reply to this question, please type Pocket Closure in your subject line.) Is it in the scope of practice for non-physician cath lab staff to close pacemaker and ICD pockets? name withheld by request EP Lab Work Schedule Our EP lab will be going to 8-hour shifts, 5 days a week in a couple of months. This is a decision that is widely unpopular with our nurses and techs. I am wondering if any other EP labs work 8-hour shifts (all 7-3:30) 5 days a week, and if so, what has been your experience with this scheduling format? Any pros, cons, suggestions? Lee Henry, RN (To reply to this question, please type Work Schedule in your subject line.) We stopped 8 hours due to increased turnover and excessive overtime. We implemented the option for 10 s and 12 s. The reduction in OT offset the expense of additional personnel to manage staffing levels. Good luck! Katrina Dunn, RN Inventory/Charging Does any lab use technology (bar coding, cabinets, etc.) to help them with their catheter and equipment inventories and charges? What technology, and how well does it work for you? Any input would be helpful. Thanks! Dale R. Beatty, RN (To reply to this question, please type Inventory/Charging in your subject line.) Corvert At our facility and surrounding area hospitals, there has been a debate about the use of Corvert to chemically convert patients from atrial fibrillation to sinus rhythm without the presence of a physician. At our facility, our current practice is to give the drug in the presence of trained professionals. We interpret this as: in the presence of someone who is ACLS certified. We recently had an ACLS-certified professional refuse to give the drug without a physician present. What is the practice at your facility regarding chemical cardioversions? From my own experience, I have worked at the facility for five years and have given the drug several times without a physician present. I do feel comfortable doing this and often help other professionals administer the drug when they are not comfortable giving it. Lisa Decker, RN, BSN, Genesis Medical Center, Davenport, Iowa (To reply to this question, please type Corvert in your subject line.) DFT Testing in Patients with Low Ejection Fractions (EF) Less than 10-15% Shaking the bushes to see if anyone has any anecdotal data regarding defibrillation threshold testing during implant in patients with a low EF% of 10 or less: initial shock, second shock, third shock, rescue-limiting inductions and testing to one course or multiple courses. Single initial shock with number of joules 10 less than defib max. Dana St. John, RN (To reply to this question, please type DFT Testing 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.) Wearing Hats and Masks / Bringing Food and Drinks Inside the EP Lab Help! We ve 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 do 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.)