Email Discussion Group: April 2008

New Questions: Hands-on Training Are there any symposiums or classes available in the United States that provide hands-on EP training? Heather Vardon, Aurora BayCare Medical Center, Green Bay, WI (To reply to this question, please type Hands-on Training in your subject line.) Refurbishing Costs How much does Ascent charge to refurbish an AcuNav catheter? name withheld by request (To reply to this question, please type Refurbishing Costs in your subject line.) I think we pay approximately $1,300 to refurbish the AcuNavs. name withheld by request Under Discussion: 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.) 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.) 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.) 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.) 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.) 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.) Our facility recently expanded the recycling from O2 finger probes and compression sleeves to EP lab catheters. So far with Ascent, the communication is open and pleasant. As for catheter tips, the only company I trust is EP Rewards. name withheld by request The recycling of platinum from EP catheters is fantastic. The revenue that comes from this practice is significant. It can be used in so many different ways for the benefit of EP labs and their staff. I have been in EP labs for 11 years, and have recycled EP catheter tips my whole EP career. The EP labs that do this use the revenue for everything from educational opportunities to buying new lead for staff. In the last 11 years I have learned a lot about recycling platinum tips. It is important that you use a recycling company and not a middle man. Platinum is worth over $2,100 per troy ounce as of late February 2008. This is double from a year ago, and 5 times since I started recycling. Many new start-up companies and middle men want a piece of the action, so I suggest that you use a refining company who has done this a long time. Next, choose a company that assigns a value to each catheter. A good recycling company has done their homework and knows how much platinum is in each type of catheter from each major vendor. This is important. It allows you to know the approximate real-time value of your shipment. It also gives you reference to what you should be getting paid, not what a middle man decides you have. Next, the turnaround time should be less than a week from when your package gets to the recycler. This will ensure your real time value, and will allow you to watch the market and send your tips when you think is a good time. Some recyclers collect six- to eight-week batches before they sell it off. However, the market can change fast in that time, and who wants to wait six to eight weeks for a check? In addition, always get references for the company you use. A company that is honest with a great reputation is mandatory for this type of transaction. According to your question, my guess is your platinum and money are long gone. Please continue to recycle, though. It is such a benefit for EP labs. Choose a better vendor. I think if you have a good vendor that the people in the EP world should share the information. I have tried several companies for the purpose of recycling, and in my experience, Cascade Refining provides the best and most honest platinum recycling service. Peter Uluave, RN/EP tech 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. 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.)