Email Discussion Group: June 2008

New Questions: Mobile EP Labs I was wondering if anyone is aware of any functioning mobile EP labs? I have found little information on mobile electrophysiology laboratories. I am specifically wondering how one is set up, the cost to run a mobile lab, funding for the lab, and how staffing works for this type of facility. — name withheld by request (To reply to this question, please type “Mobile EP Labs” in your subject line.) Conscious Sedation The discussion of “moderate sedation” or conscious sedation has been the subject of a lot of discussion in our lab. We are supposed to be sedating moderately, but we often find the physicians pushing for deeper sedation for DFTs. Currently we do not use CRNAs or anesthesia for this purpose; the RNs in the lab maintain adequate sedation levels. I've recently been researching “procedural sedation” to see if that would better describe what we do as opposed to moderate sedation. I continuously am searching for standards of practice for sedation in EP labs, particularly for long cases and DFTs. Any discussion would be helpful. — Jill, RN (To reply to this question, please type “Conscious Sedation” in your subject line.) Under Discussion: EP Schools I was wondering if someone can let me know if there are any EP schools other than the Carnegie Institute in Troy, Michigan? I live in upstate New York. — Ross Scardino (To reply to this question, please type “EP Schools” in your subject line.) Operators Do other EP labs have both nurses and RTs operate the EnSite ablation computers and the diagnosis EKG computers (like Bard), or are these usually operated by just the RTs? — name withheld by request (To reply to this question, please type “Operators” in your subject line.) Diastolic Time Indices I am a cardiology fellow at the University of Utah. My question is why aren’t abnormal phonocardiographic indices such as pre-atrial diastolic time and accelerated atrial diastolic time in heart failure used? Is the shortened diastolic time due solely to the abnormal systolic time intervals (prolonged EMD)? — Osman Ahmed, MD, University of Utah, Salt Lake City, UT (To reply to this question, please type “Diastolic Time Indices” 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.) 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.) 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.) 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, IA (To reply to this question, please type “Corvert” in your subject line.)