Email Discussion Group: February 2007

New Questions: EP Data Entry I am interested in software that would help keep physicians' statistics, inventory, billing, and complications for the EP lab. Is there any software package that would be available or could be recommended? Marshall Sayre, Chief of EP Tech (To reply to this question, please type EP Data Entry in your subject line.)   I had never seen a software application that recorded all of these items in one place, so I developed my own based on Microsoft Excel spreadsheets and Access databases. The spreadsheets track procedures by physicians and type each month, provide a running year-to-date total, compare the current year to previous years, and help predict changes for budget preparation. It also tracks device usage and costs, as well as supply costs. The database tracks procedures and procedure duration along with supplies used, procedure indication, and complications. The bad news is that you need to load the data and verify accuracy, but the good news is that it is easy to modify when things change because it isn't proprietary software. When I've been responsible for making the department budget, I'm usually on target using this system. I'd be glad to show it to you if you want.  Howard Mattingly, RN, Team Leader, EP Lab, Methodist Hospital, Indianapolis, IN Reps in EP Lab We are starting up a new EP lab. There has been some discussion about the role of reps. Our OR doesn't allow reps to do anything; they don't usually allow them in the room. We use reps for implants. What are the guidelines for reps in EP labs? Do you use OR standards for your labs? Hollie Fitzsimmons, RN (To reply to this question, please type Reps in EP Lab in your subject line.)    Regarding reps in the EP lab, we have a device company rep in the room for all device procedures. They do the initial and final device programming, testing leads, etc. anything that involves operating the device programmer. This also includes NIPS and VF induction for DFTs. They are also a resource for troubleshooting, difficult implants, etc.  We do a large number of device procedures, and we have the same group of people here all the time (in fact, most of them worked in our lab prior to going to industry), so staff and physicians are comfortable working with them and trust their expertise. Susan Deck, BS, RN, EP Educational Coordinator, Lancaster General Hospital, Lancaster, PA.  In the OR suites, the reps only perform activities directly related to their products; this includes handing off sterile leads, catheters, sheaths, wires, and devices. I also utilize them for staff inservices. Shawn Heffernan, RN.  All of the EP labs I've worked in have allowed reps in to support implants using their products. Implantable devices are complex, and reps usually know the quirks and special features of their products better than anyone else. In some labs the staff are trained to support the implants so the reps are not needed, but the reps usually support the staff until they are comfortable doing cases alone. If you go that route, make sure the reps do regular product updates so you can stay current with new product lines and features. Howard Mattingly, RN, Team Leader, EP Lab, Methodist Hospital, Indianapolis, IN ICD Support Group Our institution is planning to initiate an ICD support group and would like to hear from others what they found worked and what did not. Our community is multi-ethnic, with a large Asian population as well as Hispanic and Greek. I realize there are cultural boundaries that must be addressed, and wondered how others have worked it out. anonymous (To reply to this question, please type ICD Support Group in your subject line.)    When we started our ICD support group in 1998 (before MADIT II), the anxiety level of those patients and significant others was tremendous. Since MADIT II, the patients don't seem to have as much anxiety initially. However, once they begin getting therapy (shocks), the anxiety level again becomes a factor.  We have a meeting once every three months; one hour is spent on a specific topic, and one hour is spent on sharing and explanation/questions. It is important to have one or more "experts" (nurses/technicians) walk around as they are sharing. You would be amazed at the many misconceptions that are shared; the "experts" can quell some of these.   If anyone is interested, I would be happy to share topics/format. Gina Cusworth, RN, Manager, EP Laboratory, St. Joseph's Hospital Health Center, Syracuse, NY First Assistant Allied Professional We in the EP community are all aware that some institutions support the practice of non-MD EP personnel training and certification to insert venous sheaths and place catheters in the heart for EP studies. Is there or should there be a credentialing program that is similar to the RN First Assistant program for OR nurses that will provide the didactic and lab experience to certify desiring APs the licensing to perform sheath insertion, catheter insertion and placement and wound closure of implants? Dana St. John, RN, HealthPark Medical Center Cardiac EP/Implant Lab, Fort Myers, FL (To reply to this question, please type First Assistant AP in your subject line.)    I've heard of many programs allowing EP lab staff to insert sheaths and catheters or to close incisions. The only formal program I've ever heard of was being established by Lancaster General Hospital in Pennsylvania, and was being developed in conjunction with a local college. I'd love it if a program like that was generally available and accepted the way the RN First Assistant program in the OR is.  Two things need to be remembered, though. The RN First Assistant programs build on the existing RN license, and I think they are only certification programs. Also, having the certificate only helps if your hospital will recognize and allow you to use it. Be sure your administration will support such a program (if they allow RN First Assistants to practice, they probably will) before you take the course. Howard Mattingly, RN, Team Leader, EP Lab, Methodist Hospital, Indianapolis, IN Training Classes I'm looking for electrophysiology classes for a radiologic technologist. I hear there is a hospital in Lancaster, Pennsylvania, that may have classes. Does anyone know anything about this? It can be in any eastern state, but Pennsylvania is close to me. I'm looking for training classes that are about 2 - 3 days long. Please list places and contact information.   Di Robbins (To reply to this question, please type Training Classes in your subject line.) Under Discussion: Recycling Platinum Tips I am a new Nurse Manager to the Cath/EP lab, and one of my staff brought to my attention that we could possibly recycle the platinum tips off of the catheters and get some money back for our hospital. Does anyone know anything about this, as far as who do you send them to, as well as the steps involved in doing it? Thanks for any help that you can give me. Brad Massey, Nurse Manager, Little Rock VA Hospital, AR (Readers, to reply to this question, please type Recycling Platinum Tips in your subject line.)    A hospital using a contractor for recovering precious metal (platinum) is an important decision not to be taken lightly. Metalor Technologies USA has an extensive program that covers state and federal compliance issues. Email or call at 508-699-8800 ext. 251 and ask for Jake Shireman. Metalor is an International Primary Precious Metal Refinery; their Web site is www.metalor.com. Ask Metalor about regulations, shipping and other state and federal issues. They can also accept EP tips for processing for your team. Mike Gullison Pay Scale Differences Since the EP/Cath lab is a multidisciplined venue, we have a multi-talented group that consists of a variety of different credentialed personnel. I would like to recruit answers/input from the EP Lab Digest readers to my question: What is the pay scale(s) or pay ranges for CVT, RCIS, RCIS, and RNs? For example, here is the approximate pay scale we have at our institution: RN: $29.00 - $32.00; RCIS: $25.50 - $28.50; CVT: $23.50 - $25.50; On call: $4.00 per hour. Patricia C. (To reply to this question, please type Pay Scale Differences in your subject line.)    I think it would depend on what area in the country you live. For example, $28.00 - $30.00 for an RN is excellent in the Southeast, but in the Northeast it would be very low. Mary Creed, RN, Medical University of South Carolina Check-Off List for Non-Medical Staff I would love an outline for non-medical staff skills competency check-off list. More and more across the EP world, line access and catheter placement are being performed by non-medical staff. We have been doing this for 2+ years without one. Peter Uluave, RN/EP tech, Salt Lake Regional Medical Center, Salt Lake City, UT (To reply to this question, please type Check-Off List in your subject line.)    I can email you a check-off list for sheath insertions that is utilized by our institution. However, I would need to get permission to release this to you, probably with conditions attached. Let me know. Dana St. John, RN Noise Interference When Ablating We are currently having a problem with a lot of noise during RF ablations. Whenever we turn on the Stockert RF generator, we begin to see what looks like pacing spikes or sometimes what seems to look like VT. It is present in the surface ECG and the intercardiac signals. It also seems to happen more frequently when we do AVNRT ablations. Sometimes it is so bad that we cannot recognize anything. It does occur during other ablations, but not as bad. We have the GE CardioLab as our monitoring system. Has anyone seen this problem before? What was the solution for the problem? By the way, we have tried everything, including changing all the cables. Any hints or suggestions would be much appreciated. Jerry F. Jones, CVT (To reply to this question, please type Noise Interference When Ablating in your subject line.)   We have just completed two months worth of work on the same problem, and think we finally have an answer (I would be happy to discuss the process, but it was too long to include in this email). The problem occurred with the Stockert ablator, with or without Carto. It did not occur when we used cryo ablation. Here's what we did: 1. We removed the serial cable we were using to slave an ECG to CardioLab from Carto. Instead we plugged the CardioLab ECG onto the left side of the Carto PIU. The left leg lead from both ECG cables were placed on the patient. 2. We removed the power strip we were using for equipment. 3. We plugged the following equipment into the same set of outlets (i.e., the same electrical circuit): the Stockert ablator, the small interface box used by the Stockert, the Carto Com unit and the Biosense Webster ThermoCool pump. The Cypress ICE equipment and the extra defibrillator were removed from that circuit and plugged into a separate outlet. 4. When ablating through Carto, we turned pacing off. Instead of setting pacing through M1-M2 or R1-R2, we selected "None." I'm not sure what the magic potion was that did the trick, but something worked. I also recommend that you have GE check your protocols to be sure they are configured correctly. Ours were, but it was a good check on the system. Good luck! I developed much grey hair over this process, and am trying to convince the hospital they need to cover my hairdresser costs! Cathy Olig, RN, Lead- Electrophysiology and Pacing, Heart Center, Meriter Hospital, Madison, WI   I wonder if the ablation channel isn't active on CardioLab during RF delivery. The next time they see this noise during RF, I recommend checking the active page of CardioLab (towards the top of the page) and see if the ablation channel isn't highlighted (red). If it is, they can click off the channel and see if the noise doesn't resolve. If this is the cause of the noise, the other thing they are apt to see is erratic autosaving. Jeff Courson, DO, Stark Medical Specialties, Inc., Massillon, OH Also Under Discussion: Stereotaxis Niobe vs. Hansen Sensei I am interested in opinions from clinicians who have experience using the Stereotaxis Niobe 2 system and Hansen Medical's Sensei system. Feel free to express any thoughts regarding ease of use, economics, clinical efficacy, procedure speeds, safety, etc. I am especially interested in those clinicians who have performed human procedures using the Hansen system. anonymous (To reply to this question, please type Stereotaxis vs. Hansen in your subject line.) Working in the USA I am a cardiac physiologist from the UK and am seeking work in the US. I have noted that most jobs are for RNs; is this the case throughout the US? I have 16 years experience in a regional teaching hospital with pacing/ICD and CRT follow-up. I can also run EP lab systems, including Carto and EnSite/NavX. I hold both NASPExAM/AP exams. I would be grateful if a center is known that employs non-RN staff in CRM. Stuart Allen, Southampton General Hospital, Southampton, Hants, UK (To reply to this question, please type Working in the USA in your subject line.) Combo Lab Our hospital is looking at options for building a second EP lab. This lab will be primarily designed for ablation procedures including atrial fibrillation. However, we are looking at the possibility of it being an EP/Ablation/Cath lab. Has anyone had any experiences combining ablations and caths? anonymous (To reply to this question, please type Combo Lab in your subject line.) Quality Assurance We are a new site located in Western Maryland and have started an EP Program. We are in the infant stages of our program. I am the Quality Assurance Nurse and am wondering if there is any official EP Registry out there for data collection and QA. I am also wondering what benchmarking statistics are out there for comparison with other EP labs. I am also wondering what adverse outcomes are being collected for the EP labs and other data collection areas that EP labs are collecting internally for their program. I cannot seem to find any of this information by searching the Web, so I thought maybe I should go straight to the facilities that have this program. Pamela A. Hetrick, RN, Cardiac Data Analyst, Western Maryland Health System, Cumberland, MD (To reply to this question, please type Quality Assurance in your subject line.)