Email Discussion Group: February 2009

There are two new questions this month. Please take a look at the questions below and let us know if you can help answer any of them! You can respond by emailing us at eplabdigest@hotmail.com or visiting us online at www.eplabdigest.com. Remember, when responding to the discussion group, don’t forget to let us know if you would like your name and/or location listed. New Questions: EP and the Economy Has your EP lab been affected by this economic downturn? How is your EP lab staff managing? What changes, if any, are being made? (To reply to this question, please type “Economy” in your subject line.) Our EP lab was one step ahead of the economic downturn. Staff for years have flexed according to schedule times and cases. If a case doesn’t start until 9am, unusual currently, then the first staff member arrives at 8am to start opening the lab and calls or goes to retrieve the patient. The next staff member and scrub tech arrive 30 minutes prior to start time. If necessary, an additional staff member may be scheduled. All time is productive, and we try to avoid long breaks between cases. If for some reason there is a break between cases, the staff utilizes this time to accomplish some of the extra duties necessary to keep the lab running smoothly, and we also make post procedure or surgical patient phone calls. We also clean, dust, review inventory, and look over charges and case cards for any revisions. We have enough full days that an occasional late start or an early finish is wonderful. We also are finding it necessary to control CRM cost and keep it in line with closed patient accounts and Medicare reimbursements. (70-80% of our population falls into this category.) We now do annual homework to see where we stand with finances, and adjust CRM cost annually. It is becoming more difficult every year, so we are taking a proactive approach to keep our EP lab able to deliver the highest quality services and CRM products to our patients. — Sharon L. Duncan, RN, CPAN, RCES, EP Lab Clinical Supervisor Abandoned Leads New research reveals that abandoning a nonfunctioning lead in an ICD patient is safe and does not pose a clinically significant risk of complication. This study also suggests that lead extraction should be reserved for cases of system infection or when large numbers of leads have been abandoned. How does your lab handle the practice of abandoning leads? Is lead extraction always performed for lead malfunctions? (To reply to this question, please type “Abandoned Leads” in your subject line.) We only do lead extractions for a system infection. We have considered it for those patients who need a new lead and already have a few in place. Abandoning a lead is the preferred method if it has been in any length of time and cannot be easily removed with undoing the screw at the end. In other words, if the lead has been in less than a couple of years, it can usually be removed fairly easily or can be abandoned and capped off. Occasionally we will cut the lead and cap it, particularly if it is sitting in a spot that may be at risk of eroding through the skin. — Connie Gehin, RTR, RCIS, RCES, Meriter Hospital, Madison, WI In our lab, we typically do not remove the ICD lead unless there is an infection. We mostly leave the non-functioning ICD lead in. However, there was a case where the patient was pacer-dependent, and the non-functioning ICD lead interfered with the new functioning ICD lead and caused oversensing. The patient would have long pauses on the EKG and was symptomatic. In this case, we extracted the non-functioning ICD lead. — Lisa Decker RN, BSN, Davenport, IAp, don’t forget to let us know if you would like your name and/or location listed.