Email Discussion Group: July 2006

New Questions: Moderate Sedation I am wondering if any EP labs utilize Ativan or Xanax p.o. for atrial fibrillation ablation cases prior to moderate sedation. If your lab does utilize this pre-sedation, how is it working for you? Is the amount of sedation needed decreased? If you do not use it, why? Mary Creed, RN, Medical University South Carolina (Readers, to reply to this question, please type Moderate Sedation in your subject line.) We do not use oral pre-meds for any of our procedures. We do use propofol infusions in deep sedation for our longer procedures, including atrial fibrillation ablations. Benzodiazepines only seem to cause more complications when propofol is also given, so we avoid the combination whenever possible. Howard Mattingly, RN, Team Leader, EP Lab, Methodist Hospital, Indianapolis, IN Our electrophysiologist has been credentialed by our Anesthesia Department to use Precedex for our atrial fibrillation cases. This has resulted in lower dosages of Versed and Fentanyl. We have developed our own protocol for this. Gina Cusworth, RN, Manager, EP Laboratory, St. Joseph's Hospital Health Center, Syracuse, NY Sterile Dressing Over Device Implant Sites We would like to examine the sterile dressing policy in our EP lab. Currently the site is steri stripped, covered with dry gauze, and then a pressure dressing is applied with elastoplast over skin that has had benzoin applied to it. Many of our patients have dry and fragile skin, and some have had some skin tears and skin breakdown with this system. What other DSDs are labs using? Are there better skin protectants on the market that we could look into? Melinda Lyon, RCIS (Readers, to reply to this question, please type Sterile Dressing in your subject line.) Our physician places a sterile gauze 4 x 4 folded in half over steri strips, then covers it with an op-site. The patient is asked not to remove it and the patient can shower. The patient is seen in the office 1 week post-implant; the op-site dressing is removed and the site is then assessed by a nurse/medical assistant. If a pressure dressing is needed, the elastoplast is added on top of the op-site. Gina Cusworth, RN, Manager, EP Laboratory, St. Joseph's Hospital Health Center, Syracuse, NY We use two different types of dressing techniques. One physician prefers steri-strips with Kerlix, and then paper tape with Elastoplast on top of the paper tape. The paper tape protects the skin from the elastoplast. We never use benzione, as this solution augments the elastoplast tape adhesive ability to the skin. On normal skin this combination of benzoin and elastoplast would cause skin tear lesions. Something new that one other physician group uses is a Silverlon® dressing. This is a relatively new product that has a silvadene-like substance that is activated with sterile water and then the dressing is applied to the implant site post surgery. Our open-heart surgeons use these dressings on the post open-heart patients, and the suture lines heal faster with a decrease in infection.  In the implant lab we use a 4 x 6 dressing called an Silverlon® Island Wound Pad Dressing (catalogue #ID46). The Silverlon® dressing is applied directly over the fresh incision. The dressing is sterile, and then Kerlix followed by paper tape and then elastoplast completes the pressure dressing post-op. The next day the Kerlix, paper tape and elastoplast tape are removed and the Silverlon® dressing stays in place for three days. The website is where you can get all the information you need. Also, have you tried the new RADPAD®? It's a sterile radiation protection pad that, when placed on the surgical field cuts down on the radiation exposure for your scrub person and physician. Dana St. John, RN Some of our doctors use steri-strips covered by a gauze, then place an occlusive dressing over that. When they feel a pressure dressing is needed, we put additional gauze over the occlusive dressing so it can be removed the next day without disturbing the original dressing. If the patient has fragile skin, we lobby the doctors to use silk tape instead of Elastoplast. It won't give the same degree of compression, but it doesn't cause the same shear on the tissues either. We also make a point of anchoring the tape over the sternum and the clavicle. The skin is less mobile there, so the tissues don't pull as much. I don't know of any other skin protectants available. Try checking with your OR or asking AORN online. If anyone uses a variety of dressings and adhesives, they do. Howard Mattingly, RN, Team Leader, EP Lab, Methodist Hospital, Indianapolis, IN Under Discussion: Catheter Placement by Non-Physician Staff Need the help of the EP community: for the last four years, technologists have been placing catheters for basic EP tests for the physicians. We have come to find out that there is no policy for the staff protection. Thanks to JCAHO and the lawyers of the world, this has to be evidence-based. Do any labs out there allow catheters to be placed by non-physician staff? Looking for policies or a lab that allows this practice. Mitch Hammond, BSHSc, EP-CVT, NREMT-P (Readers, to reply to this question, please type Catheter Placement in your subject line.) In our lab, we place the venous sheaths, but not the diagnostic/ablation catheters. We could not find any literature for catheter placement and venous sheath placement. The policy for sheath insertion was approved by the cardiology committee here at our hospital along with a description of the preceptorship for "credentialing" the people inserting the sheaths. Dana St. John, RN Catheter Selection We are a newly established EP lab and are finding it extremely frustrating not to understand some of the basics about catheter selection (i.e., what catheter for what region of the heart and why). I know that there are some excellent spiral bound books for heart catheterizations and interventions; is there something out there for the EP lab? name withheld (Readers, to reply to this question, please type Catheter Selection in your subject line.) Paper Recording to New Recording System We are moving from paper reporting of our implants to our new Witt recording system. We are interested in what is the minimum reporting requirements for the body of the implant, example wordage after the Access and before Closing Incision. If you have any information you could share, we would appreciate your assistance. Thank you! Joyce Miller, RN, CCRN (Readers, to reply to this question, please type New Recording System in your subject line.)