Email Discussion Group: November 2006 / AHA Edition

New Questions: 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.) Competency in the EP Lab Can anyone give suggestions on how to start a competency program in the EP lab? We have RNs, CVTs and RTs in the lab. I need to get everyone up to speed on stimulating, scrubbing and troubleshooting. Any suggestions! Ronnie Sparrow, RN, CVRN, The Methodist Hospital, Houston, Texas (To reply to this question, please type Competency in the EP Lab in your subject line.) Discharge Instructions Post EP Studies/Ablation/ICD and Pacemaker We just started our new EP program. I am searching for discharge instructions for these procedures. If anyone has these documents, do you mind sharing with me so we can tailor our documents to the needs of our patients? Thank you for sharing! Celi Mateo, Director, Cardiovascular, Diagnostic & Treatment Services, Rush North Shore Medical Center, Skokie, Illinois (To reply to this question, please type Discharge Instructions in your subject line.) Conscious Sedation I would like to discuss with other labs the boundaries, or lack thereof, of procedural sedation and analgesia. For prolonged cases such as atrial fibrillation ablations, which last varying amounts of time between 4 to 6 hours, are the majority of labs resorting to general anesthesia? Or are they attempting to deeply sedate the patient for this length of time? Melissa Forsyth, RN (To reply to this question, please type Conscious Sedation in your subject line.) Safety How do you prevent or reduce the risk of scatter radiation during your procedure? Also, how important is it to you and your staff? K. Russell, Richmond, Virginia (To reply to this question, please type Safety in your subject line.) In our labs we use the following to help reduce exposure to scatter radiation: 1. Full length/height lead shields whenever possible; 2. Lead aprons/shields custom made to conform to the shape of the head of the table, which reduces exposure to the sedation provider; 3. Removable lead shields, which attach to the side rails of the table; 4. RadPads that are placed on the field; 5. Leaded eyeglasses; 6. Routine lead suit patency checks; 7. Monthly radiation badge readings. Shawn Heffernan, RN, Clinical Coordinator, Electrophysiology Department There is a product called a RadPad, which is applied to the surgical field, that cuts down on radiation scatter. Go to KOL Bio-Medical Instrument's website (www.kolbio.com/products.asp), and scroll down through the listing of products that this company sells. The last company listed, Worldwide Innovations & Technologies, Inc., manufactures the RadPad. This site will show all the products made to cut down on radiation scatter. You can also use a couple of these RadPads to make a mini drape and apply it to the exam table in hard-to-protect places. Dana St. John, RN, RCIS Editor's Note: You can also visit www.radpad.com for more information. Under Discussion: 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, Utah (To reply to this question, please type Check-Off List in your subject line.) Free-standing EP Labs I am trying to find out if there are any free-standing or stand-alone EP labs in the U.S. Does anyone know of any? anonymous by request (To reply to this question, please type Free-standing EP Labs in your subject line.) A Place for the RCIS in the EP Lab? I am a RCIS with 7+ years of cath lab experience, but I am working for the first time at a facility with an EP lab. I would like to transfer into the EP lab to expand my knowledge base, but this is an RN-only department at my facility. What is the trend in staffing ratios across the country for the EP lab? Since the Society for Invasive Cardiovascular Professionals (SICP) includes the EP lab in its scope of practice statement for the RCIS, I was surprised at the resistance to this change from the EP lab staff. How has the addition of RCIS-credentialed technologists been handled in other EP labs? Any insight would be appreciated. anonymous by request (To reply to this question, please type RCIS in the EP Lab in your subject line.) I am presently on a dedicated EP Team at Bon Secours-St. Mary's Hospital. There are two RNs and myself (RCIS) with 1 lab. If one of us is out, a cath lab staff person will assist in the daily procedures. The only restriction I have is the inability to administer medications. I tend to monitor and scrub most of the time. The scrub person breaks and does the burn box during ablations. My cath lab experience dates back to the late 1970s, with EP being only the last few years. At St. Mary's (three cath/peripheral labs, one EP lab), the department is also RN-based. However, there are a few paramedics, one RT and one RCIS (me). We have a good team; our skills complement one another. Presently a job description is being written for the RCIS in the EP lab. My tasks include monitoring using EP MedSystems, operating the Bloom EP stimulator; delivering the burns during an ablation, scrubbing in during all procedures (EPS/ablations, PPI, ICD, BiV ICDs), cardioversions, TEEs, tilt studies, etc.). My only limitation is giving medications that is the RN's responsibility.  Christine J. Reoch, RCIS 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 (To reply to this question, please type Catheter Selection in your subject line.) A very direct answer to your question of the basics of catheter selection, etc., is found right in EP Lab Digest itself. There is a course given several times a year in various cities around the country. It is called Order and Disorder in the Cardiac Rhythm - The Basics. This course is not only a superb listing of basic electrophysiology (including catheter placement, catheter selection, and explanation of catheter construction), it also describes the physiology and anatomy of the electrophysiology procedure. One section describes connectivity; that is, the literal connection of each catheter to the EP system junction box. Dr. Kriegh Moulton and his wife, Linda Moulton, RN, MS are the moderators of this program. They also present an advanced class (entitled Beyond the Basics), but I would not go to this until you at least understand the basics. According to EP Lab Digest's event calendar, Donna Benson can be contacted at 217-544-3306 or emailed (Dbenson@cceconsulting.net). Their website is: www.orderanddisorder.com. However, I do not remember the cost of the course(s).  I also have several books at home I can forward the book titles to you in an email. The book Practical Electrophysiology by Todd J. Cohen, MD, I have heard is an absolutely superb publication. I have not personally seen it nor do I own it, but from the description of it, I would look into it. To order, call (800)237-7285, press 5 for subscriptions or visit online at: www.practicalep.com. The cost is $90.00.  If you have any questions before then, I can be reached at Jose.Flores@stjoe.org. Good luck and don't panic...it all comes together! Jose D. Flores, RT 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, Maryland (Readers, to reply to this question, please type Quality Assurance in your subject line.) I can't answer your question. I, too, am looking for information. It seems that people from off the streets are being trained to set up sterile fields, administer meds, perform radiology and basically practice surgery. I am VERY concerned about quality assurance. Michelle Whittaker, RN, CNOR 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, Arkansas (Readers, to reply to this question, please type Recycling Platinum Tips in your subject line.) Dear B. Massey, I have been an EP nurse for about five years. During most of that time, our manager gave me the responsibility of finding the best return for our catheter tips. I would be happy to share with you information that I have learned in that time about the practice and pitfalls of platinum recovery. S. Miller, RN We have been recycling EP tips for two years and actually make some good money from them. We use Cascade Refining. The tips are paid according to a specific structure that you can obtain from them. They will send you packets to mail the tips to them; it is quite easy and a good way to have some extra educational money. Other than cutting the tips and packing them up, there is nothing that you have to do. Hope this helps. Glenn King, Phoenix, Arizona I am a catheter platinum tips buyers myself. All you have to do is to cut the tips of the EP catheters (but not too short) and mail them to my business. You will then receive a check within 7 business days of delivery. The price of each catheter tip is subject to the price of platinum on the market provided by www.kitco.com. Renault Thelemaque, RCIS, Weston, Florida The Internet will help you find the best price/recycler in your area. It is a big return for little work; we use this money to go into an education fund since money for education seems to be first cut in the budget. If you need further info, let me know and I will give you the name of the company I use. Douglas Kline, RT, (R) (CV), Specialty Leader, EP Lab, Holy Spirit Hospital, Camphill, Pennsylvania Contact EPreward: 123 N. Congress Ave., #393, Boynton Beach, FL 33426. Chris Baessler, Drexel University College of Medicine, Philadelphia, Pennsylvania Try these companies for catheter tip platinum recovery: Cascade Refining Inc., 2490 South 3200 West, Salt Lake City, UT 84119 Medical Alloy Industries, 560 Stokes Rd., Suite 23-330, Medford, NJ 08055 Phifer's Medical Recycling, P.O. Box 24439, Columbia, SC 29224-4439 E. Miller I have been in EP for many years and highly recommend Accurate Recovery Systems for recycling. They make the process very easy for the staff, and have great customer service. Their email is www.accuraterecovery.com, and their phone number is 800-396-9998. They also advertise frequently in EP Lab Digest. Janice Baker, RN, BSN