Email Discussion Group: November 2009


Do you have an EP topic that you would like to see addressed by our discussion group? Email us at eplabdigest@hotmail.com or post your question on http://eplabdigest.com/discussion-questions. We look forward to hearing from you!

Under Discussion:

Admitting Patients After AF Ablation If your facility performs AF ablations, are patients admitted following the procedure? What are your reasons for admitting/not admitting these patients? Also, do your AF ablation patients usually receive moderate sedation or general anesthesia for the procedure? — S. Deck If your lab is doing basic ablations, are you doing left-sided pathway ablations? If you have transeptal experience, you will be prepared for AF ablations. Some physicians do 1 or double transeptals, one access for ablation catheter, one for the Lasso/spiral catheter. You also need access for the ICE catheter and usually a CS catheter, so a total of 4 venous sites. We have general anesthesia for all our AF ablations; they start an arterial line for BP monitoring. Prepare your anesthesia team prior to the start of AF ablations; our physician gave a talk on the procedure and what we are doing, complications, meds...lots of heparin. I have a list of supplies, equipment you need as a lab; it helps the staff to pull for cases. EP reps may be a resource...feel free to contact me for info. A plus would be going to another lab to see an AF ablation. — Bonnie McDonald, RN, CEPS, RCES, EP Lab Coordinator, Florida Hospital Zephyrhills Universal Protocol The 2009 JC standards include more specific language on Universal Protocol and site marking for percutaneous procedures. Are there any EP labs that have adopted site marking as a pre-procedure standard for ablation and device implants? — Lee Anne Hockey, RCIS, RCES Our Universal Protocol states that diagnostic/interventional catheter insertion sites (groins, IJ, SC) do not need to be marked prior to percutaneous procedures. The protocol states that the number and size of sheaths/catheters inserted, and their placement, varies from patient to patient and physician to physician. It is my understanding that this satisfies TJC requirements. For device procedures (implants, revisions, lead repos/additions, etc.), we do mark the intended incision site. We use a sterile surgical marker (not a regular “magic marker”). The mark frequently washes off during the surgical prep, but can be reapplied by qualified personnel using a new sterile marker (the hospital has trialed numerous markers and so far we have not found any that do not wash off). The site marking is done by the implanting physician prior to the patient entering the procedure room and is to be visible after draping the patient for the procedure. TJC guidelines further state that the site mark must be removed following the procedure (to avoid confusion if further interventions are needed), so that complicates the issue further (Sharpie® markers do not wash off with the prep and are also difficult to remove after the procedure). Interestingly, a recent study showed that the only marker that did not encourage bacterial growth was the Sharpie® markers. However, experts fear that permanent markers could "tattoo" the skin, especially in infants/young children or the elderly. — anonymous