Email Discussion Group: March 2007

New Questions: Grounding Pads We need some advice in reference to the correct placement of the grounding pad for RF ablation. In our lab, we have placed the pad toward the left side of the upper back. Are there alternative sites that can be used for RF ablation? Elizabeth Gotay, EP RN (To reply to this question, please type Grounding Pads in your subject line.) EP Lab Clinical Nurse Specialist I'm looking for a job description for an EP Lab Nurse Specialist. This would be someone who does all aspects of procedures and also staff education, patient pre- and post-teaching, including post-procedure follow-up. David Reynolds, RN/RCIS, Southwest Washington Medical Center, Vancouver, WA (To reply to this question, please type Nurse Specialist in your subject line.) Prerequisites for Transitioning from Cath to EP As with the excellent description of Lancaster General's in-house EP training, I'm looking for either competency statements or examples of performance reviews for a new lab. Any input? Jerome Leblanc, RCIS (To reply to this question, please type From Cath to EP in your subject line.) Billing for Transseptal Punctures I have a question regarding billing for transseptal punctures. Our billing department at New York Hospital states that we cannot bill for a transseptal puncture during an AF ablation because it falls under the category of access.  This is confusing to me as the cath side can bill for the same procedure under a valvuloplasty. How do other institutions, or do you, bill for this portion of the AF procedure? Thanks. Edmund Donovan, RN, CN II, New York Presbyterian Hospital, New York, NY (To reply to this question, please type Billing in your subject line.) Device Cases Recently one of our physicians asked our staff members if we can obtain the training to close the pocket of a pacemaker, ICD, or a Reveal. Currently at our hospital, the only people that can close the pocket are physicians, residents, and First Assistants (FAs). To obtain a First Assistant certification, most places want you to be a current scrub tech or RN with 3+ years experience in the OR. The problem is that in our EP lab, RTs and one scrub tech are the only people that assist with the implant cases. Therefore, we fall out of the RN/ST category as a whole. We are also in a very rural area, so the classes offered are all out of state. What are other EP labs doing for an RT(R) to be able to close the pocket, if your hospital allows it? Jonathan Sheets, RT(R) (To reply to this question, please type Device Cases in your subject line.) Working in the US: State Licensing I am a cardiac physiologist (CVT) from the United Kingdom, and am trying to find out about state licensing. Do I need to be licensed to work in the US? There seems to be variance from state to state. Stuart Allen, Southampton General Hospital, Southampton, Hants, UK (To reply to this question, please type Working in the US in your subject line.) Under Discussion: Pay Scale Differences Since the EP/cath lab is a multi-disciplinary 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.)    EP/Cath lab salaries are similar at our facility, but the call is only $2.00/hour. Where can I find the call pay for cities and states with our population similar to the Dallas / Fort Worth area? Kathleen Nugent, RN 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.)   In my experience, it is more of a hassle than not. I work in a five-room cath/EP lab, and we started out having one room that was going to be a combo lab. It has since become strictly an EP room. We found that, when doing a cath, we were tripping over the EP equipment, so we found ourselves disconnecting and moving a lot of equipment out of the way. The disposable equipment was another issue. As you probably know, cath/EP rooms generally lack the space for both cath and EP equipment. We are also currently looking into building a sixth room, and that is going to be strictly an EP room, considering our experience with the combo room. Vince Bontempo, CVT 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 U.S.? 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.)   Our lab employs both RNs and techs, and all are trained to perform all tasks in the lab, the exception being that only RNs provide sedation. We perform the full gamut of adult EP procedures except for tilt tables (Non-Invasive does these) and lead extractions. If Stuart is still interested in employment, we would be more than happy to discuss that with him! I can be contacted at Mission Hospitals, EP Dept., Asheville, North Carolina, 28801. Mike Sipes, RN, Supervisor of Clinical Electrophysiology 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.) Training Classes I am 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 am 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.) 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.) 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.) 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.) 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.)