Email Discussion Group: May 2008

Welcome to the May 2008 edition of the email discussion group. As you will see, the “EP lab work schedule” question is a hot topic this month! If you would like to join in on the discussion, please email us at eplabdigest@hotmail.com or visit us at www.eplabdigest.com (click on the email discussion group link). Remember, when posting or responding to the discussion group, please let us know if you would like your name, location, and/or email address listed. We look forward to hearing from you! New Questions: EP Schools I was wondering if someone can let me know if there are any EP schools other than the Carnegie Institute in Troy, Michigan? I live in upstate New York. — Ross Scardino (To reply to this question, please type “EP Schools” in your subject line.) Operators Do other EP labs have both nurses and RTs operate the EnSite ablation computers and the diagnosis EKG computers (like Bard), or are these usually operated by just the RTs? — name withheld by request (To reply to this question, please type “Operators” in your subject line.) Diastolic Time Indices I am a cardiology fellow at the University of Utah. My question is why aren’t abnormal phonocardiographic indices such as pre-atrial diastolic time and accelerated atrial diastolic time in heart failure used? Is the shortened diastolic time due solely to the abnormal systolic time intervals (prolonged EMD)? — Osman Ahmed, MD, University of Utah, Salt Lake City, UT (To reply to this question, please type “Diastolic Time Indices” in your subject line.) Under Discussion: EP Lab Work Schedule Our EP lab will be going to 8-hour shifts, 5 days a week in a couple of months. This is a decision that is widely unpopular with our nurses and techs. I am wondering if any other EP labs work 8-hour shifts (all 7–3:30) 5 days a week, and if so, what has been your experience with this scheduling format? Any pros, cons, suggestions? — Lee Henry, RN (To reply to this question, please type “Work Schedule” in your subject line.) We start our shifts at 0600 and the contracted employees get off at 1630 (10-hour shifts). There is always one call team to stay, and on our busier days, there are two call teams. I can't imagine staring at 7:30 and expecting to be done in 8 hours. How many cases are we talking per day, and how many rooms, just EP or devices as well? — Alison D. Swarens First of all, what hours did you used to work in the EP lab? Do you want to work longer hours and get paid the overtime? Is your EP lab busy? Do you have call personnel to cover late cases? The reason I am asking all of these questions is because I want to see what the problem or issue is. I work in an EP lab that has one shift. Most of the staff that are scheduled to work EP work either from 7:30 am to 5:00 pm or from 8:00 am until 4:30 pm. However, if you are assigned to EP that day (two of us work mostly EP), you stay until the work is done. I have had some days where I work 7:00 am or 7:30 am until 9:00 pm or almost 11:00 pm. Granted, those longer days are not as many as other days where we work until 6:00-8:00 pm, but they are long days. Sometimes it wreaks havoc on your personal life. For instance, I am going to graduate school and I do my classwork in the evenings. I have a husband and two teens that I like to spend some time with. I struggle with getting exercise in and meeting up with friends sometimes. Sometimes, I am just too tired to do anything at all after I get home from work. Also, EP is getting busier. EP is frequently busier than the cath lab. We are going to be starting an atrial fibrillation program down the road, and the days are going to be quite long, especially at the beginning. I like what I do, but I am not as thrilled with the hours any longer. This is how things are where I work. If you need the longer hours, I can point you in the right direction. — name withheld by request Our lab at Providence Hospital in Columbia, South Carolina has been doing 8-hour shifts Monday through Friday for a long time. It is not too difficult, because we only do EP at the present time. We don’t implant in our labs. We do TEE, CV, and TTT. We have three rooms. Two are dedicated EP interventional labs. We have Carto and ESI mapping systems and Prucka recording systems in both labs. I keep one late team per day; they are scheduled to deal with late cases. If a difficult case or more than one case goes over, I try to get volunteers. Most of my staff are accommodating, and I try to reciprocate during slow periods with whatever their time off needs are. Plans are to move to larger facilities in the next five years and to start doing implants in the EP arena here. That will require more staff and a re-thinking of staffing patterns. — Robin Morreale, RN, MSN, RCIS In our EP lab, we work 8-hour shifts with no weekends or holidays. We have always done this. We have three RNs and one RTR. There are times we have talked about doing 10-hour shifts, but coverage is always an issue. The problem with 8-hour shifts for us has been no replacement for someone who needs the day off or is sick. We are still trying to find the perfect solution, so we would be interested in hearing if anyone is doing anything creative. Thanks for asking. — Mary Hosler, BSN, RN Hands-on Training Are there any symposiums or classes available in the United States that provide hands-on EP training? — Heather Vardon, Aurora BayCare Medical Center, Green Bay, WI (To reply to this question, please type “Hands-on Training” in your subject line.) Refurbishing Costs How much does Ascent charge to refurbish an AcuNav catheter? — name withheld by request (To reply to this question, please type “Refurbishing Costs” in your subject line.) Pause on ECG I want to learn about indications of pacing in patients with ventricular pause more than three seconds according to evidence-based medicine. Is it logical or not to choose >3 seconds? — name withheld by request (To reply to this question, please type “Pause on ECG” in your subject line.) RCES Exam Have any readers taken the new RCES exam offered by CCI? What are your thoughts on the exam? Was the suggested reading list helpful in your exam preparation? Can you specify any resources to study from in addition to CCI's reading list? Do you have suggestions for preparing for the exam? Many thanks! — Toinette Trahan, RT(R) (To reply to this question, please type “RCES Exam” in your subject line.) Line Access and Cath Placement I would love any information supporting EP lab staff line access and cath placement. — anonymous (To reply to this question, please type “Line Access and Cath Placement” in your subject line.) Pocket Closure I am a registered nurse in a fairly new EP lab. The only procedures we currently do are EP studies and AICD/Bi-V AICDs. We have one electrophysiologist on staff. He requested that myself, an RN, and another staff member (an RCIS) learn how to close the pocket. He personally taught each of us how to suture the pocket closed. After approximately 10 months, hospital administration told us we were no longer allowed to perform this task, so we quit. Now, two months later, the RN is being formally reprimanded for working out of her "scope" of practice. Do rules about this vary from state to state, institution to institution, or is it just plain wrong for anyone besides the MD to close the pocket? — anonymous (To reply to this question, please type “Pocket Closure” in your subject line.) In our EP lab, we drafted a policy that was approved by the cardiologists/ electrophysiologist in our institution that EP lab staff once trained by the cardiologist/electrophysiologist could close skin only of the pacemaker pocket and not fascia. This is not mandatory for all staff in the EP lab, only those who desire to learn the skill. — Mary Hosler, BSN, RN Catheter Recycling I have a concern regarding recycling medical catheters. I have been sending catheters to a recycling company for about 10 years. I have always sent the catheter tips in an envelope provided by the company. I have always sent it through secure and insured mail. I have no way of knowing the value of the tips other than based upon the value of the last shipment. The insurance is only valid for the shipment; after it is signed for, the insurance is invalid. Recently, within the last six months, I have not heard from the recycling company, other than the return signed receipt. I am wondering what recourse we have as customers when this happens. I have sent a letter requesting a response as to why I have not received payment for catheter tips. Any suggestions or comments please. — anonymous (To reply to this question, please type “Catheter Recycling” in your subject line.) Inventory/Charging Does any lab use technology (bar coding, cabinets, etc.) to help them with their catheter and equipment inventories and charges? What technology, and how well does it work for you? Any input would be helpful. — Dale R. Beatty, RN (To reply to this question, please type “Inventory/Charging” in your subject line.) Corvert At our facility and surrounding area hospitals, there has been a debate about the use of Corvert to chemically convert patients from atrial fibrillation to sinus rhythm without the presence of a physician. At our facility, our current practice is to give the drug in the presence of “trained professionals.” We interpret this as: in the presence of someone who is ACLS certified. We recently had an ACLS-certified professional refuse to give the drug without a physician present. What is the practice at your facility regarding chemical cardioversions? From my own experience, I have worked at the facility for five years and have given the drug several times without a physician present. I do feel comfortable doing this and often help other professionals administer the drug when they are not comfortable giving it. — Lisa Decker, RN, BSN, Genesis Medical Center, Davenport, IA (To reply to this question, please type “Corvert” in your subject line.) DFT Testing in Patients with Low Ejection Fractions (EF) Less than 10-15% Shaking the bushes to see if anyone has any anecdotal data regarding defibrillation threshold testing during implant in patients with a low EF% of 10 or less: initial shock, second shock, third shock, rescue-limiting inductions and testing to one course or multiple courses. Single initial shock with number of joules 10 less than defib max. — Dana St. John, RN (To reply to this question, please type “DFT Testing” in your subject line.) Loop Implant/Explant I was just wondering what some protocols are for loop procedures, particularly explants. I have recently been told that loop explants should take place in a positive pressure room. Any comments on this matter would be appreciated. — Edward Muxlow (To reply to this question, please type “Loop Implant/Explant” in your subject line.)