Email Discussion Group: May 2009

There are two new questions this month — take a look and let us know if you can help answer them. You can respond by emailing us at eplabdigest@hotmail.com or also by visiting us at www.eplabdigest.com. Remember, when responding to the discussion group, don’t forget to let us know if you would like your name and/or location listed.

New Questions:

Universal Protocol The 2009 JC standards include more specific language on Universal Protocol and site marking for percutaneous procedures. Are there any EP labs who have adopted site marking as a pre-procedure standard for ablation and device implants? — Lee Anne Hockey, RCIS, RCES (To reply to this question, please type “Universal Protocol” in your subject line.) We have had a Universal Protocol since 2005, and have required site marking for device implants/revisions since 2006. We do not require both sides of the chest to be marked, only the originally intended site (in our facility, typically the left). If for some reason the implant site changes (due to a total occlusion, for example), we document the change in the procedure record as well as the reason for the change. However, if we know that an existing device is going to be removed from the right side and a new device placed on the left, we do mark both sites. Because the number and placement of recording/ablation catheters varies with the type of procedure and physician preference, we do not require groin access sites to be marked. We have a statement to that effect in the Universal Protocol, so that we can show that it is 1) our usual practice, and 2) we are conforming to our policy/protocol. JC now requires that patient identification and the planned procedure (among other things) are to be verified every time the patient is “handed off” from one member of the health care team to the next. This verification is to start at the time the patient is scheduled for the procedure and continue until discharge. Documentation to support the verification process is also required. — Sue Deck, BS, RN, RCES, EP Educational Coordinator, Lancaster General Hospital ICD Patient Protocol I am looking for information and policy and procedures regarding handling of patients in the gastroenterology lab who have implantable cardiac devices, particularly ICDs. Are company reps being called in, or does the staff use magnets to pause the ICD? Any information would greatly be appreciated. — name withheld by request (To reply to this question, please type “ICD Patient Protocol” in your subject line.) For the endoscopy department, we have pacemaker specialists deactivate (reprogram) or apply the magnet to devices. The patient will get a complete evaluation post procedure to ensure device therapy is ON and stable thresholds, lead impedances, etc. If the specialist has the day off, the rep is called in, or depending on the CRNA, they will apply the magnet and then call in the rep to check post procedure. — Trish Colaluca, Pacemaker Clinic Coordinator

Under Discussion:

Digital Case Storage We’d like to know what other labs are doing with all the digital media generated in their EP labs. We have cases stored on CD for Carto, EnSite and Prucka. Does anyone have a policy regarding how long this information needs to be kept, and what type of storage is being used? — Lauren A. Crooks, RN, Sisters of Charity Providence Hospital, Electrophysiology Lab, Columbia, SC (To reply to this question, please type “Digital Case Storage” in your subject line.) Late Cases We have a busy lab, and it seems to us that complicated cases are being added or done even at the later part of the day. I wanted to know if there are any labs out there that have a policy or standard regarding late cases that are being done or added on at a later part of the day, especially complex ones. Do you have a limit or cut-off with your cases per day? If so, may we take a look at your policy regarding this matter? — name withheld by request (To reply to this question, please type “Late Cases” in your subject line.) Patient Care What suggestions can you offer in helping with patient care in the EP lab? For example, how do you help patients relax before an EP procedure? Also, what techniques do you use during procedures to make sure everything goes smoothly? (To reply to this question, please type “Patient Care” in your subject line.)