What Do You Think?

The following items are from readers responding to What Do You Think? questions from the August 2003 issue.

Usage of FemoStop

I am looking for information on usage of the FemoStop device, either post diagnostic or interventional procedures. When a FemoStop is utilized post either procedure, where do your patients recover? Do they ever go to a telemetry unit? Lastly, what is the usual duration that the device is placed for? Thanks!
Email: t9261@epix.net

When we place a FemoStop, our patients may be held in our immediate recovery area, be placed in our pre/post procedure area, or be placed in their assigned hospital bed. All of these areas are equipped for monitoring with telemetry. The duration of use can vary from 30 minutes to two hours and is directly dependent on the patient’s anti-coagulate state. Assessment of bladder fullness should always occur.

Chuck Williams RPA, RT(R)(CV)
Emory University Hospital Cardiac Cath Lab
Atlanta, GA
Email: codywms@bellsouth.net

H&P’s on Inpatients

How are you handling having H&Ps on the charts of inpatients prior to their procedure? My issues are with the patients who are direct admits in the evening, and then are scheduled for a 0530, 0630, 0730, 0830 or 0930 cath.
Are you refusing to allow patients who do not have an H&P on their chart to have their procedure? Thanks for any help/discussion you can give me.
Email: carletta@weirtonmedical.com

At our hospital, we created a short H&P form. So whether it’s an outpatient or inpatient that arrives to the cath lab without one, the MD fills it out prior to starting. Following is what our form looks like. We sent it through the various channels so that it would be accepted by Medical Records.

Sincerely,
Tracijo Capua, Cath Lab Coordinator
Flagler Hospital, St Augustine
Email: cathlab@flaglerhospital.org

History and physicals are required to be on the charts on all of patients in our cath lab system. We are not permitted to set up any patient for a procedure unless the H & P is in the chart.

Chuck Williams RPA, RT(R)(CV)
Emory University Hospital Cardiac Cath Lab
Atlanta, GA
Email: codywms@bellsouth.net

Heparinized Contrast?

Our cath lab currently heparinizes our contrast. Is this an institution-based concept or do other facilities do this as well? We are looking for information to address this issue. We originally started heparinizing the contrast when we stopped giving the patient routine heparin at the start of a diagnostic procedure. Currently we put 2,000 units per 200 cc bag of contrast. Any thoughts?
Connie, Meriter Hospital, WI
Email: csgehin@yahoo.com

We do not heparinize our contrast. Our flush solution is heparinized…and we typically have a 500cc bag on the field and also a 500cc bag that is used on the pressure line. There is 1000 units in 500cc.

Annie Ruppert RN, BSN
Sharp Memorial Hospital
Senior Cardiac Specialist
Email: Annie.Ruppert@sharp.com

I have been employed in two places prior to coming to the Emory Healthcare System that routinely heparinized Omnipaque, since this contrast media did not contain an anti-coagulant. We do not heparinize any of our contrast media routinely here. The other agents, such as Renografin, Hypaque 60 or 76, Isuvue, etc., have anticoagulants. Check the ingredients. As for heparin, we use 80 units of heparin per ml in our table and manifold solutions.

Chuck Williams RPA, RT(R)(CV)
Emory University Hospital Cardiac Cath Lab
Atlanta, GA
Email: codywms@bellsouth.net

Cath Lab Staffing Models

I am the Cardiovascular Laboratory Clinical Educator for the Mid-America Heart Institute, St. Luke’s Hospital, Kansas City, MO. I am researching cath lab staffing models to provide feedback to my vice president on this topic.
Let me start with the fact that Mid-America Heart Institute is managed through a shared governance (a Physician’s Group and St. Luke’s Hospital, Vice President, who is a RN). The question that was asked was, How many cath labs use the multi-discipline staffing model, whereby all team members (this includes RNs) rotate through the different roles? The real issue centers around RNs being the only health care worker that can assess patients of the group, thereby, should be used in that capacity on each case. Has there been any research on staffing models used in the CCL and how many labs use each type? I ran a search but did not come up with much. Any assistance you can provide or any labs out there sharing their experience would be of great help.

Sincerely,
David Warren, RCIS, CVL Education Coordinator
Mid America Heart Institute
Saint Luke's Hospital, Kansas City, Missouri
Email: dwarren@saint-lukes.org

All of our staff (registered radiologic technologists, registered cardiovascular imaging specialists, registered nurses, and licensed paramedics) are all cross trained to be scrub assistants, circulators, and monitor assistants. Each case requires one technologist or two RNs or one RN and two technologists.

Circulators, whom are trained in conscious sedation (medical anesthesia), are extenders of the anesthesia department. All have been extensively trained and precepted through rigid policy and procedures established through the Department of Nursing, Anesthesia, and Pharmacy. Annual recertification is required.

All personnel have to attend annual radiation safety meetings as part of the scrub assistant requirements. Monitoring assistance is taught to new employees by senior staff members.

Chuck Williams RPA, RT(R)(CV)
Emory University Hospital Cardiac Cath Lab
Atlanta, GA
Email: codywms@bellsouth.net

Pre/Post Procedure Units

I am in the process of researching articles about pre/post procedure units for the cardiac cath lab. We are looking at setting one up at the institution where I work. I am working on my Masters degree and looking at finding research-based evidence. From what I have heard and common sense, these units would appear to be a great idea for cath lab throughput, groin care and decreased complications, nursing/physician collaboration, and overall quality of care for the patient. Does anyone know of any sources that specifically address any of these issues?

Heather

Email: hkalin@cox.net

Our facility did a three month survey on all patients receiving cardiac catheterization. There was a section on the survey done by the cath lab and the nursing units completed a section on the groin once the patient (pt) went to the nursing unit. We collected data on number of sticks, size of sheath used, anticoagulation prior to cath, during cath, and after, 2b3a used, thrombolytics, age, previous cath procedures, PT/INR levels, pvd., etc.

The data showed that pts who had their sheaths pulled and pressure held by cath lab staff had almost no groin complications. The pts who had their sheaths pulled on the nsg units had a high bleeding complication rate. However, the complications occurred after hemostasis was achieved. The pts bleed anywhere from 1-4 hours after the sheath had been pulled. We felt that this was happening because the pts were not being observed closely enough once the sheaths were out and the site dressed. Due to increased use of closure devices, the nurses on the tele floors pull fewer sheaths than they used to. As a result, they have less experience pulling and holding pressure. Because of our findings, our facility is now going to have a 6-bed area where the pts will go to have sheaths pulled and be monitored by RNs and CVTs who work in the cath lab and have a lot of experience. We are in the process of implementing this now and hopefully will reduce the bleeding complications. Usually the acuity ratio on a tele floor is 4:1. The nurses on tele units are just not able to observe and check the pts who have had sheaths pulled frequently enough to avoid bleeding problems. I think that it is to the pts’ benefit to be in a unit that has trained staff who do nothing but pull sheaths, hold pressure and manage groins, and is staffed so pts can be monitored closely in the early hours after sheath removal.

It would be best to set up a pre/post proceddure unit for catheterizations pts. You will have less complications from bleeding and pts will be prepared for the procedure more thoroughly.

Name and institution withheld by request

Please send your questions or responses to Rebecca Yospyn at: cathlabdigest@aol.com

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