What Do You Think?

Hands-off Defibrillation There is a recent push to go to "hands-off" defibrillation for employee safety. Are your cath labs using paddles or patches for when defibrillation of a patient is required? Thanks. Karyn Hembree, RN, BSN, CCRN Cox Health Director - Cardiovascular Cath Lab Email: Karyn.Hembree at coxhealth. com Cc: cathlabdigest at aol. com We use paddles. Many of the cables that attach to the patches are not radiolucent and at times cover the coronaries. Chuck Williams, BS, RPA Atlanta, Georgia rpainga at yahoo. com We only use the hands-off during PCI and pacemaker insertions. For routine caths, we use the paddles. Tracy Capua, CCL Flagler Hospital, St. Augustine, Florida Tracy. Capua at flaglerhospital. org We use the patches at my hospital. If a patient requires defibrillation, the circulator will apply the patches and the monitor person will follow for the charging and discharging of the energy. Kevin Rich, BS, RN, RCIS ldrich3 at comcast. net In our cath lab, we always use paddles. I don’t feel there is an advantage to using patches when staff are trained and available for paddles. Tom Gaylets t9261 at epix. net All of our AICD/EPS/pacemaker patients have defibrillation pads placed on them at the time of procedure, so if they require shocks it is done through the defib pads. We do not routinely place defib pads on every patient who has a procedure done in the lab. If a patient goes into v-fib/v-tach, etc., we use defib pads and use the paddles. Annie. Ruppert at sharp. com We use paddles as the quickest method of defibrillation when the patient suddenly goes into v-fib and does not already have pads on. However, if we get an unstable patient, we place pads on in advance and use the hands-off method instead. Michael Wellner MWellner at hfmhealth. org Peer Review Does your cath lab conduct peer reviews? If so, by what method? Anonymous? Face-to-face? Online or on paper? How do you have technologists of different levels evaluate each other? Do the physicians have input on these evaluations? Thank you! Filiz Demirci, BS, RCIS Maine Medical Center Cardiac Cath Lab Email: demirf at mmc. org Cc: cathlabdigest at aol. com We have peer evaluations. The person who is getting evaluated picks a co-worker to do a peer evaluation and the manager doing the evaluation picks a peer to do one as well. Depending on your job category, the MDs may or may not have input. They have input into the manager’s evaluation, case managers and NPs, but not usually on the staff evaluations. If there is a major problem with a staff person and an MD, this will be reflected in the evaluation somehow. Annie.Ruppert@sharp.com Anonymous peer reviews are conducted by the senior staff members on paper. The process is completed by observation throughout the year. Chuck Williams, BS, RPA rpainga at yahoo. com Sheath Removal I am wondering if you have a basic competency available for sheath removal. Our ICU nursing staff will very shortly be expected to pull sheaths and it would be tremendously helpful to have a basic competency to work with if possible. Thank you, Lynn M. Wright RN, MA, MSN Clinical Nurse Specialist Passaic Beth Israel Regional Medical Center Email: lmwright at pbih. org Cc: cathlabdigest at aol. com The nurses who remove sheaths have to demonstrate basic and advanced competency. The primary complication after any invasive or interventional cardiology procedure is a femoral hematoma. I have seen several retroperitoneal hematomas from femoral hemorrhages as well as pseudoaneurysms over the past couple of years. Chuck Williams, BS, RPA rpainga at yahoo. com Groin Prep I would like to know what other cath labs’ procedure is for prepping the groin area. Do you place a towel between the legs and prep, or do you prep the entire genital area without a towel down the center for patient privacy? Anonymous by request Email: cathlabdigest at aol. com We place a towel down the middle of the groin area for patient privacy, and prep right and left groin areas. Annie. Ruppert at sharp. com Whether prepping one or both groins, we ALWAYS keep the patient’s genital area covered. No reason not to respect their privacy. What if it was your family member?! Tracy Capua, CCL Flagler Hospital, St. Augustine, Florida Tracy. Capua at flaglerhospital. org We place a towel folded very narrowly down the center to give some feeling of privacy. The site is prepped and the towel is replaced with a sterile towel that remains during the procedure. Michael Wellner MWellner at hfmhealth. org A sterile towel is placed discreetly over the genitalia on every patient. If both groins are prepped, a sterile towel is discreetly positioned so both groin areas are exposed. Before any prepping is done, a full explanation of what we are doing and why we are doing it is given to the patient. Chuck Williams, BS, RPA rpainga at yahoo. com In prepping the groin area, a sterile towel is placed and prepped on both sides with DuraPrep. Tom Gaylets t9261 at epix. net We always cover the private areas. Sometimes, such as in emergency situations, we will pull the cover to one side and shave and then complete the other side in the same manner. Once the shaving is completed, we will place a blue towel over the private areas and complete the prepping with the CloraPrep. Kevin Rich, BS, RN, RCIS ldrich3 at comcast. net Infection Rates I’m looking for information on cath lab infection rates. If any labs are interested in sharing, please email. Thank you! Anonymous by request Email: cathlabdigest at aol.com We do not have many infectious problems. I would check the CDC data systems and also check with the SCA&I. They may have more pertinent information. Chuck Williams, BS, RPA rpainga at yahoo. com Vendor Representative Credentials Are any of you looking into or have tackled the aspect of vendor representative credentialing with respect to their credentials? For example, pacemaker representatives. They come in and do some programming during and after the procedure. 1. How do we know that this person is credentialed to perform this work on our patients? Company profile on each rep that will be attending cases? 2. Should we limit this to just those who program devices or participate in the treatment of our patients, or should we extend this to all vendors within the realm of the cath lab? I look forward to your responses. Steve Gressmire, RT(R)(CV) ARRT, AAMA Cardiology Services Director Northwest Regional Medical Center Clarksdale, MS Email: Steve.Gressmire at nwmrmc. hma-corp. com Cc: cathlabdigest at aol. com Our vendors are all known to us. When a new one joins a company, the current representative brings the new one around for introductions. Tracy Capua, CCL Flagler Hospital, St. Augustine, Florida Tracy. Capua at flaglerhospital. org We have each vendor representative who has shown us how to use a device provide us with a company letter stating their training in that device and degree of experience with that product. We then have a binder in our lab with these credentials ready for any inspection. Most of our vendors understood our request and had no difficulty in providing the letter. Tom Gaylets t9261 at epix. net 1. A profile of the representative should always be obtained from their employer. Each of the representatives are required to complete extensive, documentable education and training prior to being sent solo into the field. A background check on each representative should be done by the hospital on each person. We had one representative who came close to sexually assaulting a staff nurse. He left the company about a month before the incident was reported to his regional manager. Anytime a person has committed such an act, he has had previous experiences elsewhere. Predators of this type use their job for illicit behaviors. Many hospitals grant non-physician privileges to the representatives that help physicians with specialized devices in the hospital. This is done for medical-legal reasons. In turn, they should sign in when they arrive and sign out when they leave. The representatives should not linger more then 30-45 minutes in the operating area before or after the procedure is completed. A few years ago, while we were implanting a device in a patient, a representative from another company came into the department without registering in the materials management department. He removed two pacemaker leads that were under consignment. A few days later, I received a phone call from the manufacturer, who wanted to know how two atrial leads consigned to our facility were implanted into two different patients in another facility in another state. The representative removed the leads from our department without permission. He removed them from a closed cabinet and tucked them in his attache case, then left. He was immediately and permanently barred from the hospital. Although companies consign implantable devices to our facilities, we are trusted with their detached inventories. If the devices are unaccounted for, we become responsible for the costs incurred. 2. With implantable devices, I have no problem operating analyzers or programmers for pacemakers as a registered allied healthcare worker. I do not have the extensive knowledge to program ICDs. Verifying the thresholds of the leads is not an issue with the ICDs. This technology is very advanced and only the representatives have the knowledge of how the devices need to be programmed at the time of implant. We have RNs in our pacemaker clinic who fine-tune the devices as ordered by the physicians-in-charge. Chuck Williams, BS, RPA rpainga at yahoo. com Cervical and Lumbar Damage from Lead Aprons Do you as a cath lab professional suffer from cervical and/or lumbar disc damage? My suspicion is that wearing the lead as often and for as long as we do, that the weight is causing a significant percent of our professionals’ to suffer lifetime damage! Bob Basile Email: bobstero at ptd. net Cc: cathlabdigest at aol. com I have been in the field for over 25 years with 15 years wearing a lead apron 5 days a week, on-call for 7-10 days a month. The other 10 years I was in admin, supporting those who wore lead aprons. As you may know, there are back support devices, lightweight lead, skirt/vest, etc., configurations to help ease the potential damage to backs and necks. I have seen staff and MDs concerned about potential damage but I am not aware of any studies or personally seen or experienced long-term damage. I feel that as much as possible, we should utilize lead apron weight-reducing alternatives available, take occasional breaks as able, and perform exercises that build strong back muscles. Jon RCIS Acceptance I am currently a traveler and I am running into more job openings across the country that are only accepting RTs/ARRTs for tech positions in their labs. I have an AS degree in Cardiopulmonary Technology and my RCIS. Is there some way to improve the job opportunities for the RCIS people? RCIS credentialing is SPECIFIC to the cardiac cath lab. We have to gain better control over the cath lab tech market. How can this be done? Is there some way to promote the RCIS techs? How can we better educate cath labs on our skills/education abilities and improve our job market? Thank you for your time and attention. Frances Sutera CPT, RCIS Email: fjs412 at yahoo. com Cc: cathlabdigest at aol. com I read your letter in the August 2006 issue of Cath Lab Digest with great interest. I have worked in the same hospital in northern California for 23 years and have worked in and around cath labs for over 30 years. I have a two-year degree, but not in a related field. I trained on the job, starting in the mid-1970s. I have belonged to more than one professional organization and have had more than one credential. I have had my RCIS for about three years now. In the past year, my lab has gone from being almost totally cross-trained to being a lab where job responsibilities are very closely defined. I am no longer allowed to pan the table or even do simple saturations. This has greatly impacted my job satisfaction and the job satisfaction of other techs in the lab who are not RTs or RNs. In the past 23 years, I have trained a good number of RTs and RNs to work in the cath lab and have now been told that I am not qualified to do things I have taught and done for years. It is frustrating to say the least. I too, hope that some national legislation can improve our standing. My hospital regards me as an unlicensed person. I am attending the SoCal SICP symposium in September, in hope that some direction will be provided. Good luck to all of us. Deborah L. James, RCIS San Francisco, California djmama51 at hotmail. com