What Do You Think?

Sheath Removal Our cath lab wants to start having RNs being responsible for sheath removal. Are there any sources or articles you could recommend to assist us in training and putting together a hospital policy for sheath removal? Your help would be greatly appreciated. Thank you, Linda Kolacinski LJKSKI@aol.com Ella Vinokur, RN, MS, NP-C: We are currently working on a procedure manual with an interactive CD-ROM tutorial for clinical staff on the sheath removal process. If you are interested and would like more information, please contact me at EVNP98@aol.com A.Termier, RN, CCRN: Boulder Community Hospital sheath removal policy is as follows: 1. RNs in our recovery room are certified by Datascope and remove sheaths and VasoSeal. 2. Scrub CVT/RCIS/RNs Perclose in the lab post procedure (ACTs under 300). This is dependent on cardiologist preference. Charles: I would suggest going to www.google.com, and using this search engine to find articles on sheath removal. In the Emory University Hospital system, RNs have been removing sheaths for years. On our cardiac floors, RNs are certified after a preceptorship to remove sheaths on interventional classes that do not meet vascular closure guidelines. Hats, Masks & Eye Protection I’m a supervisor of a cath lab in Arizona. I’m in the process of updating our policies and procedures. What is your position or standard (or is there a standard) for the use of hats, masks, and eye protection within the procedure rooms? I know that cath labs do things differently wherever you go. Any input would be much appreciated! Thank you, Doug DougCDIC@aol.com Termiera (from Boulder Community Hospital cath lab): In over 8 years, we have not been using hats or masks for caths/PTCAs, only pacers and now AICDs. Eye protection is strongly encouraged for all cases. In various QAs we have done over the years, we have not found an increase in infection rate or that we are above any national average. Cath Lab Degree? Can you tell me of any universities that offer a Bachelors of Science in the cath lab? kcc9682@msn.com Brenda: I graduated from Northeastern University (Boston, MA) in 1999 with a Bachelors of Science degree (cardiopulmonary science). The class was devised of 3 concentrations: cardiovascular science, respiratory therapy, and exercise physiology. During the first two years of the program, we all studied together for the basic college courses. The last two years of the program, the three areas of concentration broke apart. The cardiovascular science concentration was for all cath lab and electrophysiology people. I was able to graduate and immediately start working in a cath lab. Hope this helps. Cath Lab Daily Operations I am doing research on the actual daily operations of a cath lab. 1. What are your normal hours of operation? a. Do you flex hours? b. Do you cross-train or is staffing included in recovery? c. Do you recover your own patients or if not, who does? d. Do you pull your own sheaths or follow through post Angio-Seals? e. Hours of operation 2. If more than one lab, how do you do your scheduling? a. Does each doc have scheduled time? b. Is it based on physician skill? c. Do you start your day and keep on going? d. Would a call-in team cover late cases? e. Do you find yourselves working late on average? f. Do you have a cut off time or number you can do in a day? g. Do you do your intervention at same setting as cath? 3. Are you involved in recovery, EKGs, and echos, or are you cath procedures only? 4. How many people do you base your labs on: a. Skill level, how many? b. Procedure involvement? c. Do you do your own transporting? I know it is hard to count procedures, because everyone has their own way of counting them, but if you can also give me an idea of patients, procedures and interventions, I would appreciate it for comparisons. Thanks, Roberta Sparks, Good Samaritan Hospital, Downers Grove, Illinois Roberta.Sparks@advocatehealth.com Editor’s Note: For more answers to Roberta’s question, please see our Email Discussion Group in the March 2002 issue. Glen A. Goetlz, RT(R)(CV): First, a little about our hospital. We are a 540-bed teaching facility that is connected to a very large independent clinic. The physician number (including satellite centers) is approximately 500. We have about 17 cathing physicians. We have 3 dedicated cath labs, 1 EP lab, and 2 vascular labs, and we are located in Wisconsin. I am the lead person (normally called assistant supervisor). My education background is an RT(R)(CV). I have been at this facility for 26 years. We have teams (consisting of an RN, RT(R), ORT and CVT) that start at 0700 and 0830. Our on-call team starts at 0930. Set hours are 0700-1800. On-call is 1800-0700. A schedule is provided, but personnel are free to switch in order to help the home life at any time. Just as long as it is covered. The clinic has patients that have traveled long distances, so we try to accommodate same-day caths. In 98% of the cases, we do interventions in the same setting as the caths. We do not formally cross-train. We have several RT(R)s that will fill in for the ORTs on EPs, vascular cases and coronary caths when needed. We have an outpatient recovery area that is staffed with its own staff. They are under the control of the department, but we do not cross-train in the area. If they need help, we will provide that assistance. We pull the sheaths in the rooms at the end of the cases. If a patient does go to their room with the sheaths in place, we are not responsible for pulling them. Each case is scheduled either through myself or the department secretary. At the current time, we have an automatic time build-in for each type of case, i.e., coronary, heart cath, vein grafts, etc., in 15-minute time frames. I am in the process of fine-tuning that to be more physician skill-based. Not an easy task. We do have an excellent data base to help with this. For the most part, we start our day and keep on going. Our outpatient center does not accept patients after 1600, so we try to have them completed by then. We try to get everyone a lunch, but breaks are not planned by any means. The call-in team will stay until all the cases are done. For the most part, our on-call team is out by 1900. We try to have the 0700 teams out on time. Most often, if they have to stay, it is to finish the case they are working on. We average 6-10 weekend cases. For elective cases, we try to limit them to before 1700. There is no magic cut-off number of cases. Our patient acuity and case mix make it impossible to do this. We do cath lab cases, special procedures and EP, including AICDs, pacemakers and conscious sedation for ERCPs and discograms. When fully staffed, we have: 1 manager 1 lead person 9 RNs 8 RT(R)s 7 ORTs 7 CVTs, and 1 department secretary. With time off in mind, we keep a minimum of 6 teams per day. For cardiac cases, we have 1 RT(R), 1 RN, 1 ORT and 1 CVT. For specials and EPs, we do not have the CVT. We did all our own transporting until 6 months ago. Our hospital just moved to a central transport team, which is working quite well. We use our outpatient staff for recovery. We do about: 3000 cath procedures 600 interventions 550-600 EPs, RFAs, pacers 2500 special procedures Our procedures are all coronary interventions, valvuloplasties, mapping EPs, biventricular pacemakers, AAA graft stenting and carotid stenting. We are in the very beginning planning phase to see if splitting our departments into separate entities will help the labs. First planned is the EP section.