What Do You Think?

What Do You Think?

Multiple new and ongoing questions from readers. Your responses are welcome! Answer or pose a question at cathlabdigest@aol.com _______________________________


Post Recovery Situation I am interested in knowing what the post recovery time is for patients that are being admitted to the hospital post cath or PCI. Currently, the lab I am working in requires the CCL to recover all patients being discharged from the CCL holding/recovery. We are a small facility with only 1 call team, which at this time is only one nurse. The nurse ends up staying 90 percent of the time. Should a STEMI come in, then the nurse has to transfer the patient to the ICU to continue the recovery time and discharge. Mitzi Latour Email: mlatourrn@yahoo.com CC: cathlabdigest@aol.com Stocking the Impella How many Impella 2.5 systems do you carry in stock? What is the minimum level you keep on hand at all times? Would you ever keep only 1 unit on site at all times? We have 5 rooms and we do approximately 4,800 procedures a year. Scott Fylling, RCIS Email: Scott.Fylling@bhsnet.org Cc: cathlabdigest@aol.com Data Collection, QI Position We want to create a job in our cath lab that isolates data collection and quality improvement initiatives and does not require an RN. I can’t find any similar job descriptions online. Does a position like this even exist? Erin Email: erin.caruso@caritaschristi.org Cc: cathlabdigest@aol.com Panning Program I had a small program that teaches staff and students to “pan the table” for the physician during a case. Since I have gotten my new computer, I cannot find it. Does anyone know where I could re-download this program? It is such an excellent tool to use for teaching panning. Everything is backwards and when better to study than sitting behind your computer screen, panning with your mouse? Jason Email: Itroje@aol.com Cc: cathlabdigest@aol.com


Dry Trays and D2B I need evidence-based info regarding the practice of setting up dry trays to reduce door-to-balloon times. Any help would be greatly appreciated. Rhonda Kempa, RN, RCIS Email: rkempa@wpahs.org Cc: cathlabdigest@aol.com Sterile Field Range I have heard several different answers to the following question. In the cath lab setting, when a sterile field has been opened for a diagnostic cath and/or STEMI, and for some reason it is aborted, how long is the sterile field good for to be used on another diagnostic cath and/or STEMI if covered? I have heard a range from 8 to 24 hours for a wet field that has been covered and 12 to 48 hours for a dry field that has been covered. Is there a standard? Nick Teaver, RN West Georgia Health System Email: teavern@wghs.org Cc: cathlabdigest@aol.com I think these two questions fall somewhat in the same area, so I will answer both Rhonda and Nick at the same time. I do believe setting up dry tables helps your door-to-balloon times. It may only be 5-7 minutes, but every minute counts — “time is muscle.” The first person who arrives turns on equipment, gets patient info, uncovers the table and wets the table. That way, when the second member arrives, they can stop in the ER and bring the patient to the room or at least let ER staff know they can bring the patient up. If there is extra ER staff and they bring the patient up, then that second person is able to ready anything in the room that may need to be done. Most of our staff members get to the hospital within 3-5 minutes of one another. As far as a dry table that is covered, at my hospital, a dry covered table is 24 hours and a wet covered table is 12 hours. I don’t think there is any standard. As a matter of fact, I think this practice is somewhat frowned upon by AORN* standards. We get by with it because we have proved that having a dry table ready for STEMI has improved our D2B time. When time is muscle, who’s going to argue with that? lqqk2c123@yahoo.com *Association of periOperative Registered Nurses (AORN) RN + RT Individuals? Does anyone know about individuals who carry both RN and RT certificates?  I have my RT and have been accepted to an RN program. It is my hope that some day I will be able to utilize both degrees in one lab, but obviously not during the same case. I haven’t gotten much feedback from my current employer, so I was hoping for some feedback to see if this type of thing has ever been done before. Thanks in advance! Gary Coelho Email: garycoelho@yahoo.com Cc: cathlabdigest@aol.com Gary, I am an RN/RT. I was an RT for 6 years, working in interventional radiology, when I decided to go back to nursing school. My employer at the time was very supportive of my decision and worked around my nursing program schedule. I transferred from radiology to the CCL about 4 months before graduating nursing school. So I was working as an RT, then upon graduation was changed to an RN (on paper). However, I still held both credentials and license, and still do. People often ask me if I work as an RN or RT. I always say I can’t really turn one off and the other on. They work within me simultaneously. It is who I am. In 2002, I also decided to become certified as an RCIS by CCI. I felt that certification would validate my education and experience in invasive cardiology. I recommend pursuing that certification as well. I feel that having both educational backgrounds really helped me be successful on the RCIS exam. Since then, I have worked in the cath lab as an RN/RT in various aspects, and am currently per diem as an RN in an outpatient CCL/peripheral vascular lab at St. Mary’s Medical Center. The reason I choose to hold an RN position is because I can then work in the pre/post recovery area as well as the procedure rooms. I now teach full-time in a radiology technology program. I am also completing my MSN in nursing education and plan to pursue a DNP upon graduation in spring of 2010. I have always felt very valued by my employers because of my dual education. Because of my dual education, I am a huge advocate for interprofessional education at the University of Southern Indiana, where I teach. We work together to incorporate nursing, radiology, respiratory and even occupational therapy into simulation scenarios. I believe that my dual education has made me more aware of the need to recognize and respect the roles of other health care professionals. Please feel free to email me with any questions. Good luck. Jennifer Titzer, BSN, RN, RT(R), RCIS jltitzer@usi.edu I carry both RN and RT certificates. I’ve worked in the cath lab for nine years as an RT and just this past summer completed my RN. I am currently utilizing both degrees while working in the cath lab. Having both degrees also alleviates problems with call coverage because I am interchangeable. I work in a small cath lab made up of only 7 employees that take call. One of my coworkers in our cath lab also carries both degrees. There were many reasons that drove my desire to acquire both degrees, but the most important one for me was to have more options in my career path. In the past, I struggled with the feeling of being limited in employment options and at times even felt “trapped” in a demanding job that required a lot of on-call hours. I felt that completing my RN degree would open up many more opportunities for me and increase my current job satisfaction. So far the investment has paid off and I am more satisfied with my job. Once I have completed with my orientation period, I am looking at taking the registry exam for my RCIS. I feel that education is a lifelong journey that never stops. Tammy Petersen, RN, RT(R), EMT-B mtpetersen@netins.net Time-Out Information At LaPorte Hospital cath lab, we perform a “time-out” at the beginning of every case. Patient information includes: patient name, DOB, MR#, procedure being performed, and physician performing the procedure. Is this enough information for time-out or is there additional information that needs to be stated? Should we also be addressing if antibiotics were administered or fluids for irrigation purpose, safety precautions based on patient history, etc.? Roma Thibaut Email: r.thibaut@lph.org Cc: cathlabdigest@aol.com Yes! You need more in your time out, things like: • Allergies • Is the patient on heparin, or was it stopped in the last hour or so? • Dye load • We should always use blood and body fluid protection, but it is nice to know if maybe we need to have some extra protection, like double gloves for HIV, hepatitis, and any recent trauma or major bleeding events. All of these may affect how we treat the patient. As an example, for a patient who recently fell and has some head trauma, or just got several teeth pulled, we might not want to give IIb/IIIas and may want to wait before we do an elective PCI. Cathin' in Kansas ___________________________

Re: FemoStop Usage

Please explain the standard of practice for FemoStop usage. I’m an experienced CCL RN with over 15 years of clinical experience. The standard of care I have learned to give is that FemoStop is not to be used for routine sheath pulling. I have only used it after manual compression where complications arose and extended compression was necessary. It has also been my experience that when the FemoStop is being used that close patient observation and monitoring is essential. FemoStop usage has always required a physician order for use in my practice. I’ve heard feedback arguing that sheath pulling causes carpal tunnel syndrome. That also has not been my experience. Proper technique in pulling sheaths and groin management is essential for safe and successful outcomes for both the patient and the clinician. I look forward to your feedback. Susan Andrews Email: susan.andrews@provena.org Cc: cathlabdigest@aol.com CLD encourages readers to respond to Ms. Andrews. We shared her question with St. Jude Medical, manufacturer of the FemoStop device. The company’s response is below. The FemoStop™ Compression Assist device offered by St. Jude Medical has a long history of successful use, and is the worldwide market share leader in femoral compression assist devices in catheterization labs around the world. When FemoStop was first introduced in 1992, hemostasis management options were limited to manual compression and using a C-Clamp. The FemoStop provided a solution to the limitations of these techniques by offering a clear dome for puncture site visibility and a manometer for constant pressure application feedback. Because of these benefits, many facilities apply FemoStop as their front-line sheath pulling device. The Freeman Study protocol (http://www.invasivecardiology.com/article/5271, The Journal of Invasive Cardiology) demonstrates ambulation in diagnostic cases in as little as 90 minutes. Monitoring is still required with FemoStop; however, with the hands-free device, staff can now focus on other patient monitoring items and tasks. Any repetitive task, such as manual compression, has the potential to cause repetitive stress injuries. In research done by Martha Holton, RN, BS, CCRN, RCIS, FSICP (http://www.cathlabdigest.com/article/3898), 77 out of 110 anonymous survey respondents replied that injuries have arisen directly from manual compression at their cath lab. The FemoStop Compression Assist Device offers an alternative to the limitations of manual compression that, when used properly, benefits both the patient and the clinician. The graph above provides an example timeline for sheath removal with Femostop Gold.