December to February EP Education Schedule

Upcoming EP Education & Inservices:

      

 16 December 2014 (Tuesday)

    Pacemaker/ICD Basics

            Chad Beaver, BME CCDS

             St Jude Medical

  Time/Location: 0730hrs in Prep and Recovery Conference Room

06 January 2015 (Tuesday)

   nMARQ Ablation Ssytem         

Biosense Webster
Whitney Smith
Time/Location: 0730hrs in HVC Room #5

20 January 2015 (Tuesday)

    Device Programming Basics

            Chad Beaver, BME CCDS

            St Jude Medical

     Time/Location: 0730hrs in Prep and Recovery Conference Room

03 February 2015 (Tuesday)

   Inappropriate Sinus Tachycardia (IST)

      Barb Knick, RN CSRN BSN RCES

                Time/Location: 0730hrs in Prep and Recovery Conference Room

17 February 2015 (Tuesday)

   Inappropriate Sinus Tachycardia (IST) Drug Protocal

      Barb Knick, RN CSRN BSN RCES

                Time/Location: 0730hrs in Prep and Recovery Conference Room

13-16 May 2015 (Tuesday)

   36th Annual Heart Rhythm Scientific Sessions

        Boston, MA

                Boston Convention and Exhibition Center 

                Read more: http://www.hrsonline.org/Education-Meetings/Scientific-Sessions/

Important information about Spinal Stimulators.

Important information about Spinal Stimulators.

For patients that have an implanted Spinal Stimulator; RF Ablation is contraindicated.

A  Spinal stimulator has electrodes that are implanted on the spinal cord and this can cause complications during RF Ablation. Spinal cord injury occurs from the electrodes interacting with the RF energy.  During RF ablation, the spinal stimulator electrodes act as an antenna and heat up which can cause thermal injury to the spinal cord. Spinal cord injury can still occur even if the device is turned off or partially removed.

The Medtronic website states:

 Spinal Cord Stimulation; Indications, Safety, and Warnings: Contraindications

Diathermy: Do not use shortwave diathermy, microwave or therapeutic ultrasound diathermy (all now referred to as diathermy) on patients implanted with a neurostimulation system. Energy from diathermy can be transferred through the implanted system and cause tissue damage at the locations of the implanted electrodes, resulting in severe injury or death.

Warnings:

Sources of strong electromagnetic interference (eg, defibrillation, diathermy, electrocautery, MRI, RF ablation, and therapeutic ultrasound) can interact with the neurostimulation system, resulting in serious patient injury or death. These and other sources of EMI can also result in system damage, operational changes to the neurostimulator or unexpected changes in stimulation. Rupture or piercing of the neurostimulator can result in severe burns. An implanted cardiac device (eg, pacemaker, defibrillator) may damage a neurostimulator, and the electrical pulses from the neurostimulator may result in an inappropriate response of the cardiac device.

Images for Spinal Electrodes

Below is a fluoro image of implanted spinal stimulator electrodes from a recent patient. This patient was scheduled for an SVT ablation. The patient DID NOT inform anyone about this implanted device and it was not listed in his H&P or any hospital records. The first indication that the device was present was in the first fluoro image (please see below).

Although this is a very rare occurrence, it can have devastating effects on the patient. This is why it is important for us to screen all patients for any type of implantable stimulator. This procedure had to be aborted after discovering an implanted spinal stimulator and rescheduled for a different date and procedure type.

**Stimulator Electrodes highlighted in in yellow

ECG of the Week 29May2014

 

ECG of  the Week

29 May 2014 

What’s going on here?? 

The correct answer will contain:

1)  The correct interpretation of the ECG  

                                  2) An brief explanation of how you arrived with your answer. 

i.e. If the ECG was 3^rd degree block your answer should be something like;

“Third Degree Block. There is complete dissociation of atrial and ventricular activity.” 

The first person to submit (e-mail) the correct answer and the brief explanation about the ECG will win a $5.00 Starbucks Gift card!!!

 

Top 10 Steps to Radiation Safety

FYI

This is from an email sent out by MUSC

!!Top 10 Steps to Radiation Safety!!

 Because of its potential damaging effects, the amount of radiation exposure should be minimized. The exposure to radiation should be as low as reasonably achievable (ALARA).

 

 

1.      All operators of mobile or portable x‐ray equipment are required to have a dosimetry badge

2.      Fetal monitors are recommended, but not required, for pregnant individuals.  When a fetal monitor is requested, a written notification to the Radiation Safety Office (2‐4255) must be submitted.

3.      Wear a dosimetry badge at all times when in a fluoroscopic suite.

4.      All dosimetry badges must be turned in to the Radiation Safety Office by the 10^th of the month.

5.      Wear your dosimetry badge on the upper body in a location which is most likely to receive the exposure.

6.      If you lose your dosimetry badge, contact the Radiation Safety Office (2‐4255).

7.      Wear proper protective equipment (PPE), lead apron, thyroid shield, and lead gloves as needed.

8.      Always be aware of the three main principles of reducing radiation exposure:

a.      Time – minimize the amount of time in radiation area

b.      Distance – distance self as much as possible from radiation sources

c.       Shielding – use protective shielding devices

9.      Only licensed x‐ray technologist or trained licensed practitioner shall operate x-ray equipment.

10.  Only licensed x‐ray technologist or trained licensed practitioner shall position the c‐arm or mobile radiographic unit over the patient or area of interest. Non-licensed personnel are only allowed to move the c‐arm or other radiation generating device into the suite of operation, and turning the unit on to enter patient data.

 



Basic Electrophysiology and RCES Prep Course

 
These classes are open to everyone

 Below are the Outlines and Objectives for the first two Classes.

As soon as I finalize the other class outlines I will post them.

Classes will be held the First and Third Tuesday of each month from 0730 to 0830

Room# 3422 (Prep and Recovery Conference Room)

==============================================================================

March 4^th, 2014

Class I - Types of Procedures

Lecture by: Brent A Lawhon, CVT CEPS

Objectives for Class I: Types of Procedures

1)      Identify the types of procedures performed in Electrophysiology

2)      Understand the difference between procedures performed in Electrophysiology

3)      Understand the risk factors for each type of procedure

Types of Procedures encountered in Electrophysiology Outline 

A)     Diagnostic Procedures

1) Tilt Table Testing

2) E.P. Study

3) Ultrasound (Echo) Studies

                a) TEE

                b) Transthoracic

4) Cardioversions

B)      Therapeutic   Procedures

1)      RF Ablations

a)      SVT Ablations

                    b)      Atrial Fib Ablations

                    c)       VT Ablations

     2)      Device Implantation

                    a)      ILR Placement

                    b)      Pacemaker  Placement - Single and Duel Chamber

                    c)       ICD Placement – Single and Duel Chamber

                    d)      CRT placement – Pacemaker and Defibrillator

                    e)      Sub-Q ICD

C)      Other Procedures

     1) DFT

     2) Device Interrogation and Reprogramming

 

======================================================================

March 18^th, 2014               

Class II - Pre-Procedure Activites

Lecture by: Ginny Hoff, RN

Objectives for Class II - Pre-Procedure Activities

1)     Identify the importance of using the EP Lab Procedure Safety Checklist

2)     Identify the importance of obtaining Pre-Procedure Verification and the proper reporting of abnormality’s  

3)     Recognize abnormal lab values and identity to whom they will be reported

4)     Recognize abnormal lab values as they pertain to devices and ablations

5)     Recognize abnormal vital signs and rhythm as they pertain to devices and ablations

6)     Recognize antibiotic use as they pertain to devices

7)     Discuss the importance of medical history as they pertain to devices and ablations

8)     Understand the Sedation Risk Factors as they pertain to devices and ablations

9)     Discuss the Anticoagulation/Antiplatelet Regime as they pertain to devices and ablations

10)  Identify the importance of obtaining Post Procedure Timeout information and the proper reporting of a anormality

 **25% of Questions come from this section**

Pre Procedure Activities Outline

A. Patient Preparation for Procedure

1) Ensure proper patient ID

2) Correct Consents for procedure

3) Maintain patient and family comfort

4) Basic patient assessment

a. Subjective assessment

b. Objective assessment

5) Patient and Family Teaching

a. Approximant length of procedure time

b. What to expect during procedure

c. Post procedure activities.

6) Review of Medical Record

7) Verify Physician Orders

8) IV placement and Lab Draws

9) Site preparation

10) Urinary catheter placement

B. Normal and Abnormal Lab Values

1) Normal Values

2) Abnormal Values

3) Critical values

C. 12 Lead ECG

1) Correct Lead Placement

D. Pre-procedure sedation

E. Other Pre-Procedure activities

1) Interrogation and Programming of existing device (i.e. Pacemaker, ICD, etc.)

2) Pre-procedure assessment of skin, documentation and photo for thermal burn.

===============================================================

 

April 1, 2014

      

Class III - Procedural activities

Part 1

Ablation Procedures

 

Lecture by: Barb Knick, RN BSN RCES

Ablation Procedural Activities Outline





A.      Procedural Activities

1)      Sterile Technique

2)      Sterile Procedure Table Set-up

B.      Ablation Activities

1)      Equipment needed for procedure

2)      Assist with sheath Placement (Venous and Arterial)

3)      Assist with Catheter Placement

4)      Assist with Trans septal Puncture

5)      Assist with Ablation

C.      Non-Invasive Procedures

1)      Equipment needed for procedures

2)      Assist with Cardioversion

3)      Assist with TEE exam.

4)      Assist with Tilt Table Exam

5)      Assist with DFT’s and Device Testing

D.      Emergency Procedures

 

 

====================================================================

 

April 15, 2014

Class IV - Procedural activities

Part 2

LECTURE BY: DIANA VANBENSCHOTEN, RT(R)

 

                   A.      Procedural Activities

1)      Principles of Sterile Technique

2)      Sterile Procedure Table Set-up

                   B. Patient Preparation and Positioning

                   C.      Device Activities

1)      Equipment needed for Procedure

2)      Assist with Pacemaker implantation

3)      Assist with ICD Implantation

4)      Assist with CRT implantation

5)      Assist with Lead Extractions

6)      Sub-Q ICD

D.      Emergency Procedures

 

==================================================================

 

Date: TBA

Class V - General Anatomy and Physiology

LECTURE BY: James Merriam, M.D.

 

            A.      General Cardiac Anatomy Physiology

1)      Basic Cardiac Anatomy

2)      Cardiac Pathophysiology

3)      Cardiac Action Potential

4)      Cardiac Conduction

 

**This Class may be broken into two or more classes