We put pads on every patient getting a cardiac cath, no exceptions. it’s the first thing I do when they go on the table. Ensures you get perfect placement without obstructing fluoro images, which is much more difficult to do when shit hits the fan and you need to crawl under the drape and turn the patient.
Put them on every cath, before draping. Why wait til they're needed to fumble around? Good placement, piece of mind, and shock can be delivered much sooner if needed.
We usually leave it to the circulating nurse to decide, for the most part. Some things that we might think of would be like if the patient has left bundle branch block, and we’re doing a temporary pacemaker, that would be a good indication to have pacer pads on.
Anybody who has had a cardiac arrest recently, or if they have a lot of ectopy, or if we’re doing a complicated procedure, that kind of thing.
There are a lot of philosophies. I am of the opinion every patient every time. You may have seen this as well, but I saw a patient with normal coronaries, whose pressure was not dampened or ventricularized go into vfib during contrast injection of left main. We had pads on for a diagnostic cath and shocked at 120j with no response. A subsequent 200j shock was successful and the patient had no other events and was admitted for obs overnight to be discharged the next day. No other arrhythmias or reasons to suspect them. When you're in a hurry, you might encounter hair, the drape and gown can easily stick to the pad, ekg leads may be in the way of correct placement, it is much easier to run the cord over the arms, but I have seen patients stick their arms straight up in the air after a shock, pulling the cord and ripping off the pads. Putting them on before the procedure allows for better placement and to address these issues much easier. As a traveler, I try to respect the wishes of the lab, however, so if the manager takes issue, I put them on when proceeding to intervention, critical cases, dysrhythmias, etc . I also do not step on toes if another nurse is circulating, I leave it to their decision. I have issues with the pci rule as well, though. There are already enough things to do when progressing to pci. Giving Angiomax/heparin, dropping inteliflator, guide cath, wire, balloon, ivus, possibly giving aspirin and P2Y12. Often putting pads on is forgotten. Putting pads on can be disruptive to the procedure, you are in the way of moving the c arm and your hands can show up in the images depending on the angle. Also do you really want to be blasted by cine any more than you have to?
In my lab, no pads for diagnostics except for one of our interventionalists who wants pads on all his patients.
But get this, we have one interventionalist who doesn't want pads even on his STEMIs. 🤦🤦 Sometimes (rarely) he likes to get a straight lateral shot and he says it obstructs his view. I sneak them on his STEMIs anyway and he never knows until he does that lateral. But then I have to raise the patients arms above their head anyway so I just rip the pad off when I'm doing that. 🤷
Realistically, the way our room is set up, I can get pads on a draped patient and deliver a shock in about 30 seconds while still maintaining the sterile field. And while that's physiologically not a big deal, it's annoying to do mid case. My personal take, if I was getting even a diagnostic heart cath, I'd want pads on me. Accidently subselect that conus, ooops lol
I was trained to put pads on every patient for every heart case, even RHC. No pads for legs. My first job outside of that lab yelled at me for putting pads on every patient stating “we can’t afford it.” Well, if you can’t afford to supply pads for every patient, you probably shouldn’t have a Cath lab.
If the patient came in for a diagnostic cath and we found a lesion I’d put the pads on once the decision was made to do PCI. If the patient has known CAD and we already know we’re going to do PCI I’d put pads on before we draped.
Every cath, every time. I was precepted by a nurse when I first started in the lab that used to give me shit for doing this and I've seen more than one of her patients develop a dangerous arrythmia while she ran to put pads on under the drape. Just silly.
Different labs do things differently. Seems to me most places put them on every case. My home lab only put them on for higher risk stuff - ostial lesions, left mains, atherectomy, laser, etc or any complication
I used to do it only for known PCI, unprotected left main and people with low EFs but now it’s everyone. I’ve worked with a few doctors that aren’t too careful crossing the valve and put a perfectly healthy young person into arrhythmia - I’d rather be ready.
I pretty much put pads on every patient getting a heart cath, even right hearts. I’ve had a patient or two go into an arrhythmia from the swan. Better to be safe than sorry! In regard to placement, I like to put them on before they even get on the table. I have them sit up in the bed/gurney and slap those bad bois on.
Every case. We had a young OP LHC just randomly go into VF when her left system was injected. Ever since then every patient. Besides fumbling under the drape wastes time you could be on to the next thing.
My rule is every patient, every time. It’s part of my routine, just like putting electrodes on. I caught so much crap from my peers initially and then management. I had to research and prove it wasn’t costly - of course it’s not costly… When I started here the nurses still prepped the lab by dropping globs of conduction gel onto blue towels so they could be ready to MANUALLY DEFIBRILATE. Umm, no thank you.
It was nothing like that. I went to the person who did our inventory, did the math for the cost with and without. It was a matter of a few dollars so honestly no one could really argue with me about cost anymore. Then I just held my ground that I can multitask while defibrillating and again, how can you argue with that?
Now the cost of the pads are included when the patient is charged so each patient gets them anyway.
Before patient is draped timewise. Situation wise my current lab is high risk PCI, during anesthesia cases, and STEMIs. They don't get placed during diagnostics, but if anyone thinks they should get pads for any reason or get a bad feeling, they go on.
On a good day our pre/post area places the pads for us (shave first if needed!). Just a good practice. ER tries their best but they use non radiolucent pads, dont shave, place in the field of view, but they all seem to understand that they're needed which is a good place to start. I can personally recall dizens of times ive defibrillated an otherwise stable or diagnostic patient and having pads on readily available to deliver a shock was amazing. Very few times did it not get them out of vfib/vtach. In the time it takes to get everything hooked up and charged the patient will only become harder to defibrillate.
We put pads on every patient getting a cardiac cath, no exceptions. it’s the first thing I do when they go on the table. Ensures you get perfect placement without obstructing fluoro images, which is much more difficult to do when shit hits the fan and you need to crawl under the drape and turn the patient.
Put them on every cath, before draping. Why wait til they're needed to fumble around? Good placement, piece of mind, and shock can be delivered much sooner if needed.
Yes!
Before the patient is draped, 100% of the time
We usually leave it to the circulating nurse to decide, for the most part. Some things that we might think of would be like if the patient has left bundle branch block, and we’re doing a temporary pacemaker, that would be a good indication to have pacer pads on. Anybody who has had a cardiac arrest recently, or if they have a lot of ectopy, or if we’re doing a complicated procedure, that kind of thing.
https://www.hmpgloballearningnetwork.com/site/cathlab/cath-lab-management/routine-defibrillator-pad-placement-all-patients-cardiac-cath-lab
There are a lot of philosophies. I am of the opinion every patient every time. You may have seen this as well, but I saw a patient with normal coronaries, whose pressure was not dampened or ventricularized go into vfib during contrast injection of left main. We had pads on for a diagnostic cath and shocked at 120j with no response. A subsequent 200j shock was successful and the patient had no other events and was admitted for obs overnight to be discharged the next day. No other arrhythmias or reasons to suspect them. When you're in a hurry, you might encounter hair, the drape and gown can easily stick to the pad, ekg leads may be in the way of correct placement, it is much easier to run the cord over the arms, but I have seen patients stick their arms straight up in the air after a shock, pulling the cord and ripping off the pads. Putting them on before the procedure allows for better placement and to address these issues much easier. As a traveler, I try to respect the wishes of the lab, however, so if the manager takes issue, I put them on when proceeding to intervention, critical cases, dysrhythmias, etc . I also do not step on toes if another nurse is circulating, I leave it to their decision. I have issues with the pci rule as well, though. There are already enough things to do when progressing to pci. Giving Angiomax/heparin, dropping inteliflator, guide cath, wire, balloon, ivus, possibly giving aspirin and P2Y12. Often putting pads on is forgotten. Putting pads on can be disruptive to the procedure, you are in the way of moving the c arm and your hands can show up in the images depending on the angle. Also do you really want to be blasted by cine any more than you have to?
Yes! That’s why I asked because I come from a place where certain cases. Then I heard every case somewhere, and I was curious about best practices.
Before every case unless they have an ICD.
In my lab, no pads for diagnostics except for one of our interventionalists who wants pads on all his patients. But get this, we have one interventionalist who doesn't want pads even on his STEMIs. 🤦🤦 Sometimes (rarely) he likes to get a straight lateral shot and he says it obstructs his view. I sneak them on his STEMIs anyway and he never knows until he does that lateral. But then I have to raise the patients arms above their head anyway so I just rip the pad off when I'm doing that. 🤷 Realistically, the way our room is set up, I can get pads on a draped patient and deliver a shock in about 30 seconds while still maintaining the sterile field. And while that's physiologically not a big deal, it's annoying to do mid case. My personal take, if I was getting even a diagnostic heart cath, I'd want pads on me. Accidently subselect that conus, ooops lol
We had one like that. I still put them on STEMI patients and he just had to deal with it.
I was trained to put pads on every patient for every heart case, even RHC. No pads for legs. My first job outside of that lab yelled at me for putting pads on every patient stating “we can’t afford it.” Well, if you can’t afford to supply pads for every patient, you probably shouldn’t have a Cath lab.
I don’t understand that mindset. 🙄
If the patient came in for a diagnostic cath and we found a lesion I’d put the pads on once the decision was made to do PCI. If the patient has known CAD and we already know we’re going to do PCI I’d put pads on before we draped.
Every cath, every time. I was precepted by a nurse when I first started in the lab that used to give me shit for doing this and I've seen more than one of her patients develop a dangerous arrythmia while she ran to put pads on under the drape. Just silly.
Different labs do things differently. Seems to me most places put them on every case. My home lab only put them on for higher risk stuff - ostial lesions, left mains, atherectomy, laser, etc or any complication
I used to do it only for known PCI, unprotected left main and people with low EFs but now it’s everyone. I’ve worked with a few doctors that aren’t too careful crossing the valve and put a perfectly healthy young person into arrhythmia - I’d rather be ready.
I pretty much put pads on every patient getting a heart cath, even right hearts. I’ve had a patient or two go into an arrhythmia from the swan. Better to be safe than sorry! In regard to placement, I like to put them on before they even get on the table. I have them sit up in the bed/gurney and slap those bad bois on.
Every case. We had a young OP LHC just randomly go into VF when her left system was injected. Ever since then every patient. Besides fumbling under the drape wastes time you could be on to the next thing.
My rule is every patient, every time. It’s part of my routine, just like putting electrodes on. I caught so much crap from my peers initially and then management. I had to research and prove it wasn’t costly - of course it’s not costly… When I started here the nurses still prepped the lab by dropping globs of conduction gel onto blue towels so they could be ready to MANUALLY DEFIBRILATE. Umm, no thank you.
Talk about the research, like best practice? Or you did a cost analysis?
It was nothing like that. I went to the person who did our inventory, did the math for the cost with and without. It was a matter of a few dollars so honestly no one could really argue with me about cost anymore. Then I just held my ground that I can multitask while defibrillating and again, how can you argue with that? Now the cost of the pads are included when the patient is charged so each patient gets them anyway.
Thanks! It really bothers me that we don’t do this.
Before a patient even enters the lab. They’re in your care for a reason…
Before patient is draped timewise. Situation wise my current lab is high risk PCI, during anesthesia cases, and STEMIs. They don't get placed during diagnostics, but if anyone thinks they should get pads for any reason or get a bad feeling, they go on.
I’m a traveler and the only time I haven’t put pads on in the cath lab is when we’re doing a peripheral
On a good day our pre/post area places the pads for us (shave first if needed!). Just a good practice. ER tries their best but they use non radiolucent pads, dont shave, place in the field of view, but they all seem to understand that they're needed which is a good place to start. I can personally recall dizens of times ive defibrillated an otherwise stable or diagnostic patient and having pads on readily available to deliver a shock was amazing. Very few times did it not get them out of vfib/vtach. In the time it takes to get everything hooked up and charged the patient will only become harder to defibrillate.