EP Lab Digest - September 2007 - (Page 21)

SEPTEMBER 2007 EP DEVICES 21 to acute implants. In fact, likelihood of metastatic spread is similar in both chronic and acute implants. Furthermore, “phlebitis and lymphadenitis caused by an infected intravenous fluid administration site has the potential of infecting a new device implant pocket and probably a chronic pocket.”1 Therefore, one may deduce that intravenous fluids should not be administered on the same side as the implanted device. Every attempt should also be made to find out how an infection started. It is thought to be counterproductive to treat a device infection, implant a new device, and have it become re-infected because the infection was the result of metastatic spread from some remote infection.1 Infections caused by a transient bacteremia due to teeth cleaning or by a biopsy or removal of a colon polyp may be prevented by use of prophylactic antibiotics. Antibiotics are essential to the management of device infections. They should be used in conjunction with the corrective surgical procedures. All device infections should be treated with intravenous antibiotics before the corrective surgical procedures are performed. Because the infecting bacterium and its susceptibilities usually are not known when therapy is instituted, it is suggested to administer 1 gram of vancomycin and 60 mg of gentamicin to all patients before the surgical procedure. All other antibiotics should be stopped at this point, “unless culture susceptibilities show them to be effective.”1 In particular, the antibiotic vancomycin is often used since “most infections are caused by staphylococci, and almost all staphylococci are susceptible to vancomycin.”1 In addition, allergic reactions to vancomycin are rare.The patient may experience itching and have a flushed appearance, but this is caused by rapid infusion of the drug and are not signs of an allergy. Gentamicin has been suggested for administration for general gramnegative coverage, and prophylactic doses should be given.1 Ciprofloxacin and levofloxacin are the more frequently prescribed oral antibiotics for treatment before and after discharge from the hospital. The duration of antibiotic therapy before the procedure should be determined by the magnitude of the infection. Antibiotic therapy is found not to be curative and should not be used alone as a curative approach. Antibiotics can cause remission of the clinical signs and symptoms. The remission with virulent bacteria such as S. aureus is short term, and the signs and symptoms usually reappear as soon as the antibiotic therapy is stopped. The length of remission is usually related to the condition of the pocket. For example, in pockets subjected to concealed infection, with a thick layer of encapsulating fibrous tissue, infection is found to usually recur within one or two weeks after the antibiotics are stopped. More normal pockets have longer remissions due to the ability of the body’s defense systems to engage the bacteria.1 Another persuasive reason for avoiding long-term treatment with antibiotics is the development of resistance to the drugs. Current intravascular extraction techniques are effective for extraction of pacemaker leads. However, there are still complications to be taken into account with small but significant risk. Lead extraction as primary treatment, including antibiotic therapy, even for localized infections, will result in the best opportunity to cure the infection and prevent systematic complications. Reference 1. Ellenbogen KA, Kay GN, Lau CP, Wilkoff BL. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy, 3rd Edition. Philadelphia: Saunders, 2007: pp. 878-920. Editor’s Note: This article was peer reviewed by one or more members of EP Lab Digest’s editorial board. EPLD Survey First Annual SALARY SURVEY Welcome to EP Lab Digest’s first salary survey! Anyone working in the EP lab can participate. Results will be published in a future issue of EP Lab Digest. RETURN SURVEYS TO: jelrod@hmpcommunications.com or via fax at 817-549-1472 In order for your survey to be included, you MUST answer all questions. 1. Are you a: (check all that apply, but also circle what you consider your “dominant” credential) ❏ RN ❏ CVT ❏ RT(R) ❏ CCRN ❏ RCIS ❏ Manager/Supervisor ❏ Director ❏ Other (please specify) 2. Your region: ❏ Midwest (IA, IL, IN, MI, MN, MO, MS, OH, WI) ❏ Pacific Coast (AK, CA, HI, OR, WA) ❏ New England/Middle Atlantic (CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VE) ❏ Middle South/South (AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, WV, VA) ❏ Central/Mountain Region/Southwest (AZ, CO, ID, KS, MT, ND, NE, NM, NV, OK, SD, TX, WY, UT) 3. Years of experience in the EP lab: ❏ 0-2 years ❏ 3-5 years ❏ 6-9 years 4. Size of your EP lab facility: 5. I am paid: ❏ 10+ years Procedures per year EP lab suites Hourly (amount) $ ❏ Certification (RCIS, CCRN) 6. In the past year, I received the following bonus: ❏ None ❏ Retention ❏ Referral ❏ New Hire 7. Does your lab tie pay raises/advances to completion of continuing education, mentoring or preceptoring of new employees, or service on department committees? ❏ Yes ❏ No ❏ Yes ❏ No 8. Does your lab offer an increase in pay upon completion of the EP associated professional certification? If you are a manager and you will be responding for your entire lab, please list salaries below by credential and years of experience. Also, please fill out the survey above to add your own information to the survey. Salary for: RN RCIS CVT RT (R) other: 0-2 years 3-5 years 6-9 years 10+years

Table of Contents Feed for the Digital Edition of EP Lab Digest - September 2007

The ICD Shock and Stress Management Program: Interview with Samuel F. Sears Jr., PhD Universal ECG Screening: The Advocate’s Perspective Contents Letter from the Editor Spotlight Interview: Morristown Memorial Hospital 10-Minute Interview: About the Mended Hearts and Mended Little Hearts Organizations ICD Patient Support Groups Email Discussion Group: September 2007 Technology: Only As Good As the Attitude Behind It! Electrophysiologic Management and Treatment of Chronic and Acute Cardiac Device Infection First Annual EP Lab Digest Salary Survey Events Calendar Industry News and Products

EP Lab Digest - September 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.