This section under development
Pre Procedure / Patient Prep

When I first started working in EP, it was not uncommon for the patient to arrive in the lab with only a vague idea of what exactly was going to happen. Those of us who worked in situations like this became adept at providing answers to the many questions the patients would have. In most of today’s EP programs, the information provided for the patient is much more extensive and the caregiver rarely finds themselves in the position of needing to answer a multitude of questions before the procedure. For those who are not fortunate enough to find yourself working in a program with good patient education, I have compiled some information on questions that many patients asked me or those that I have worked with. These can be accessed by selecting the Patient Questions link at the left side of this page.

Skin Prep for patch placement

No Alchohol - much of this information has been previously covered in the patient care section of working in the lab / introduction to EP. It is included in both locations because of the importance of the subject matter and due to the fact that few ppl seem to be aware of these details.
Placement of RF / Defib patches
1 or 2 defibs
Necessary 12 lead
Pt. Interview
Review History

link back to patient care section (that section linked here)

Skin Prep

          Once the patient has been moved over to the fluoro table, the task of hooking up the various patches used during the procedure begins. A key aspect of successful patch placement involves good skin preparation prior to placing the various patches. While there are a number of different approaches to skin prep, there is one key piece of knowledge that every one who works in the lab should be aware of; never use alcohol to prep a patient’s skin for any type of patch placement.

          Alcohol may provide a good clean surface, however, if it has not completely evaporated before a patch is placed on the patient’s skin, the adhesive used to keep the patch stuck to the patient’s skin may react with the alcohol that is still present. When this happens, it is possible for the skin to become red and irritated and even cause a first degree burn. Have you ever taken the patches off of a patient at the end of a procedure and found the patient’s skin red and irritated? It is quite possible that alcohol is the source of the irritation.

          Another useful piece of information that can prevent skin irritation has to do with warming any of the patches prior to placing them on the skin. EP labs are, like most procedure rooms, kept at a cooler temperature to minimize growth of infectious agents and keep computerized equipment working optimally. While this is in the patient’s best interest, this fact is often overlooked by the patient when they have first arrived in this cold sterile environment. At that moment, they are simply aware of the fact that they are cold and somewhat exposed.

          Most caregivers who work in the lab posses some degree of empathy with their patients and will often do whatever they can to keep them comfortable. One of the steps that many labs take to alleviate the cold of the early stages of the procedure is to place the patches in the blanket warmer. While the intent of this is to take the cold chill from the moment the patch is placed upon the skin, warming the patches does create an additional problem.

          The blanket warmers I have checked in various labs will be set anywhere from 110-140 degrees fahrenheit. When the patches are removed from the blanket warmer, the exterior surfaces will quickly disperse the heat energy so that they do not feel hot to the touch. Unfortunately, not all the heat energy absorbed by the patches can disperse. There is a conductive gel that is protected under the plastic sheet that is peeled off before the patch is placed on the skin. The plastic sheet is not removed until just before the patch is placed in contact with the patient’s skin. There is only a brief moment or two for the heat energy that is trapped in the gel to dissipate. If the caregiver does not stand there and allow the heat to disperse into the air, the heat will instead, disperse into the patient’s skin, often causing a burn.