Transfer of the paced patient

daedalus

daedalus

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Hi guys, Im looking for a curbside consult. The other day the RN on my team and I had a patient that was on TCP with external pads, and was unable to be without it during the transfer. The sending hospital's monitor/defib was different from ours, and our nurse is relatively new and asked my opinion. I recommended we ready our pacer and pads, remove the hospitals, and make a quick swap. Of course I understand the risks to this procedure including problems getting capture again, and if anyone here has better advice for us. We would both really appreciate your knowledge and experience.

We ended up swapping as described above.
 
In the past we'd take the hospital's equipment with us, if needed, and then return it to the hospital. Would this have not been possible?
 
MMiz said:
In the past we'd take the hospital's equipment with us, if needed, and then return it to the hospital. Would this have not been possible?
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Big liability when you do that. The RN will not be familiar with that equipment and it may put that hospital down one piece of emergency equipment. At one time we did do loaner equipment with a form for the Paramedic or RN to sign to release the sending hospital from liability if they didn't know what they were doing and our equipment was still attached. But, our attorneys told us it wasn't worth the paper it was written on. If we send any of our ICU/ED equipment such as a monitor, defibrillator or ventilator, one of our staff must accompany.

Was the patient being actively paced? Switching out is common since the many different EMS services rarely have the same equipment as the many different hospitals. Some of our own equipment within the hospital must be switched out due to incompatibility between manufacturers.

Some manufacturers do have adapters for their pads that will connect to others that eliminates the need for changing out.
 
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re

I agree with Vent, as that has been our policy as long as i can remember. And if memory serves we never had a problems regaining capture after switching pads.

Corky
 
I'm confused, if you're taking an RN, shouldn't the RN know their employer's equipment?
 
I think the RN worked for teh transfer service, not the ED.

Here we carry adaptors to mate any pads to any monitor. We tend to like em
 
either switch at hospital or kidnap someone who is familiar with it.
 
MMiz said:
I'm confused, if you're taking an RN, shouldn't the RN know their employer's equipment?
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California....

The CCTs usually have their own MICNs.

If the transfer is emergent and only Paramedics are available from EMS and not a CCT truck, the hospital will usually free up one of their RNs who is an MICN. But, if a CCT service is contracted, they should know these things. If the RN shows this type of incompetency, the sending hospital should put one of their staff on to ensure the patient is cared for. The cable incompatibilty is not something new and almost every experienced ED and/or ICU RN has gone through this before.
 
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Maybe Rid or Vent could answer this, but why wouldn't the original hospital put in a transvenous pacer since it seems that it's going to be a while before the patient can have something more permanent done?
 
JPINFV said:
Maybe Rid or Vent could answer this, but why wouldn't the original hospital put in a transvenous pacer since it seems that it's going to be a while before the patient can have something more permanent done?
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1. Skill and expertise of the medical staff at the sending facility

2. Distance/time to interventional cardiologist

3. Responsiveness of the heart to external pacing

4. Etiology behind the rhythm that needs pacing. (meds, metabolic, lesions etc)

5. Cath Lab may also be needed if rhythm failure is due to MI and/or blockage

6. Underlying infection or sepsis.
 
Interesting thoughts. My RN was not familiar with the Philips monitor they were using at the sending facility. We utilize Zoll, and the ER she practiced at for most of her career used something else. She is a very knowledgeable RN however new to CCT work and wanted to know if there was a standard way we were to switch these out. The pads were not compatible with our monitor. We were able to switch the whole setup, however the patient had an underlying rate of below forty so we were concerned. The transfer was emergent.
 
daedalus said:
Interesting thoughts. My RN was not familiar with the Philips monitor they were using at the sending facility. We utilize Zoll, and the ER she practiced at for most of her career used something else. She is a very knowledgeable RN however new to CCT work and wanted to know if there was a standard way we were to switch these out. The pads were not compatible with our monitor. We were able to switch the whole setup, however the patient had an underlying rate of below forty so we were concerned. The transfer was emergent.
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It doesn't matter if she is new to CCT. This problem is encountered many times in a hospital. If she had adequate experience and knowledge she would have known about the different monitors and their cables. What if this was an IABP? Would she have not known about connection issues?

Was the rate of 40 a perfusing rate or electrical? What was the mentation of the patient? 40 can be a decent rate for some depending on the symptoms. Some little generals pace just as a precaution because the rate is below 60. I'm sure the transfer was emergent if the hospital didn't have the ability to care for the patient. But, if the RN gets focused on only one problem, she may be ineffective at assessing the whole patient.

I have the utmost respect for most RNs on CCT but occasionally some get hired with may years of ICU experience in a unit of low acuity.
 
I've seen "quick swaps" fail twice with TCP. Asystole both times. One died. Take the other facilities monitor. Return it to them later. It doesn't take a genius to figure out another pacing system, frankly. Ask the other facility for a quick in-service as needed.
 
VentMedic said:
It doesn't matter if she is new to CCT. This problem is encountered many times in a hospital. If she had adequate experience and knowledge she would have known about the different monitors and their cables. What if this was an IABP? Would she have not known about connection issues?

Was the rate of 40 a perfusing rate or electrical? What was the mentation of the patient? 40 can be a decent rate for some depending on the symptoms. Some little generals pace just as a precaution because the rate is below 60. I'm sure the transfer was emergent if the hospital didn't have the ability to care for the patient. But, if the RN gets focused on only one problem, she may be ineffective at assessing the whole patient.

I have the utmost respect for most RNs on CCT but occasionally some get hired with may years of ICU experience in a unit of low acuity.
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Pt was a member of the EVS staff at the sending hospital, she collapsed in a hallway. When we had arrived she was being paced in the ICU at a rate of 60, and she was sedated. We were to transfer her to Cedars Sinai.

Everytime we have dealt with IABP we usually take a Perfusionist. BTW people, if you want to know about another serious health care professional, look up the education and responsibilities of a perfusionist. Boy were my eyes opened.
 
In Los Angeles, taking a perfusionist seems to be the standard, at least for kaiser patients. Kaiser also requires an MD to be on the ambulance if: a patient is on a vent via ET tube, the patient is having a neurological emergency, and patients going for any kind of emergent cardiac surgery. This requires us to pick up a doctor from the nearest kaiser hospital and than go en route to the sending facility.
 
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