The Fruits of Our Labor: Scrub Techs Close Patients with Perclose at Providence

Providence Health Center is a 170-bed acute care hospital located in Central Texas. They have 2 Siemens cath labs with a new Siemens/Stereotaxis multi-use lab in the process of being built (Iselin, NJ). The cath lab has a group of physicians with 8 cardiologists along with one physician who works alone. They currently staff 5 full-time scrub techs: 3 RT(R)s and 2 RCISs, along with 5 full-time RNs and 1 part-time RT(R) and 1 part-time RN. In addition, 2 full-time cath techs help with stocking supplies, holding manual compression and transporting patients. Providence performs approximately 1400 cardiac catheterizations, 500 peripheral procedures and 700 electrophysiology procedures annually, including pacemakers and defibrillators. Providence took part in two recent multi-center studies conducted by Abbott Vascular Devices. The first was a study on immediate ambulation and the second a nurse/tech operator registry. Yes, the nurse/tech registry focused on the usage of Perclose by non-physician operators. In this registry, we had the highest total number of successful procedures in the study and were one of three facilities participating that had 100% device success. We also participated in the immediate ambulation study, which involved the closure and immediate ambulation of patients with a normal study, i.e., heart cath or peripheral angiogram. The access site was closed with Perclose and upon ambulation, the patient walked 15 feet, was put in a wheelchair, returned to our outpatient areas for a 1-hour period, then sent home. In 7 days, the patient received a phone call to determine any complications, comfort levels, and any difficulties since leaving the hospital (overall satisfaction). We currently treat all patients with a normal study in this manner, where applicable. In the post catheterization orders (discharge), the physician just states 1-hour bed rest and a home time, and the nurses in our outpatient area call if they need any clarification. What is Providence’s current groin complication rate? Currently, we close 99% of our patients, including diagnostic catheterizations, interventions and peripheral interventions. One percent receive manual compression. Our complication rate is approximately 1% yearly. Providence has a unique tracking system for complications regarding hemostasis. Can you describe it? Providence has recently incorporated a paperless Charting System (Wizard Information Systems, Leatherhead, Surrey, U.K.). This database is used to track each patient throughout their hospital stay and for all follow-up on hospital stays. We also document in our monitoring system (Witt Series IV, Melbourne, FL) any groin/access site complications that occur before the patient leaves our department. After leaving the hospital as an outpatient, the patient receives a call from an outpatient department nurse to follow up on their safe arrival. On a monthly and quarterly basis, one of our RNs queries each database and records the number of groin complications (hematomas, late bleeds, failed ambulations). Also, each quarter, we print out a graph showing the results of all closures (hematoma rate). To what can you attribute your rate of success? Volume! Our physicians have seen the fruits of our labor, so they assume that we will close all patients with the Perclose closure device. We currently have 3 RT(R)s and 2 RCIS scrub techs that are trained to use the Perclose device. We attribute our success to the fact that we use the device on the majority of our patients and the staff is very comfortable in its use. When did you first begin using the device? We started using the Perclose device in March 2002. This facility has always utilized the scrub tech position to close all access sites. The physicians insist that the scrub techs close the access site to allow them to start their dictation and also facilitate room turnover. We have no current clinical ladder. We have two scrub techs that are extremely proficient and they proctor all new techs. Do you utilize any other closure devices? We do also utilize the VasoSeal ES (Datascope Corporation, Mahwah, NJ) but on a very limited scale, approximately 1% of all closures.

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