June FY23

[kristenhorsman]

Wai-Ling Lo mentioned that they have had some new recruitment to the EP cohort lately. According to her, one of the most exciting procedures in EP lab is lead extraction. She submitted a short and sweet chapter about anesthesia for lead extraction for your review. It covers the technique and anesthesia management for lead extraction. For those who don't work up on the fifth floor, it is still an easy read to get to know the procedure they do frequently in the event you join them in the future.


Please reference the email that I sent out for the article and answer the following questions:

1. If the EP team will place a femoral arterial line, will you still place a radial arterial line?

2. If there is a SVC tear from the lead extraction, how will you administer blood and medication?

[nanci]

1. If the EP team will place a femoral arterial line, will you still place a radial arterial line?
You can use the radial A-line for hemodynamic monitoring while the EP team uses the femoral arterial line as a bypass cannulation site.


2. If there is a SVC tear from the lead extraction, how will you administer blood and medication?
Can use lower body large bore peripheral IV access.

[aileenm4]

1. radial Arterial line should be placed based on case by case need and co morbidity and reason for lead extraction, but in general these patients usually will all need and arterial line for hemodynamics on induction as well, so my answer is yes

2.if catastrophic tear in SVC, use the large bore central line in femoral that EP physician placed and they can use a balloon device to tamponade and rescue

[Dahlia Rouchon, CRNA]

1. I will typically use the femoral line for the procedure. In the case of a more unstable patient with ICU post operative care, I would place a radial a line.
2. I would administer blood through a large bore PIV, with femoral vein access as well if allowed.

[Dahlia Rouchon, CRNA]

Jun 8, 2023 15:12:41 GMT -5 Dahlia Rouchon, CRNA said:

1. I will typically use the femoral line for the procedure. In the case of a more unstable patient with ICU post operative care, I would place a radial a line.
2. I would administer blood through a large bore PIV, with femoral vein access as well if allowed.

Addendum-

A bridge balloon can be used to decrease risk of death to SVC tears, to tamponade bleeding.

[Christine Velarde]

I do not do procedures in EP. However I'm glad the article talked about the procedure , what is places, a large femoral line and what various anesthetists would use in and emergency situation. It seems an arterial line is also placed in sicker patients.
If a tear should occur it is recommended that a large bore PIV is accessed, femoral vein access and a balloon device to tamponade SVC tear.

[Tracey Trainum]

1. According to the reading, a radial a line can be placed before induction for hemodynamic use/management, or a femoral line can be placed after induction by the EP physician for hemodynamic use/management, AND for providing a quick percutaneous bypass cannulation site. I do not currently do EP procedures, but it seems to me an arterial line would be useful in sicker patients for hemodynamic monitoring while the femoral line is used by the EP physician as the bypass cannulation site.

2. If there is a large SVC tear from lead extraction, blood and medications can be administered through the femoral line placed by the EP physician. If this is not possible, administration should occur through a large bore PIV while a balloon is inflated in the SVC to tamponade the bleed.

[Amy Swank]

1. If EP team places art line, will radial art line still be placed?
Article says that a radial art line can be placed before induction if needed for hemodynamic management, or a femoral art line can be placed after induction by EP for hemodynamic management and for a quick percutaneous bypass site.
2. If SVC tear from lead extraction, how will blood and meds be infused?
After the induction of GETA, the EP places a large-bore central line, most commonly in the femoral vein for resuscitative purposes. Apparently, there has been a remarkable reduction in intraoperative deaths from SVC tears, with advances in technology, mainly the use of a bridge occlusion balloon.