Procedure monitoring vitals

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thecentral09

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Hey team.
I am currently splitting time doing procedures between office and ASC. I have searched for threads regarding procedural monitoring, including CO2, SPO2, Bo, ekg etc. are there any specific guidelines for general pain procedures regarding monitoring, obviously this doesn’t apply for sedation cases, but any specific guidelines for how various cases are monitored?
Do you all tailor it type of procedure (ie cercvical with EKG, SI with just SPO2)?
 
Haven't seen specific guidelines but here's what we do in HOPD:

All office procedures with continuous pulse ox, q5min bp.

EKG only if relevant(ex. cervical RFA in someone with a pacemaker).
 
pulse ox with HR only. BP pre-procedure. whats an EKG? im sure as hell not interpreting that. what if there is a WPW or arrhythmia that is missed?
 
BP before and after.

No monitoring for anything other than SCS due to MAC.
 
we dont monitor at all for procedures, just sedation procedures HOPD here.
just bp before and after
 
In office, we do pulse ox. Pre and post BP

If we give IV sedation we have been doing pulse ox, BP and 3 lead with a nurse in the room. Most we are doing is 2mg versed. Not sure we need the nurse.
 
outpatient HOPD suite, no sedation here
continuous pulse ox and heart rate and q5 min bp check with stim trials

other than that just pre and post procedure vitals
 
Thank you all.
All appropriate without overkill, didn’t know if any seasoned folks who were involved in any liability scenario knew of any published guidelines. Thank you!
 
DOctorJay said:
outpatient HOPD suite, no sedation here
continuous pulse ox and heart rate and q5 min bp check with stim trials

other than that just pre and post procedure vitals
Click to expand...
Do you treat the elevated blood pressure during your check? Do you abandon the procedure based on the blood pressure while ur passing the lead? Just curious, how does the q5 min check change ur management?
 
painfree23 said:
Do you treat the elevated blood pressure during your check? Do you abandon the procedure based on the blood pressure while ur passing the lead? Just curious, how does the q5 min check change ur management?
Click to expand...
yeah that's a great question, I haven't had to do anything with managing the blood pressure and pointing this out really makes it seem like it just gives the nurses something to do. I'm not sure if it's some requirement or what but "we've always done it that way here", haha.
 
Just vitals before and after. Nothing during procedure unless giving sedation. Will place an IV for cervicals just bc higher rate of vasovagal and other complications. Actually have stopped placing IV’s if they are repeat cervicals and didn’t have any issues with the previous injection
 
I put a pulse ox on a patient today because he has a pacer and I was doing an RF. His heart rate was 122 (asymptomatic), so I took him down and ran an EKG. A-fib with RVR. Gave him a copy of his EKG and sent him to his cardiologist. Yes, I know he would have been just fine if I went ahead and did the RFA anyway, but I don’t want to be blamed for anything that might be wrong with his pacemaker or heart.
 
you should put the pacemaker on asynchronous pacing mode with a magnet for RFA. the pacer is probably in for bradyarrhythmia from afib. his high heartrate may mean that he may not be taking his meds...
 
Ducttape said:
you should put the pacemaker on asynchronous pacing mode with a magnet for RFA. the pacer is probably in for bradyarrhythmia from afib. his high heartrate may mean that he may not be taking his meds...
Click to expand...
No way I’m going to be putting a magnet on the pacer, because I don’t have any details about what type of pacemaker it is or how it behaves with the magnet. Also for lumbar I don’t ever have an issue with interference, and for thoracic and cervical, or if they have a defibrillator, I do it bipolar.
 
um....

thats one of the safest things you can do to the pacemaker, and better than ignoring it.

as an anesthesiologist, you know that.

or involve the cardiologist, which is most appropriate.
 
Ducttape said:
um....

thats one of the safest things you can do to the pacemaker, and better than ignoring it.

as an anesthesiologist, you know that.

or involve the cardiologist, which is most appropriate.
Click to expand...
U don’t just throw a magnet on it. Not all pacemakers change to an asynchronous rate that the patient can tolerate. Please don’t tell me u do this without interrogating it first.
 
Ducttape said:
um....

thats one of the safest things you can do to the pacemaker, and better than ignoring it.

as an anesthesiologist, you know that.

or involve the cardiologist, which is most appropriate.
Click to expand...
No, as an anesthesiologist I know that some pacemakers and defibrillators do not behave the same way. You may be disabling the defib function but not the pacing, it may not return to normal after the magnet is removed. Putting a non-dependent patient in asynchronous mode places them at risk of R on T pacing and induction of arrhythmia. please tell me you’re asking the cardiologist before placing a magnet.
 
painfree23 said:
U don’t just throw a magnet on it. Not all pacemakers change to an asynchronous rate that the patient can tolerate. Please don’t tell me u do this without interrogating it first.
Click to expand...
clearly you need to spend 5 seconds reading their charts.

PACEMAKERS do not have a defib function.

the asynchronous mode is set up by a good cardiologist to be appropriate perfusion when in asynchronous mode, and most are at 70 bpm.

you are correct in stating do not put magnet on AICD.
 
Ducttape said:
clearly you need to spend 5 seconds reading their charts.

PACEMAKERS do not have a defib function.

the asynchronous mode is set up by a good cardiologist to be appropriate perfusion when in asynchronous mode, and most are at 70 bpm.

you are correct in stating do not put magnet on AICD.
Click to expand...
Ok, so saying “it’s one of the safest things you can do…AFTER reviewing their charts” is a correct response. Not just putting the magnet on..that’s not the safest thing without knowing what it does.
 
Ducttape said:
clearly you need to spend 5 seconds reading their charts.

PACEMAKERS do not have a defib function.

the asynchronous mode is set up by a good cardiologist to be appropriate perfusion when in asynchronous mode, and most are at 70 bpm.

you are correct in stating do not put magnet on AICD.
Click to expand...
I am aware of the difference between a pacemaker and a defibrillator. Some patients are not. Some forget to even make a note that they have an AICD. I ask all patients before RF whether they have a pacemaker or defibrillator. Reviewing the chart is fine if you’re in an academic group where the patient sees cardiology as well and you can pull up the pacer interrogation, where it says the magnet behavior. Otherwise you’re talking getting a cardiology clearance. Most of the time what I got back on that is “proceed with caution” or “cleared for general anesthesia” (no, I’m not doing these under general - usually oral sedation in office). Nothing about actual pacer management during RFA.

My point is, don’t bother with a magnet; just do the RF in a way that won’t interfere. For lumbar RFA, which is below the ulbilicus, no need for a magnet.

“For surgery below the umbilicus, the HRS/ASA statement recommends that there is minimal need to reprogram a CIED or place a magnet on the CIED because the risk of oversensing, generator damage, or lead damage is small. Magnets may still be used, but it is vital to understand the different magnet responses for CIEDs”.(ref)

For locations with more significant risk, use bipolar, which is an option for us for RF.
 
We get clearance for every person with a cardiac device purely from a liability stanfpoint
 
Essentially has options for the cardiologist to Circle, options include no magnet needed, place magnet, and does it need interrogated afterwards?
 
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