Patient Care, Safety, and Professional Practice
Before and during the case
Verify informed consent, allergies, anticoagulation status, and prior device history. Perform a formal time-out with the team: patient identity, procedure, site, and any implants. Confirm that diathermy, pacing, and ICD therapies are addressed, and that the patient is on continuous ECG, pulse oximetry, and blood pressure monitoring. Sterile technique is non-negotiable: hand hygiene, full barrier precautions, and careful catheter handling to prevent contamination of the field.
Radiation and electrical safety
Use ALARA: lowest reasonable fluoroscopy time, collimation, last-image hold, and appropriate shielding. Dose falls with the inverse square of distance - doubling your distance from the source cuts dose to about one quarter. Wear a lead apron and thyroid shield, and wear dosimetry badges as required. Report unusually high dosimetry readings. Electrical safety means isolated patient connections, intact cables, and no fluid near equipment.
Professional practice
Document procedures, medications, radiation dose, and any adverse events accurately. Know your scope of practice and escalate concerns through the chain of command. Patients in the EP lab are often anxious and awake; explain what they will feel, and keep them informed during pacing and ablation.
Worked example
If your fluoroscopy time is running long, the highest-yield moves are usually collimation, reduced magnification, and last-image hold rather than simply working faster. Doubling your standing distance from the patient cuts your personal dose roughly fourfold.
Trap
A time-out done after sedation but before the first catheter is still a time-out - but it must be verbal, team-wide, and documented. Skipping it because the case is 'routine' is a classic safety failure.