Stress Echocardiogram

Transcription

1 Purpose: Heart First Guidelines Stress Echocardiogram To outline the guidelines and protocols for performing Stress Echocardiograms as established by the American College of Cardiology References: 1. Stress Echo Instructions 2. Medical Director Attestation 3. ICA Echocardiography (ICAEL) standard- Training 4. AHA-Stress Test Guidelines Indications: Include but are not limited to: Evaluation of resting and post-exercise segmental wall motion in symptomatic or high-risk individuals. Assessment of exercise capacity. Stratifying severity of coronary artery disease Follow-up on patients with known cardiac abnormalities Patient Preparation: Ensure patient is informed of instructions upon time of scheduling (Refer to instructions sheet ); remind them approximate testing time is 1 hour (set appropriate expectations ) If procedure is to be performed on a new patient assessment sheet completed Explanation of procedure is to be completed and written consent form signed Electrodes sites on patient need to be prepped by wiping with alcohol prep pad to remove oils Attach electrodes and wires and perform impedance check prior to obtaining resting ekg Procedure:

2 Obtain/Review brief verbal history and obtain resting Blood pressure (BP) and Electrocardiogram (EKG) Present EKG and brief history to supervising physician Perform pre- Echocardiogram Patients are exercised according to the standard Bruce protocol while a qualified physician, nurse practitioner or physician assistant is present and available ( ears length) The patient will exercise until one of three criteria is met: - Patient becomes fatigued or symptomatic and cannot continue - Patient s heart rate reaches at least 85% of maximal predicted heart rate (220-patient age) - ST deviation >2mm below baseline - Moderate or greater CP with EKG changes - Drop in BP of 20mm Hg (or 10mm Hg with AS) - Sustained V-tach - ST elevation <1mm above baseline - Physician request Relative end point/notify supervising physician - Mild CP with EKG changes - Moderate or greater CP with no EKG changes - Drop in BP of 10 mmhg - Short runs of V-tach Perform post- Echocardiogram Obtain BP immediately after imaging complete Monitor HR and BP at three minute intervals until return to/trending towards approximate baseline Follow up: Patient reports symptoms or Technologist notes abnormality Supervising Physician reviews the test prior to patient leaving As indicated based on read; follow up appointment, Cath or ED visit is arranged No symptoms or abnormalities noted Patient is released to check out and communicated that results will be called within 72 business hours Tech processes data and prepares for physician read. Per ICA standards; report it to be completed within 48 hours of testing Physician reads test and indicates interpretation and follow up on report Report called back to patient - If report is normal; MA or LVN can call test results and read scripting for normal results. Any further care questions or symptoms must be routed to RN, NP/PA or physician - If report is abnormal; NP/PA or physician communicates to patient and follow up is scheduled - All communication is logged in EMR (date/communication/ actions) - All testing strips, EKGs and final report is scanned into EMR

3 Stress Test / Stress Echo Instructions APPOINTMENT DATE: APPOINTMENT TIME: SPECIFIC INSTRUCTIONS FOR STRESS TEST/STRESS ECHOCARDIOGRAHM TEST

4 No caffeine on the day of your stress test. No nicotine for at least 4 hours prior to your test. No food or drink (except water) at least 3 hours prior to your stress test. In addition to these instructions, make sure you wear comfortable clothes and tennis shoes, since you will be on the treadmill for this test. Please take all your regular morning medications unless otherwise directed by your physician not to. If you have any other questions please call us at (972) between the hours of 8:00am-5pm. APPROXIMATE TEST TIME: 1 HOUR Medical Director Attestation Supervision of Stress Tests by Non-Physician Personnel Following the IAC Standards and Guidelines for Adult Echocardiography Accreditation Part B, 3.6.3B, all non-physician personnel supervising stress tests will meet the training and competency outlined by the ACC/AHA Clinical Competence Statement on Stress Testing: Cognitive skills needed to competently supervise exercise tests: Knowledge of appropriate indications for exercise testing Knowledge of alternative physiological cardiovascular tests

5 Knowledge of appropriate contraindications, risks, and risk assessment of testing (not limited to Bayes theorem and sensitivity/specificity, including concepts of absolute and relative risk) Knowledge to promptly recognize and treat complications of exercise testing Competence in cardiopulmonary resuscitation and successful completion of an AHA-sponsored course in advanced cardiovascular life support and renewal on a regular basis Knowledge of various exercise protocols and indications for each Knowledge of basic cardiovascular and exercise physiology, including hemodynamic response to exercise Knowledge of cardiac arrhythmias and the ability to recognize and treat serious arrhythmias Knowledge of cardiovascular drugs and how they can affect exercise performance, hemodynamics, and the ECG Knowledge of the effects of age and disease on hemodynamic and ECG responses to exercise Knowledge of principles and details of exercise testing, including proper lead placement and skin preparation Knowledge of end points of exercise testing and indications to terminate exercise testing Bibliography Exercise Testing: ACC/AHA 2002 Guideline Update for Exercise Testing: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) ; Journal of the American College of Cardiology 2002 Oct 16:40(8): clinical/guidelines/exercise/exercise_clean.pdf I,, attest that non-physician personnel supervising stress tests meet the training and competency requirements above. Signature: Date: ICA Echocardiography (ICEAL)

6 STANDARD Training Heart First Guidelines 3.6B Stress echocardiography is a diagnostic test which, if performed and/or interpreted incorrectly, can lead to serious consequences for the patient B Accurate performance of stress echocardiography requires that the performing sonographer and interpreting physician are adequately trained and experienced to perform and interpret stress echocardiograms B All personnel directly supervising stress procedures must have appropriate training/experience. While physician presence during stress testing is not required, the facility must assure that appropriate staff is present based upon the types of procedures being performed and the patients' risks of adverse events B If a non-physician (e.g., properly trained nurse, physician assistant, nurse practitioner, exercise physiologist) practicing under the physician's license is supervising the stress test, the Medical Director or physician director of the stress facility must provide written attestation of appropriate training and competence as outlined in the American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing. Comment: For specific training and competence requirements, see Bibliography B At a minimum, at least two qualified people are required to be in attendance during stress testing B Basic Life Support All personnel, including physicians, directly supervising stress procedures must have appropriate training/experience and must be certified in basic life support B Advanced Cardiac Life Support There must be ACLS certified personnel on-site and immediately available during cardiac stress procedures.