practical logbook 2017. practical logbook 2016 … logbook bhrs... · - 2 - specific points any...

PRACTICAL LOGBOOK 2016.

Candidate Name:

Examination Registration No.:

PRACTICAL LOGBOOK 2017.

nicolabennett

Typewritten Text

nicolabennett

Typewritten Text

nicolabennett

Typewritten Text

nicolabennett

Typewritten Text

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INTRODUCTION TO LOGBOOK AND INSTRUCTIONS FOR USE

This logbook supersedes any previous versions and must be used if you have registered to sit the BHRS certification exam in 2016.

The logbook forms part of the requirements for British Heart Rhythm Society certification. It is specifically aimed at practitioners with a particular interest in cardiac device implantation and management. A separate logbook exists for cardiac electrophysiology.

There is only one logbook covering devices. All sections of the logbook must be completed

prospectively with cases from within a 24 month period from your agreed logbook start date. Logbooks submitted after your confirmed deadline date will not be marked unless prior

written authorisation for an extension has been granted.

All case studies must be completed in full and contain appropriate documentation of ECGs, electrograms and measurements.

You must obtain verification of the information and completion of the assessment sections from your supervisor, who must be experienced in device management and ideally hold BHRS certification (previously Heart Rhythm UK certificate of accreditation) or the IBHRE qualification (pacing and devices) or the EHRA CP/AP qualifications. Medical device company representatives will not be accepted as a supervisors.

How to apply for a log-book extension

Only 1 extension will be awarded for exceptional circumstances. No extension will be awarded retrospectively.

A request for a log book extension must be put in writing and sent to British Heart Rhythm Society, email [email protected]

Further information on the logbook can be obtained from the British Heart Rhythm Society, PO Box 3697, Stratford upon Avon CV37 8YL. E-mail: [email protected]. Tel: 01789 867 526.

7

Further information on the logbook can be obtained from the British Heart Rhythm Society, Unit 6BEssex House, Cromwell Business Park, Chipping Norton, Oxfordshire OX7 5SR.E-mail: [email protected]. Tel: 01789 867 526.

mailto:[email protected]

mailto:[email protected]

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SPECIFIC POINTS

Any patient identifiable information present within the logbook will result in an automatic fail. Do not cover patient identifiable information with marker pen - with time this fades. Please pay particular attention to 12 lead ECGs and device interrogation print outs

The logbook is divided into 4 sections Section 1: Implanting procedure (as physiologist) Section 2: Follow-up (as physiologist) Section 3: Case studies Section 4: Assessments

For doctors / allied health professionals completing the log you need to take on the role as a cardiac physiologist for ALL sections of the logbook.

Please note that no case from section 1 can be used as a case study in section 3. All details of CRT implants / follow ups can be CRT-P or D devices. CRT-D devices can count towards ICDs numbers and CRT/ICD devices can count towards pacemakers but not vice versa.

Section 3 Please note ALL case studies should include copies of any investigations performed plus copies of pre and post implant 12 lead ECGs.

Summary of Information Required

Number Section 1: Implants Pacemaker Implants 30 ICD / CRT Implants 15 Section 2: Follow-up Pacemakers 60 ICD 10 CRT ICD 10 Section 3: Case studies Pacemakers 15 ICD 5 CRT ICD 5 Section 4: Skills Assessment Implant assessments 3 Follow up assessments 4

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BHRS CERTIFICATION: CARDIAC DEVICE LOG BOOK

Candidate Details

Name

Address

Contact details Telephone and/or email

Hospitals In Which Work Undertaken

Time Period Address

Supervisor Details

Name

Professional title/position

Address

Contact details Telephone and/or email

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EXTRACT FROM SPECIALTY TRAINING CURRICULUM FOR CARDIOLOGY TRAINEES (StRs) AUGUST 2010

CORE HEART RHYTHM TRAINING

The necessary skills, attitudes and experience will come from a mixture of attendance at specialist arrhythmia clinics, experiential learning, formal training at study days and/or postgraduate courses. As part of a portfolio you should keep a logbook of cases and

procedures observed and undertaken.

As a guide, it is likely that in order to gain sufficient experience procedures the trainee will need to be involved in: the implantation as well as the pre- and post- procedure care of at least 25 patients requiring permanent pacemakers; at least five ICD implants and five CRT procedures

ADVANCED HEART RHYTHM TRAINING

Numbers of Procedures There is a widespread perception that numbers of procedures undertaken provide a guide to development of competence but trainees learn at different rates and absolute numbers, however high, may not guarantee competence. Therefore, competence will be assessed using DOPS, (Direct Observation of Procedural Skills). However, to guide planning of training there are indicative minimum numbers of procedures likely to be needed to be completed before competence is achieved.

Implantable Devices for Managing Arrhythmias: Implantation of 100 systems by the trainee; 100 follow up patients requiring pacemaker interrogation and/or programming; implantation of 25 ICDs and supervision of 50 patients in programming clinics; implantation of 30 BiV devices and their programming and optimisation in a minimum of 30 patients with heart failure using modern techniques such as tissue Doppler imaging.

Continuing Medical Education & Professional Development Trainees will be expected to have: CCAD-verified training logbooks for procedures and outcomes; attendance of local and national training days – at least 2 per year; certified attendance at BHRS / Heart Rhythm UK arrhythmia and device therapy training days each year; certified attendance at one international EP meeting a year during advanced EP training is highly desirable; certified attendance at live electrophysiology/device courses where appropriate.

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SECTION 1: DEVICE IMPLANT PROCEDURE (AS PHYSIOLOGIST) Section 1

30 pacemaker implants Out of the 30 cases 5 should be for elective generator replacements (box changes) In addition to the 30 pacemaker implants 15 ICD/CRT implants are required of which 5 must include CRT (P or D) devices

Specify patient symptoms, ECG abnormality and aetiology in addition to their codes. Copies of 12 lead ECGs are not required for completion of section 1

Anaesthetic: Local or general. If general, give reason Vascular access: Subclavian, cephalic, other Sutures: Vicryl, Ethibond, etc. Specify suture material used for sleeves and wound closure Antibiotic regimen: Pre and post procedure and peri-procedure (e.g. gentamicin to pocket)

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SECTION 1: PACEMAKER IMPLANT (AS PHYSIOLOGIST)

No. 1 Date: Patient Initials: Symptom Implant Code: ECG Implant Code: Aetiology Implant Code:

IMPLANT DETAILS MANUFACTURER AND MODEL PACING PARAMETERS Complications up to Discharge: Anaesthetic: Generator: Atrial Ventricular

Pacing Threshold @ 0.5ms (V) Vascular Access:

Atrial Lead: Amplitude (mV)

Follow Up Arrangements: Antibiotic Regimen:

Impedance ( ) Ventricular Lead: Sutures Used:

Slew rate (Vs-1) Final Pacing Mode:















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SECTION 1: ICD/CRT IMPLANT (AS PHYSIOLOGIST)

No. 1 Date: Patient Initials:

Symptom Implant Code: ECG Implant Code: Aetiology Implant Code:





Impedance ( ) RV Lead & LV Lead:

Sutures used: Slew rate (V/sec)

Final Pacing Mode:

Details of LV lead placement: Guide catheter(s) used: Vein used:









Final Pacing Mode:


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Final Pacing Mode:










Final Pacing Mode:


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Final Pacing Mode:










Final Pacing Mode:


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Final Pacing Mode:










Final Pacing Mode:


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Final Pacing Mode:










Final Pacing Mode:


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Final Pacing Mode:










Final Pacing Mode:


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Final Pacing Mode:










Final Pacing Mode:


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Final Pacing Mode:


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SECTION 2: PACEMAKER FOLLOW-UP (AS PHYSIOLOGIST)

No. Implant Date

Patient Initials

Generator (Manufacturer and

model) Amplitude

Pacing Threshold Impedance Battery Wound

Site OK? Describe any parameters

reprogrammed? Pacing Mode

Supervisor Initials

A V A V A V Imp V

1

2

3

4

5

6

7

8

9

10

11

12

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No. Implant Date

Patient Initials


model) Amplitude




Supervisor Initials

A V A V A V Imp V

13

14

15

16

17

18

19

20

21

22

23

24

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No. Implant Date

Patient Initials


model) Amplitude




Supervisor Initials

A V A V A V Imp V

25

26

27

28

29

30

31

32

33

34

35

36

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No. Implant Date

Patient Initials


model) Amplitude




Supervisor Initials

A V A V A V Imp V

37

38

39

40

41

42

43

44

45

46

47

48

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No. Implant Date

Patient Initials


model) Amplitude




Supervisor Initials

A V A V A V Imp V

49

50

51

52

53

54

55

56

57

58

59

60

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SECTION 2: ICD FOLLOW-UP (AS PHYSIOLOGIST)

No. Device Implant Date

Patient Initials

Generator (Manufacturer and model)

Amplitude Pacing Threshold Impedance Wound



Supervisor Initials

A RV LV A RV LV A RV LV

1 ICD

2 ICD

3 ICD

4 ICD

5 ICD

6 ICD

7 ICD

8 ICD

9 ICD

10 ICD

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SECTION 2: CRT FOLLOW-UP (AS PHYSIOLOGIST)

No. Device Implant Date

Patient Initials

Generator (Manufacturer and model)

Amplitude Pacing Threshold Impedance Wound



Supervisor Initials

A RV LV A RV LV A RV LV

1 CRT±D

2 CRT±D

3 CRT±D

4 CRT±D

5 CRT±D

6 CRT±D

7 CRT±D

8 CRT±D

9 CRT±D

10 CRT±D

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SECTION 3: PACEMAKER CASE STUDIES Case 1 CLINICAL DETAILS:

Date: Patient Initials:

Clinical History:

Investigations performed & results: (Copies to be included) ECG, echocardiogram, Holter monitor, ILR (loop recorder), exercise test, coronary angiogram, tilt test, cardiac MRI, carotid sinus massage, EP Studies

Reason for pacemaker: (Including reference to national / international guidance)

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IMPLANT DETAILS:

No. 1



IMPLANT DETAILS MANUFACTURER AND MODEL PACING PARAMETERS

INCLUDE PAPER PRINT OUTS OF IMPLANT MEASUREMENTS

Anaesthetic: Generator: Atrial Ventricular

Pacing Threshold @ 0.5ms (V)

Vascular Access:

Atrial Lead, Fixation & Position: Amplitude (mV)

Procedural Complications:

Antibiotic Regimen:

Impedance ( ) Ventricular Lead, Fixation & Position:

Sutures Used: Slew rate (Vs-1)

Pacing Mode:

POST IMPLANT CHECKS:

No. 1


POST IMPLANT CHECKS

MANUFACTURER AND MODEL PACING PARAMETERS Post-procedural Complications:

Wound: Generator Site: Atrial Ventricular


Atrial Lead Position:

Amplitude (mV) CXR (pneumothorax etc.):

Impedance ( )

Final Pacing Mode:

Ventricular Lead Position:

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PROGRAMMING CONSIDERATIONS: No. 1 Date:

Patient Initials: PLEASE PROVIDE EXPLANATION OF DEVICE SET-UP

To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate

Rate response set up

AV Delays

INCLUDE PRINT OUTS OF FINAL DEVICE SET-UP

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Case 2 CLINICAL DETAILS:


Clinical History:



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IMPLANT DETAILS:

No. 2







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 2


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 3







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 3


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 4







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 4


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 5







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 5


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 6







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 6


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 7







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 7


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 8







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 8


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 9







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 9


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 10







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 10


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 11







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 11


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 12







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 12


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 13







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 13


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 14







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 14


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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Clinical History:



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IMPLANT DETAILS:

No. 15







Vascular Access:



Antibiotic Regimen:



Pacing Mode:


No. 15


POST IMPLANT CHECKS






Impedance ( )

Final Pacing Mode:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays


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SECTION 3: ICD CASE STUDIES Case 1 CLINICAL DETAILS:


Clinical History:


Reason for ICD:

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IMPLANT DETAILS:

No. 1







Atrial Lead, Fixation & Position:

Amplitude (mV)


Antibiotic Regimen:

Impedance ( )

RV:

Ventricular Lead, Fixation, Position, Single or Dual Coil:

Shock:


Pacing Mode:

Were NICE Criteria met (please specify):

DFT TEST (PLEASE PROVIDE PRINTOUTS OF TEST) Details of VF induction and termination (if not performed state why):

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No. 1


POST IMPLANT CHECKS






Impedance ( )

RV: Final Pacing Mode:

Ventricular Lead Position: Shock:

Driving advice given:


Patient Initials: PLEASE PROVIDE EXPLANATION OF DEVICE SET-UP To Include

Choice of Mode Lower Rate Upper Rate Sensor Rate Rate response set up AV Delays Tachycardia Set-up

(No. of zones, rationale for zones ATP set up, SVT discriminators)


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Clinical History:


Reason for ICD:

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IMPLANT DETAILS:

No. 2








Amplitude (mV)


Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:



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No. 2


POST IMPLANT CHECKS






Impedance ( )









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Clinical History:


Reason for ICD:

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IMPLANT DETAILS:

No. 3








Amplitude (mV)


Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:



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No. 3


POST IMPLANT CHECKS






Impedance ( )









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Clinical History:


Reason for ICD:

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IMPLANT DETAILS:

No. 4








Amplitude (mV)


Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:



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No. 4


POST IMPLANT CHECKS






Impedance ( )









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Clinical History:


Reason for ICD:

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IMPLANT DETAILS:

No. 5








Amplitude (mV)


Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:



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No. 5


POST IMPLANT CHECKS






Impedance ( )









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SECTION 3: CRT CASE STUDY Case 1 CLINICAL DETAILS:


Clinical History:


Reason for CRT ± D:

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IMPLANT DETAILS:

No. 1





Anaesthetic: Generator: Atrial RV LV


Vascular Access:


Amplitude (mV) Procedural Complications:

Antibiotic Regimen:

Impedance ( )

RV:

Ventricular Lead, Fixation, Position, Single or Dual Coil & LV lead:

Shock:


Pacing Mode:


IMPLANT PROCEDURE: LV LEAD Guide catheter(s) used: LV Lead choice:

Was final LV lead position/vein used the operators initial choice? If not why? Vein used:

Procedure Length: Screening Time: Radiation Dose:

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No. 1


POST IMPLANT CHECKS


Wound: Generator Site: Atrial RV LV


Atrial Lead Position: Amplitude (mV)

CXR (pneumothorax etc.):

Impedance ( )


RV Lead Position: Shock:

LV Lead Position:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays

Tachycardia Set-up (No. of zones, rationale for zones ATP set up, SVT discriminators)

BiV set up VV settings


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Clinical History:



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IMPLANT DETAILS:

No. 2







Vascular Access:



Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:





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No. 2


POST IMPLANT CHECKS






Impedance ( )



LV Lead Position:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays




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Clinical History:



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IMPLANT DETAILS:

No. 3







Vascular Access:



Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:





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No. 3


POST IMPLANT CHECKS






Impedance ( )



LV Lead Position:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays




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Clinical History:



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IMPLANT DETAILS:

No. 4







Vascular Access:



Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:





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No. 4


POST IMPLANT CHECKS






Impedance ( )



LV Lead Position:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays




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Clinical History:



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IMPLANT DETAILS:

No. 5







Vascular Access:



Antibiotic Regimen:

Impedance ( )

RV:


Shock:


Pacing Mode:





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No. 5


POST IMPLANT CHECKS






Impedance ( )



LV Lead Position:


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To Include

Choice of Mode

Lower Rate

Upper Rate

Sensor Rate


AV Delays




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SECTION 4: DUAL CHAMBER PACEMAKER IMPLANT MEASUREMENTS – SKILLS ASSESSMENT

Assessor: Date:

Assessment: 1 - 3 Unsatisfactory 4 - 6 Satisfactory (0 not applicable) 7 - 9 Above expected

SKILL ASSESSMENT (AS PER KEY)

PSA Connections

A and V lead impedance

R Wave measurement

Ventricular threshold test

Explanation of Wedensky effect

P Wave measurement

Atrial threshold test

Stability

10V Assessor comments (You must justify each score of 1 – 3 with at least one explanation / example):

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SECTION 4: ICD IMPLANT MEASUREMENTS – SKILLS ASSESSMENT

Assessor: Date:



Kit selection

Device set-up pre-implant

Implant forms completion

P and R wave measurement

A and V lead impedance

A and V threshold tests

Device measurements

VF induction

Post-implant set-up Assessor comments (You must justify each score of 1 – 3 with at least one explanation / example):

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SECTION 4: CRT IMPLANT MEASUREMENTS – SKILLS ASSESSMENT

Assessor: Date:



Kit selection

Coronary vein identification

PSA connections

A, RV and LV signal measurement

A, RV and LV lead impedance

Atrial threshold test

RV threshold test

LV threshold test

VF induction

Post-implant set-up Assessor comments (You must justify each score of 1 – 3 with at least one explanation / example):

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SECTION 4: DIRECT OBSERVATION OF PROCEDURAL SKILLS (DOPS)

Instructions for assessor(s) Please mark each component of the exercise on a scale of 1 (extremely poor) to 9 (extremely good). A score of 1 - 3 is considered unsatisfactory, 4 - 6 satisfactory and 7 - 9 is considered above that expected

Please note that your scoring should reflect the performance of the trainee against that which you would reasonably expect at their stage of training and level of experience

You must justify each score of 1 - 3 with at least one explanation/example in the comments box, failure to do so will invalidate the assessment

Please feel free to add any other relevant opinions about the trainee’s strengths and weaknesses in the space provided

SKILLS ASSESSMENT (FOR FOLLOW-UP PROCEDURES)

Single chamber pacemaker

Dual chamber pacemaker

ICD

CRT (P or D)

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SECTION 4: SINGLE CHAMBER PACEMAKER FOLLOW UP – SKILLS ASSESSMENT 1. Interacts appropriately with staff in pacing clinic

N/A 1 2 3 4 5 6 7 8 9 Unsatisfactory Satisfactory Above expected

2. Prepares patient appropriately


3. Obtains clinical history


4. Appropriate R/P wave measurement


5. Appropriate lead impedance measurement


6. Appropriate threshold test


7. Appropriate retrograde conduction check


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8. Appropriate diagnostics interpretation N/A 1 2 3 4 5 6 7 8 9

Unsatisfactory Satisfactory Above expected

9. Reprogramming / recommendations N/A 1 2 3 4 5 6 7 8 9


10. Overall technical ability N/A 1 2 3 4 5 6 7 8 9


Assessors comments on trainee’s performance on this occasion:

Trainee’s comments on their performance on this occasion:

Signature of trainee: Signature of supervisor: Date:

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SECTION 4: DUAL CHAMBER PACEMAKER FOLLOW UP – SKILLS ASSESSMENT 1. Interacts appropriately with staff in pacing clinic










6. Appropriate threshold test


7. Appropriate retrograde conduction check


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8. Appropriate diagnostics interpretation N/A 1 2 3 4 5 6 7 8 9









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SECTION 4: ICD FOLLOW UP – SKILLS ASSESSMENT 1. Interacts appropriately with staff in pacing clinic






4. Appropriate diagnostics interpretation


5. Appropriate arrhythmia interpretation






8. Appropriate shock lead impedance measurement


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9. Appropriate threshold test N/A 1 2 3 4 5 6 7 8 9









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SECTION 4: CRT FOLLOW UP – SKILLS ASSESSMENT 1. Interacts appropriately with staff in pacing clinic






4. Appropriate diagnostics interpretation


5. Appropriate arrhythmia interpretation






8. Appropriate shock lead impedance measurement


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9. Appropriate threshold test N/A 1 2 3 4 5 6 7 8 9









practical logbook 2017. practical logbook 2016 … logbook bhrs... · - 2 - specific points any...

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