Hi Michael, If you have a look at AS2500 page 23 you will see clearly that central line insertion is not considered a cardiac type procedure. As for the type of procedure being clearly defined ........ essentially it is does electrical contact with the ventricle occur? If so - cardiac, if not body. Note it must be the ventricle.
From AS2500..... "Placement of a central venous catheter into the superior vena cava is not a cardiac-type procedure even if the catheter is connected to an electrical device such as a pressure transducer. However, placement of a Swann-Ganz pulmonary catheter through the right ventricle requires cardiac protection. In procedures in which a subclavian catheter is inserted, e.g. for haemodialysis access, with the intention that the catheter tip will be positioned in the superior vena cava, care needs to be taken that the tip does not enter the heart, since such positioning may raise the classification of subsequent procedures to cardiac-type. Radiographic verification of the positioning of the catheter should be performed. Measurement by a liquid manometer of right atrial pressures with a saline-filled catheter does not have to be done in a cardiac-or body-protected area as there is no electrical connection. The use of electrical pressure transducers to measure radial arterial pressure is a body-type procedure and not a cardiac-type procedure." N.B. This is by no means advice and your institution will need to make its own decision. Regards, Leigh Baker Manager Medical Engineering and Physics [cid:image001.gif@01CA41CE.724148F0] St Vincent's Hospital P.O. Box 2900 Fitzroy Victoria 3065 Phone: (03) 9288 4254 Fax: (03) 9288 4347 Email: leigh.ba...@svhm.org.au From: Sullivan, Michael R [mailto:michael.sulli...@dhhs.tas.gov.au] Sent: Wednesday, 30 September 2009 12:45 PM To: Ruff, Megan; Porter, John R; bmelist@bme.asn.au Subject: RE: [bmelist] Renal Unit Body Protect or Cardiac Protect Wiring Hi guys, I'm not a BME, but if clinicians are going to be inserting short to medium term central lines, in this unit, then there is a direct path right to the 'source'. I'm pretty sure if this was the case, (insertions), then cardiac protection would be in order. I reckon that you need the scope of use / practice defined. M ________________________________ From: Ruff, Megan [mailto:megan.r...@mh.org.au] Sent: Wednesday, 30 September 2009 11:12 AM To: Porter, John R; bmelist@bme.asn.au Subject: RE: [bmelist] Renal Unit Body Protect or Cardiac Protect Wiring Hi John, We specify Body Protection. The flowchart contained in AS/NZS 2500 (section and figure 4.5 in the 2004 edition) requires cardiac protection 'if the applied part makes contact with the LV or RV of the heart'. As the fluid lines are completely electrically isolated from the machine I'm not sure if they are even considered an Applied Part. However, if you consider them an Applied Part on the basis that because they contain conductive fluid they are a potential conductor, dialysis falls into the category of a Body procedure under the above criteria even if you're dialysing a patient with a permacath that has been placed very close to the atrium. The machines themselves are Type B equipment (Gambros are, anyway, I haven't got anything else handy to check), and if you have a look at the requirements for home dialysis installations in 2500 and 3003, Body Protection is specified, not cardiac. I hope that helps. Regards, Megan Ruff Dialysis Service Technician Melbourne Health/North West Dialysis Service ph) 0437 009 708 ________________________________ From: Porter, John R [mailto:john.por...@dhhs.tas.gov.au] Sent: Wednesday, 30 September 2009 8:48 AM To: bmelist@bme.asn.au Subject: [bmelist] Renal Unit Body Protect or Cardiac Protect Wiring We are establishing a new Satellite Renal Unit and my recommendation is that it only needs to be wired as Body Protected, outlined in AS/NZS 3003. Other individuals believe that is should be Cardiac Protected which I believe is unnecessary. What are the views of others on this issue and what level of protection are most Renal Units wired? John Porter Team Leader Electrical/Mechanical Building & Engineering Launceston General Hospital Ph: 03 6348 7433 Fx: 03 6348 7430 Email: john.por...@dhhs.tas.gov.au<mailto:john.por...@dhhs.tas.gov.au> CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. 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