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Cardiac ablation

Q

I’m an RN working in a hospital electrophysiology lab. Recently, I attended a cardiology conference where we discussed whether the College supports nurses in performing cardiac ablation – a procedure in which a catheter is threaded into the heart and energy is applied to destroy heart tissue that’s causing an abnormal rhythm. Someone said that, according to the Regulated Health Professions Act, nurses cannot perform this procedure. If nurses are not authorized to perform cardiac ablation, do they require delegation?

A

To determine if you can perform a specific procedure, start by looking at the controlled acts in the RHPA. Controlled acts are procedures that carry a risk of harm if performed by an unqualified person. Nurses do not have the authority in the legislation to perform the procedures requiring the application of energy listed in regulation 107/96 of the RHPA and would require delegation from a physician to perform these activities.

While cardiac ablation is an application of energy and carries a risk of harm, ablation is not listed in regulation 107/96 so is not a controlled act that requires delegation.

It follows, then, that nurses may perform cardiac ablation, in collaboration with a cardiologist, once specific conditions are met as outlined in the new Decisions About Procedures and Authority practice standard that is included with this issue. Decision-making points include the following: whether the nurse is an appropriate practitioner to perform the procedure, taking into account the risks of cardiac ablation and the client’s condition; whether the nurse has the authority in the form of a valid order or medical directive; and whether the nurse is competent to perform cardiac ablation and has the appropriate practice setting and human resources to support safe, effective and ethical client care.

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