EP Lab Nurse Brain Sheet | Electrophysiology Procedure Report Sheet (Print + Fillable PDF)

Made by a nurse with 10 years in ICU, trauma, surgery, and the ER. One page per patient that follows an EP lab case from the pre-procedure checklist through access, heparin and ACT, findings and the site and rhythm checks afterward.

WHAT'S INCLUDED

• Patient info, allergies (contrast, latex, iodine), code status, indication, electrophysiologist and room, NPO time, rhythm on arrival
• Pre-procedure checklist: consent, H&P, NPO, anticoagulation held or on, IV access, TEE or CT clot check, pads on, antiarrhythmics held, pre-med, pregnancy test
• History: AFib, SVT, VT/VF, HTN, CHF or low EF, CAD, CKD, stroke or TIA, OSA, prior ablation or device
• Anticoagulant and antiarrhythmic box with last doses and INR, plus home meds held or given
• Labs row: creatinine/GFR, K, Mg, Hgb, Plt, INR, ACT, TSH
• Procedure type: EP study, AFib ablation, SVT ablation, VT ablation, pacemaker, ICD/CRT, loop recorder, cardioversion, TEE, lead extraction
• Access and closure: femoral, subclavian or IJ; figure-of-8, Perclose, manual hold, pocket closed
• Findings, device settings and lesion sets, sedation, heparin and ACT goal, protamine, fluids and irrigation, meds given
• After-procedure table: BP, HR and rhythm, SpO2, site, distal pulse, pain, initials
• Bedrest, telemetry and device check, anticoagulation restart, wound or pocket care, plus a handoff and to-do list

FORMATS: Moon theme / US Letter and A4 / Print version plus a fillable version for tablet or computer. 4 PDFs in the download.

Instant digital download. Nothing will be shipped.

For personal use. This is not a medical record or a substitute for your facility's charting, so always follow your unit's protocol. Follow your facility's privacy policy and shred after shift.

AI DISCLOSURE: Some design elements and mockup images were created with the help of AI tools. The layout and clinical content were designed by a registered nurse.