What the room is set up to do
Every EP case has the same four jobs happening at once:
- The operator is working catheters from the right femoral, watching fluoro and intracardiac signals.
- Anesthesia is at the head of the bed managing airway, sedation, and hemodynamics.
- The mapping tech is building anatomy and annotating points.
- The circulating RN is documenting, drawing meds, and running the room.
The room layout exists to let those four roles work without bumping into each other or each other’s equipment.
Standard positions
The table
- Patient supine, arms tucked or boarded depending on case
- Head end clear for anesthesia — no rolling stools, no IV poles parked there
- Right groin presented to the operator; left groin available as backup or for ICE
- Foot of bed has space for the operator’s instrument table
Operator side (patient’s right)
- Sterile back table at the foot, angled inward toward the operator
- Mayo stand draped across the patient’s thighs with active catheters and sheaths
- RF / cryo generator on the operator’s right, within cable reach
- Foot pedals: fluoro, cine save, RF — all confirmed positioned before drape
Mapping station (patient’s left, head-of-table corner)
- Mapping tech faces both the patient and the screen bank
- Carto / EnSite workstation within reach of operator over the drape if needed
- Reference patches placed on the patient’s back already — not a scramble at the moment of mapping
Anesthesia (head of bed)
- Anesthesia machine, drug cart, suction
- Airway equipment visible and accessible without moving the table
- BIS or depth monitor if used
- TEE setup on the anesthesia side for structural / LAA cases
Screens
- Operator’s main bank shows fluoro, hemodynamics, and intracardiac electrograms
- Mapping screen on the secondary bank, angled so operator can see it without turning fully
- Anesthesia has their own monitor
Floor and cable management
- Cables routed under the table or down the operator side, never crossing the anesthesia approach
- Foot pedals taped down or in pedal trays
- C-arm sweep path checked before drape — if the arm hits a cable in a steep oblique, we found out in advance
- Lead aprons hung, not piled on the floor
Roles around the room
- Operator — sterile, scrubbed, runs the catheters
- First assistant / fellow — sterile, second pair of hands
- Mapping tech — non-sterile, at the workstation
- Circulating RN — non-sterile, runs the room, draws meds for sedation cases
- Anesthesia (CRNA / MD) — at the head, for any propofol or GA case
- Rep (when present) — back of room, watching, not in the sterile corridor
What to catch on the pre-case timeout
These are the small things that get missed when the room is rushed:
- Defib pads on the patient — front and back if anterior-posterior, before drape goes down
- Mapping reference patches on the back, intact, plugged in
- Both groin sites prepped (case may need contralateral access)
- IV access patent on the non-procedure arm, free for anesthesia
- Foley if it’s a long case
- SCDs on
- Antibiotic timing for device cases — within an hour of incision
- Pacing pads and external pacer both turned on, set, and tested
- Crash cart location confirmed with the team
- TEE probe and ICE probe ready if planned
Safety habits that aren’t optional
- Lead checks — every team member who’s in the room while fluoro is on has lead, including the rep
- Dosimetry badges worn and read
- Sharps stay on the operator’s side — never passed across the patient
- Time-out is done with everyone listening, not while someone is still drawing meds
- Sterile field protection — no one walks between the table and the mayo stand
- Universal “stop” — anyone in the room can call a stop for safety, no questions asked