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R. Chawla and V. Roy

 

 

between the index finger and the thumb. When the tip is at a downward angle, advance toward the apex.

3.No spikes seen and no output: Suspect failure of the battery or generator or a loose connection.

4.Spikes seen but no capture:

Suspect a loose connection but may be due to exit block causing a high threshold. Check the position of the pacing wire and consider repositioning.

Step 7: How to monitor

Assess rhythm for appropriate pacemaker function:

1.Capture: Is there a QRS complex for every ventricular pacing?

2.Rate: Is the rate at or above the pacemaker rate if in the demand mode?

3.Sensing: Does the sensitivity light indicate that every QRS complex is sensed?

Step 8: Postprocedural investigations and precautions

1. A chest X-ray is needed to confirm a satisfactory position of the wire and to exclude a pneumothorax.

2. Ensure the pacing wire is secured.

3. Check and document all connections, battery, and control settings every 4 h and document.

4. Sterile precaution is required as in handling a central line.

5. Keep the pulse generator dry and the controls protected from mishandling.

6. Protect the patient from electromicroshock and electromagnetic interference by covering the exposed wires and the pulse generator, wearing gloves when handling exposed wires; avoid any patient contact with electrical apparatus.

Suggested Reading

1.Ellenbogen KA, Wood MA. Cardiac pacing and ICDs. 5th ed. Malden: Blackwell Publishing; 2008.

2.Cooper DH, Krainik AJ, Lubner SJ, Reno HEL. Washington manual of medical therapeutics. 32nd ed. Department of Medicine, Washington University School of Medicine. Published by Lippincott Williams & Wilkins; 2007. p. 150.

3.Fink MP, Abraham E, Vincent JL, Kochanek PM. Textbook of critical care. 5th ed. Philadelphia: Elsevier Saunders; 2005. Chapter 211, p. 1817–24.

It gives a comprehensive description of the pacemaker and procedure of insertion and enlists the indications for temporary pacing.

4.Irwin RS, Rippe JM. Irwin and Rippe’s intensive care medicine. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. Chapter 5, p. 66–72.

Detailed procedure and indication with pictorial depiction.

5.Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, et al. Update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations. Circulation. 1999;100:1016–30.

A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction).

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