Jane Salvaggio ARNP CV Surgery

Post-op Goal: Maximize Cardiac Output (CO)

= HR x
BRADYARRHYTHMIA TOO SLOW Sinus node dysfunction A-V block TACHYARRHYTHMIAS TOO FAST Atrial tachycardias Junctional tachycardias Ventricular tachycardias PRELOAD AFTERLOAD CONTRACTILITY

Rare ! Multiple atrial suture lines? Resecting in the sub-aortic region? Acute myocarditis ? Corrected TGA (L-TGA) ?

Why were pacing wires placed? All wires identified? What are the settings? Are all connections tight and secure? Is it working as it should?

LABEL A =Atrial on the R side V= Ventricular on the L side G =Ground through the skin

Ground is always positive Pacing wire in the negative terminal

Chambered Paced ?

Chambered Sensed?

Response to Sensing?

Chambered Paced?

Chambered Sensed?

Response to Sensing?

Chamber Paced ?

Chamber Sensed ?
Response to Sensing?

D
D

AV Interval

milliseconds

mA (milliamperes) ?

TEMPORARY WIRES ! Changes with time !

Can your baby go to MRI ?

Can you disconnect the generator, then go to MRI? What if you see this approaching your bedside?
Disconnect Or 15cm away from leads and pacemaker

AV sequential pacing

Failure to Capture

Check all connections Check/change battery Increase mA Lead rearrangement Change pacemaker

AAI pacing Failure to sense Check connections Increase sensitivity Check battery Change leads (faulty placement or fibrosis)

Other clues ?

Decreased UO Decreased pulses

Menu 3 RAP pick rate 80-800 press and hold SELECT to deliver RAP

Way to recapture/control rapid atrial arrhythmias and break it for improved CO No ventricular support during RAP Record event Resuscitation fluid, meds, pacing

Infections Myocardial injury Ventricular arrhythmias Perforation Tamponade Bleeding

At time of Removal Monitor x4 hours

 Safety

first protect from liquids protect from electricity protect from children Check patient Check settings vs monitor Check connections Strip recorder @ bedside