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INTRODUCTION
A pacemaker is an electronic device that provides electrical stimuli to the heart muscles.
Pacemaker are usually used when a patients has a slower than normal impulse formation or a
conduction disturbances that causes symptoms. They may also be used to control some
tachydysrhythmias that do not respond to medication therapy. Biventricular pacing may be
used to treat advanced heart failure that does not respond to medication therapy.
DEFINITION-
“A pacemaker is a small electronic device that’s place in the chest or abdomen to help control
abnormal heart rhythm. This device uses electrical pulses to prompt the heart to beat at a
normal rate”.
“A pacemaker is a small device ,about the size of a half dollar piece, that’s placed under the
skin near the heart to help control heart beat. A pacemaker is implanted as part of what’s
often referred to as ‘cardiac resynchronization therapy’.
PURPOSES-
To initiate heart rate when the heart naturals pacemaker unable to do so.
To maintain the heart beat and heart function.
To control the heart rate.
COMONENTS OF PACEMAKER-
A battery - which usually last 6 to 10 years depending on how advanced the device is
(more advance pace maker tends to use more energy so have a shorter battery life.
A pulse generator-the pulse generator has several controls. They are energy output,
heart rate and pacing mode.
A tiny computer circuit: - it converts energy from the battery in to electrical
impulses, which flow down the wires and stimulate heart to contract.
TYPES OF PACEMAKER-
1. TEMPORARY PACEMAKERS
2. PERMANENT PACEMAKERS
INDICATIONS:-
I II III IV V
Chamber Chamber Response to Programmability Antitachycardia
paced sensed sensing rate modulation function
O = None O = None O = None O = None O = None
A= A = ATRIUM T = triggered P = Simple P = Pacing
ATRIUM programmable
V= V= I = Inhibited M = Multi S = Shock
VEMTRICLE VEMTRICLE programmable
D = DUAL D = DUAL D = Dual (T R = Rate modulation D = dual (P and
CHAMBER CHAMBER and I ) S)
(A and V ( A and V )
)
PURPOSES-
EQUIPMENTS-
Additional equipments-
PATIENTS ASSESMENT-
PATIENTS PREPRATION-
PROCEDURE
4 Apply ECG electrode of conventional three Check intrinsic rhythm and pacer
lead, single channel monitoring system. sensing function.
5 Adjust ECG lead and size to maximum R Detection of intrinsic rhythm is
wave size. necessary for proper demand
pacing.
6 Apply the back (posterior, + ) pacing Placement of pacing patches in the
electrode between the spine and left recommended anatomic location
scapula at the level of heart. will enhance the potentials for
successful pacing.
7 Apply the front (anterior, -) pacing Placement of the pacing patches in
electrode at the left, fourth intercostals the recommended anatomic location
space, midclavicular line. will enhance the potentials for
successful pacing.
8 When the patients is too unstable to allow Facilitates ease of electrode
posterior placement, the back electrode placement for emergent pacing.
may be placed over the patients right
sternal area at the second or third
intercostals space. The front electrode will
be maintained at the apex.
9 Connect pacing electrodes to cable and Necessary for the delivery of
connect to external pulse generator. electric energy.
10 Consider administering sedation before Transcutaneous pacing can be
initiate pacing. uncomfortable for the patients.
11 Set pacemaker settings as prescribed by the Each patients may require different
physicians or advanced practice nurse, pacemaker setting to provide safe
including rate, level of energy, and mode, if and effective external pacing.
available (demand/synchronous, non- Pacing should be maintained at a
demand / asynchronous) rate that maintains adequate cardiac
output but does not induce
ischemia.
12 Initiate pacing by slowly increasing the Use of lowest amount of energy that
energy level (mA) delivered until consistently results in myocardial
consistent capture occurs at the prescribed capture and contraction to minimize
rate. discomfort.
13 Monitor ECG tracing artifact and Ensures adequate functioning of the
associated capture or sensing. pacer.
14 Palpate patient’s femoral and carotid pulse. Ensures adequate blood flow with
paced complexes.
15 Evaluate patients comfort. Pacing may be tolerated or
uncomfortable for the patients.
16 Discards used supplies, and wash hands. Reduce transmission of
microorganism.
INDICATION-
ADDITIONAL EQUIPMENTS-
Emergency equipment.
Fluoroscopy.
12- Lead ECG.
PROCEDURE
The transvenous and epicardial pacing are initiated as temporary measure when there
has been a failure of the normal conduction system of the heart to produce an electrical
impulse, resulting in hemodynamic compromise or other debilitating symptoms in the
patients.
PURPOSE-
INDICATION-
1. Emergency equipment.
2. Fluoroscopy.
3. 12- Lead ECG.
PROCEDURE
Connect
2 patient to bedside monitoring system, and Monitoring intrinsic rhythm as well as
monitor ECG continuously. rhythm during and after the procedure to
evaluate for adequate rate and
pacemaker function.
3 Assess pacemaker functioning. Ensures functional pacemaker pulse
generator.
4 Attach the connecting cable to the pulse Prepare the pacing system.
generator.
6 Expose the epicardial pacing wires and Identify correct chamber for pacing.
identify the chamber of origin. Wires
exiting to the right of the sternum are
arterial in origin. Wires exiting to the right
of the sternum are ventricular origin.
7 Connects the epicardial wires to the pulse The epicardial wires must be securely
generator via connecting cable. Ensure that connected to the pulse generator to
the positive and negative electrodes are ensure appropriate sensing and capture
connected to the respective positive or as well as to prevent in advertent
negative terminals on the pulse generator disconnection.
via the connecting cable.
8 Set pacemaker settings as prescribed by the Each patient may require different
physicians or advanced practice nurse, pacemaker setting to provide safe and
including rate, level of energy, and mode, effective external pacing. Pacing should
if available (demand/synchronous, non- be maintained at a rate that maintains
demand / asynchronous) adequate cardiac output but does not
induce ischemia.
9 Assess patient’s response to pacing Pacemakers setting are determined by
including blood pressure, level of patient’s response.
consciousness, heart rhythm, and other
hemodynamic parameters.
PERMANENT PACEMAKER
PURPOSES
CONTRAINDICATION-
Active infection.(endocarditis)
Bleeding.
COMPLICATION
Local infection at entry site.
Bleeding and hematoma at the lead entry site.
Hemothorax or pneuomothorax.
Failure to sense.
Failure to capture.
Atrial and ventricular septal perforation.
Atelectasis.
Pericardial fluid accumulation.
Diaphragmatic stimulation.
BOOKS REFERENCES:-
Bottinger B W, Rauch H, Bohrer H, Motsch J, Soder M, Fleischer F, Martin E.
Continous versus intermittent cardiac output measurement in cardiac surgical patients
undergoing hypothermic cardiopulmonary bypass. J CardiothoracVascAnesth. (1995);
9(4):405–411.
Nelson L D. The new pulmonary arterial catheters. Crit Care Clinics. (1996);
12(4):795–818.
Nettina M. Sandra (2010), Lippincott Manual of Nursing Practice, New Delhi,
Wolters Kluwers.
Ansari Javed (2012), Examination Master in Medical Surgical Nursing- II, New
Delhi, S. Vikas & Company.
Knight P Bradley (2016), Patient information: Cardioversion (Beyond the Basics),
Mayo clinic(2014),Tests and Procedures Cardioversion
INTERNET REFERENCES:-
www.ncbi.nlm.nih.gov/pubmed/12024086
https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/.../ucm_300451.pdf
https://medlineplus.gov › Medical Encyclopedia
https://www.healthline.com/health/heart-pacemaker
MAR BASELIOS COLLEGE OF NURSING, BHOPAL
ASSIGNMENT ON
PACEMAKER