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Pacemaker Implantation
Pacemaker Implantation
Age : 52 year
Gender : Male
Monthly income :
Religion : Hindu
Date of Admission :
Address : Virpur
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PACEMAKER INSERTION
PACEMAKER INSERTION:
A pacemaker insertion is the implantation of a
small electronic device (artificial pacemaker) that is usually placed in
the chest (just below the collarbone) to help regulate the heart rate in
those patient who have temporary or permanent dysrhythmias.
DEFINITION OF PACEMAKER:
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PURPOSES:
• To correctly pace the heart.
INDICATIONS
• Arrhythmias—Atrial fibrillation
• Bradycardia
• Heart transplants
• Long QT syndrome
• Syncope
• Tachycardia
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COMPONENTS OF PACEMAKER:
2. Electrode leads
These leads are thin pieces of insulated wire that deliver electrical
impulses to and from the heart.
single-chamber pacemakers:
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Dual-chamber pacemakers:
Bi-ventricular pacemakers:
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Mode of pacing:
1. Fixed mode: In the fixed rate mode, the pacemaker fires electrical
stimuli at a preset rate regardless of the person's inherent rhythm.
Asynchronous pacing is rarely used.
1. Transvenous implantation:
Also called endocardial implantation. The pacemaker is usually
implanted on your left side, as this is closer to the heart and allows
for the wires to be inserted easily into the heart.
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2. Epicardial implantation:
Here, the electrode lead is attached directly onto the outer surface of
the heart – the epicardium – through a small incision (cut) in the wall
of your abdomen or chest. The pacemaker box is often placed under
the skin of abdomen.
TYPES OF PACEMAKERS:
Depening on the condition of the patient the pacemaker may be two
type:
1 Temporary pacemakers :
These are intended for short-term use during hospitalization. Are
used to support patients until they improve or reserve a Permanent
pacemakers.
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2 Permanent pacemakers:
Permanent pacemakers are pacemakers that are intended for long
term use.
Definition:
Equipment:
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• 9-V battery for pulse generator
• Connecting cables
• Alligator clips or wires with connecting pins
• ECG monitor and recorder
• Supplies for dressing at insertion site
Additional equipment, to have available as needed, includes
the following:
• Local anesthetic
• Percutaneous introducer needle or 14-gauge needle
• Introducer sheath with dilator
• Guidewire (per physician or advanced practice nurse choice)
• Suture, syringes, needles, and scalpel
• Emergency equipment (i.e., automated external defi brilla-
tor [AED], defi brillator)
• Portable ultrasound scan equipment
• Fluoroscopy
• Lead aprons or shields
• 12-lead ECG machine
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PROCEDURE OF TEMPORARY TRANSENOUS PACEMAKER INSRTION:
Steps of procedure Rationale
1. HH
2. PE
3. Connect the patient to the bedside monitoring system, 3. Monitors the patient’s intrinsic heart rate and rhythm
and monitor the ECG continuously during and after the procedure to evaluate for adequate
rate and pacemaker function.
4. Dispose of used supplies and wash hands. 4. Minimizes the risk of infection.
5. Check the placement of the central venous access with 5. Central venous access is needed as the transvenous
chest radiography before starting the procedure. pacing catheter is passed through the central venous
system.
6. Assess functioning of the temporary pacemaker, 6. Ensures a functional pacemaker pulse generator.
and insert a new battery into the pulse generator before.
beginning therapy.
7. Attach the connecting cable to the pulse generator, 7 Prepares the pacing system; the pacing stimulus travels
Connecting the “positive” on the cable to the “positive” from the pulse generator to the negative terminal, and
on the pulse generator and the “negative” on the energy returns to the pulse generator via the positive
cable to the “negative” on the pulse generator. terminal.
8. All personnel performing and assisting with the procedure 8. Minimizes the risk of infection and maintains standard
should wash hands and apply PE and sterile equipment and sterile precautions.
(e.g., masks, head covers, goggles or face shields, sterile
gowns, and gloves).
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continue...
9. Cleanse the site with antiseptic solution (e.g., 2% 9. Minimizes the risk of infection.
Chlorhexidine -based preparation).
10. Provides a sterile field and reduces the transmission
10. Drape the site with the sterile drapes. of microorganisms.
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Continue...
16. Secure the pacemaker equipment such as strapping 16. The pulse generator should be protected from
the pulse generator to the patient ’ s torso or securing falling or becoming inadvertently detached by patient
the pulse generator in a carrying device. movement
17. Remove PE and discard used supplies in appropriate 17. Reduces the transmission of microorganisms;
receptacles Standard Precautions.
18. HH
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After Care:
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PERMANENT PACEMAKER IMPLANTATION
Definition:
Purpose:
Equipment:
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Pre – PPI Care:
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Post PM Care:
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