Before the Procedure. You won't be allowed to eat or drink for eight hours prior to the procedure. We will instruct you if you need to stop any medications before the procedure. During the Procedure. Patients will receive some sedation intravenously to help with relaxation during the procedure. Pacemaker Insertion Process Generally, a pacemaker insertion follows this process: Patients will be asked to remove any jewelry or other objects that may interfere with the procedure Patients will be asked to remove clothing and will be given a gown to wear Patients will be asked to empty their bladder prior to the procedure An intravenous IV line will be started in the hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed Patients will be placed in a supine on back position on the procedure table Patients will be connected to an electrocardiogram ECG or EKG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes.
Vital signs heart rate, blood pressure, breathing rate, and oxygenation level will be monitored during the procedure Large electrode pads will be placed on the front and back of the chest Patients will receive a sedative medication in IV before the procedure to help patients relax. However, patients will likely remain awake during the procedure The pacemaker insertion site will be cleansed with antiseptic soap Sterile towels and a sheet will be placed around this area A local anesthetic will be injected into the skin at the insertion site Once the anesthetic has taken effect, the doctor will make a small incision at the insertion site A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone.
The sheath is a plastic tube through which the pacemaker lead wire will be inserted into the blood vessel and advanced into the heart It will be very important for patients to remain still during the procedure so that the placement will not be disturbed and to prevent damage to the insertion site The lead wire will be inserted through the introducer into the blood vessel.
The doctor will advance the lead wire through the blood vessel into the heart Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. Fluoroscopy, a special type of X-ray that will be displayed on a TV monitor , may be used to assist in testing the location of the leads Once the lead wire has been tested, an incision will be made close to the location of the catheter insertion just under the collarbone.
Patients will receive local anesthetic medication before the incision is made The pacemaker generator will be slipped under the skin through the incision after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side. If patients are right-handed, the device will be placed in the upper left chest. After the Procedure. Wound Care Change the dressing over the PM incision site daily: Remember to wash your hands before and after changing the dressing Remove the dressing from your incision and look at it carefully in a mirror If you have steri-strips, do not remove them the steri-strips will be removed at your two-week incision check-up Replace the dressing with a clean dressing dressing materials should be provided to you before your discharge Notify the Stanford Cardiac Arrhythmia Service at for the following: Infection - swelling, redness, or warmth around the incision; significant pain when touched; yellowish, greenish, or bloody discharges on your dressing or on the incision; foul smell Bleeding - blood oozing from the incision or PM site has become swollen or enlarged and feels tense bleeding beneath the skin Fever - if you are feeling excessively warm or have chills and your temperature is greater than F Sponge bath only for the first 5 days following the PM implantation.
Showers can be done after the fifth day, unless otherwise instructed by your doctor The incision site can get wet; do not cover the incision with plastic wrap while showering Do not rub directly over the incision site or use a wash cloth, but let the water or soapy water flow Do not submerge your incision site in the tub, pool, hot tub or lake until it is well healed at least 7 days Avoid using deodorants, powders, creams, lotions, etc. Do not rub while drying.
Activity Activity on the side of the pacemaker should be limited for week six weeks recommended for biventricular pacemaker as follows: Do not lift the elbow that is on the side of your pacemaker above the shoulder. Movement of the large shoulder muscle could cause the lead inside of the heart to move out of position. Repositioning of the leads will require another surgical procedure. Do not participate in any activities that require forceful large arm movements, such as basketball, swimming, golf, and vacuuming Do not lift anything over 10 pounds We recommend walking for at least 30 minutes, five days a week.
You may increase your activities slowly and resume your usual level of activity after 6 weeks If you have additional questions about activities and exercise, please discuss them with us. Driving should be discussed on an individual basis with your doctor.
Electromagnetic Interference Electromagnetic fields can interfere with the pacemaker's ability to sense an abnormal rhythm. Some devices and machines are safe to use while other devices are not: Microwave ovens, computers, VCRs, small electrical tools, and garage door openers are all safe to use Avoid devices or areas that have strong electric or magnetic fields such as: leaning over a car engine while it is running, running motorcycle engines, power plants, ham radios, etc.
Cellular phones, MP3 players, and headphones should be held at least 6 inches away from your pacemaker. Hold the phone on the ear opposite your pacemaker and avoid keeping your phone and headphones in a pocket on top of your pacemaker.
Avoid resting your head on the chest of a person with a pacemaker while wearing headphones When traveling in the airport, tell security you have a pacemaker and request for a hand search instead of walking through the metal detector.
The metal detector will not harm the pacemaker but it may set off the alarm. Limit scanning with a hand-held metal detector over the device no longer than necessary.
Inform your health care provider that you have a pacemaker before they perform any test or procedure using medical or electronic devices. The electrocautery might be misinterpreted by the pacemaker as heart beats and withhold pacing Normal teeth cleaning are safe and require no special instructions. You cannot have an MRI because of the possible magnetic interference. Identification Carry your pacemaker identification card in your wallet at all times. Follow-Up It is very important that you have your pacemaker checked regularly 4 to 6 weeks after implant and every 6 months thereafter.
Need to schedule an appointment? Please call Cardiac Arrhythmia Service at Symptoms - Medical emerygency You should lie down immediately, make sure you are in a safe environment, away from any machines or moving vehicles, and call a friend or family member, or call , if you feel any of the following symptoms: Lightheadedness Fast heart rate palpitations Dizziness Chest pain Shortness of breath Fainting or near fainting syncope Important Phone Numbers: Stanford Arrhythmia Service: - for questions or problems available 24 hours a day, 7 days a week Stanford Device Clinic: - for appointments.
Frequently Asked Questions. What precautions should I take with my artificial pacemaker? Discuss the following in detail with the doctor: Use caution when going through airport security detectors. Can I participate in regular, daily activities with a pacemaker? Patients with a pacemaker may still be able do the following: Exercise moderately, upon advice from the doctor Drive or travel Return to work Work in the yard or house Participate in sports and other recreational activities Take showers and baths Continue sexual relationships When involved in a physical, recreational, or sporting activity, a person with a pacemaker should avoid receiving a blow to the skin over the pacemaker.
How can I ensure the pacemaker is working properly? The proper method for checking the accuracy of the pacemaker includes the following: Patients should their pulse regularly to make sure the pacemaker is keeping pulse at the targeted rate Check the "pacing lead" the lead which sends information from the heart to the pacemaker with an electrocardiogram ECG at your doctor's office. In addition, patients may participate in a telephonic checkup for the pacemaker on a periodic basis.
The doctor will provide special instructions See the doctor regularly for check-ups Report any unusual symptoms or symptoms like those had prior to the pacemaker insertion to the doctor immediately Always consult your doctor for more information, if needed. What is the pulse? Taking a pulse not only measures the heart rate, but also can indicate: Heart rhythm abnormal rhythm may indicate a heart disorder Strength of the pulse a weak pulse may indicate a fast heart beat in which some beats are too weak to feel, heart failure, or a low volume of blood in the circulatory system.
How do I take an accurate pulse? Play Video. How do I check my pulse? When taking your pulse: Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse Begin counting the pulse when the clock's second hand is on the 12 Count your pulse for 60 seconds or for 15 seconds and then multiply by four to calculate beats per minute When counting, do not watch the clock continuously, but concentrate on the beats of the pulse If unsure about your results, ask another person to count for you If the doctor has ordered you to check your own pulse and you are having difficulty finding it, consult your doctor for additional instruction.
Do mobile phones or other devices interfere with pacemakers? Epub Oct J Clin Med. Ann Card Anaesth. Cao Q, Zhang J, Xu G ; Hemodynamic changes and baroreflex sensitivity associated with carotid endarterectomy and carotid artery stenting.
Interv Neurol. Epub Jun Temporary Cardiac Pacing ; University of Ottowa, He thought Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy.
Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Potential complications related to the use of pacing lead systems with the Model include, but are not limited to, myocardial irritability resulting in fibrillation, infarction, pericarditis, rejection, muscle and nerve stimulation, and infection.
Complication related to inhibition or reversion of the pacemaker in the presence of strong electromagnetic interference. Whenever possible, for the safety of the patient, disconnect the temporary pacemaker from the implanted lead system before defibrillating or cardioverting. Excessive defibrillation energy can damage the temporary pacemaker.
This can result in a large current flowing through the implanted lead system and temporary pacemaker, which could reduce intended defibrillation energy delivered to the patient or cause myocardial damage. A lead with extension cable constitutes a direct, low-resistance current path to the myocardium.
During connection and testing procedures, only battery-powered instrumentation should be used. Extreme caution must be taken to properly ground all line-powered equipment used in the vicinity of the patient.
Electrosurgical units can cause tachyarrhythmias by inducing current on the leads. Improper connection, displacement or fracture of leads or cables may result in pacemaker system failure.
Inspect leads and cables for damage before each use. The pacing lead system may cease to function at any time due to improper connections or lead-related problems such as displacement or fracture. Transcutaneous pacemakers have two variables that the caregiver has to control: the strength of the electrical impulse and the rate of impulses per minute.
Rate is pretty self-explanatory. This is a treatment for symptomatic bradycardia, so the rate setting should be faster than the patient's arrhythmia.
Usually, we shoot for a number around 80 per minute. This varies by locale, so be sure to check with your medical director for guidance on proper pacing rate. Electrical impulse strength is measured in milliamperes milliamps for those in the know.
It takes a minimum amount of energy to break through a patient's threshold to trigger a contraction. That threshold is different for every patient and the most common mistake in using a transcutaneous pacemaker is failing to crank up the energy high enough.
To make things even more complicated, there are different thresholds for the conduction pathways of the heart and the actual heart muscle, which means it's possible for the ECG to look like the pacemaker is working, but the heart muscle isn't actually responding.
Each model is different and it's really important that each caregiver spends time to familiarize herself with the device she'll be using in the field. That being said, the procedures are very similar across multiple brands. The pacer pads must be attached along with the monitoring electrodes. When transcutaneous pacemakers and defibrillators were separate devices, the pacer pads had to be placed out of the way of the defibrillator paddles in case of cardiac arrest, a legitimate concern when playing around with a patient's cardiac conduction system.
Now that most transcutaneous pacemakers double as defibrillators, the patches are often placed the same for both uses. Again, follow the manufacturer's directions. The patient must be connected to the cardiac monitor. This is important. For those who are familiar with the way most manual cardiac defibrillators work, it's a common mistake to assume that the pacemaker electrodes pacer pads will be able to also monitor the patient's heart rhythm.
That's how defibrillators work, but defibrillators deliver a single shock and then go back to monitoring the rhythm.
A transcutaneous pacemaker is continuously delivering impulses and doesn't really have a chance to monitor anything through the pacer pads. Make sure the ECG monitor is set to read a lead through the monitoring electrodes and not through the pacer pads.
If it is set to read through the pads, many devices simply won't work when pacing is tried. Once the device is properly applied and activated, look for pacer spikes in the ECG tracing. Once we have that, it's time to pace the patient:. Once the pacemaker is working and the patient's condition is improving, consider sedation. This thing hurts like crazy. There will be a lot of skeletal muscle contraction of the chest wall with each impulse.
The patient can tolerate it for a few minutes, but not for too long.
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