1 / 18

Cardiac Issues 2011

Kevin P Foley MD FACC Yakima Heart Center Yakima Washington. Cardiac Issues 2011. Temporary Pacing. Bradycardia: MI, hyperK, Ischemic/Coronary Disease, drug effects, post cardiac surgery Methods available: transvenous, epicardial, transthoracic Available technology

abba
Download Presentation

Cardiac Issues 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Kevin P Foley MD FACC Yakima Heart Center Yakima Washington Cardiac Issues 2011

  2. Temporary Pacing • Bradycardia: MI, hyperK, Ischemic/Coronary Disease, drug effects, post cardiac surgery • Methods available: transvenous, epicardial, transthoracic • Available technology • Issues in care and monitoring

  3. Transvenous Pacing • Venous access: subclavian, internal jugular, femoral, antecubital • Pacing catheters • Straight or J tipped • Solid or balloon guided • Fluoroscopy: Portable C arm or Cath Lab • Resuscitation equipment available

  4. Temporary Pacing Bipolar Contacts: negative to tip Proximal to Positive (P-P)

  5. Temporary Pacing Balloon guided multipurpose Catheter with electrical connec

  6. Temporary Pacing Older style Connecting wire With unshrouded Pins Newer wires are shrouded

  7. Pacemaker Connections • Shrouded connector • !Compatible connections!

  8. Temporary Pacing Temporary Pacer: select rate, output (MA), sensitivity

  9. Temporary Pacing X-ray appearance: Atrial J shaped Ventricular: apex RV

  10. Temporary Pacing--Procedure • Sterile technique • Vascular access • Place temporary pacing catheter • Connect to pacer box • Assess capture: high output, reduce, note when capture lost • Assess sensing: see next slide • SECURE the pacing catheter • Post insertion chest X-ray for position and possible pneumothorax

  11. Assessing Sensing • If temporary box capable: directly measure size of R and P waves • If not: set sensitivity to maximum • Set demand rate low enough to allow the patient to have their own rhythm • Back off demand dial until appropriate sensing lost—That position is “Sensing Threshold”

  12. Loss of capture • Assess rhythm: sense—capture--timing • Immediately check connections: tight, intact • Increase output of pacer • Reposition patient • Invert polarity • Consider conversion from bipolar to unipolar path

  13. Bipolar to Unipolar Conversion • Pacing lead tip connection (negative, black) remains connected • Proximal connection (positive, red) jumped with alligator wire to monitor contact on patient’s chest • Maximum output from pacer • Rarely done

  14. Epicardial Pacemaker • Most commonly post op cardiac surgery • Same principles of pacing • Same generator • May be atrial and ventricular connections • Caution with connectors: electrically isolate • May be patient positional issues

  15. Transthoracic Pacing

  16. Transthoracic Pacing • Note: MONITOR: DEFIB • Rate and MA Controls

  17. Transthoracic Pacing • Emergent alternative • External patches to patients chest (A-P > ant chest • Know your external pacer/defibrillator controls • Increase power output (mA) to point of capture • May cause patient discomfort

  18. Problems of Transthoracic Pacing • Stimulus overloads regular ECG monitors: patient ECG ‘blown away’ • Hard to assess capture on small screen monitor • Delivery of transthoracic stim causes muscle contraction and transmitted pressure wave to groin—Hard to be certain of femoral pulse in a critical situation

More Related