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PACEMAKERS

 A cardiac pacemaker is an electronic device that delivers direct stimulation to the


heart, causing electrical depolarization and cardiac contraction.
 The pacemaker initiates and maintains the heart rate when the natural pacemakers
of the heart are unable to do so.

CLINICAL INDICATIONS
 Symptomatic Bradyarrhythmias
 Sinoatrial bradyarrhythmias
 Sinoatrial arrest
 Sick Sinus Syndrome
 Heart Block
 Second Degree Heart Block
 Complete Heart Block
 Prophylaxis
 Following Acute MI; arrhythmias and conduction defect
 Before or following cardiac surgery
 Tachyarrhythmias
 Supraventricular
 Ventricular

PACING MODES:

1. DEMAND (Synchronous, non-competitive) Atrial / Ventricular


a. It triggers electrical firings only when the heart rate goes slow.
b. It does not compete with the heart’s basic rhythm.
c. When the heart rate falls below a predetermined escape interval
(programmed into pulse generator), an electrical stimulus is delivered to
the heart.

2. FIXED RATE (Asynchronous, Competitive) Atrial / Ventricular


a. It delivers an electrical stimulus at a preset constant rate that is
independent of the patient’s own rhythm.
b. Does not allow atrial contribution to the cardiac output. May be valuable
in complete Heart Block.

3. SYNCHRONOUS Atrial / Ventricular


a. A demand form of pacing which is able to increase heart rate to
accompany the physiological demands of the body.
b. An actual electrode senses the patient’s atrial depolarization, waits for a
preset interval (simulated PR interval) and triggers firing of ventricular
pacer.
c. If rapid atrial rhythm occurs, the ventricular pacemaker stimulates the
ventricle at a fixed rate independent of atrial activity.
TEMPORARY PACEMAKERS

 Temporary pacing of the heart is usually done as an emergency procedure that


allows observation of the effects of pacing on heart function before a permanent
pacemaker is implanted.
 The external pulse generator is attached to the patient.

PERMANENT PACEMAKER

 Permanent pacing of the heart may be implanted through the following


techniques:
o Transvenous (Endocardial)
 The electrode is threaded through cephalic or external jugular vein
into the right ventricle. This is done under local anesthesia.
 The peripheral end of the electrode is connected to the pulse
generator, which is implanted underneath the skin below the right
or left pectoral region.
o Transthoracic (Epicardial)
 Anterior chest is opened and electrodes are sutured to the surface
of the right or left ventricle or atrium, then threaded
subcutaneously to the abdominal wall either above or below the
waist.

NURSING INTERVENTIONS FOR CLIENTS WITH ARTIFICIAL CARDIAC


PACEMAKERS

 Monitor ECG following implantation of pacemaker, VS.


 Observe for indications of pacemaker malfunction as dizziness, faintness,
lightheadedness, chest pain, shortness of breath.
 Make sure all equipment in the client’s unit is grounded, to prevent ventricular
fibrillation.
 Practice sterile technique for dressing changes to prevent wound infection
 Avoid going near or using microwave oven (move 3 feet away from the device)
 Observe for signs and symptoms of infection around generator and leads - fever,
heat, pain, and skin impairment at the implant site.
 Avoid contact sports, because electrode may be displaced.
 Provide psychological support.
 Provide client education, which includes the following:
o Take daily pulse for one full minute
 Report any sudden slowing of pulse greater than 4 to 5 beats per
minute or any increase in pulse rate.
 The best time to take the daily pulse is in the morning upon
awakening. Report signs and symptoms of dizziness, fainting,
palpitation, prolonged hiccups and chest pain to the physician.
(Indicative of pacemaker failure)
 May use electrical device with caution, if dizziness occurs, stop
using the device.
 Sources of ElectroMagenetic Interference (EMI) that may affect
some pulse generators are as follows:
 High - Energy radar
 TV and Radio Transmitters
 Electrocautery machines
 Airport screening device
 Antitheft devices
o Move 5 to 10 feet away from the source of EMI if
dizziness occurs.

CARDIOVERSION AND DEFIBRILLATION


 Cardioversion is the synchronous application of an electrical shock of short
duration to the heart through the use of chest paddles.
 It is done to convert cardiac dysrhythmias into a more
hemodynamically stable, sinus rhythm.
 Electric shock is applied during the R wave; never on the T wave.
 Defibrillation is unsynchronized passing of an electrical shock of short duration
through the heart to terminate ventricular fibrillation or ventricular tachycardia
without a pulse.

NURSING CARE DURING CARDIOVERSION AND DEFIBRILLATION

1. Place the client in a flat, firm surface


2. Apply interface material (gel, paste, saline pads) to the paddles.
a. This is for better contact with the skin and to prevent burns.
3. Grasp the paddles only by the insulated handles. To prevent electrocution.
4. Give command for personnel to STAND CLEAR of the client and the bed.
5. Apply the chest paddles at the Right of the sternum, third ICS and the other one
on the left midaxillary, fifth ICS.
6. Push the discharge buttons in both paddles simultaneously
7. Defibrillation is done before CPR.

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