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CARE OF PPI AND ICD IN THE CCU

CARE OF PPI AND ICD IN THE CCU. DR VISWANATHAN V CARDIOLOGIST, ICVD,MMM. www.anaesthesia.co.in anaesthesia.co.in@gmail.com. NBG CODE FOR PACING. PACEMAKER COMPLICATIONS. IMPLANT RELATED + ECCHYMOSIS + PUNCTURE RELATED + HEMATOMA

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CARE OF PPI AND ICD IN THE CCU

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  1. CARE OF PPI AND ICD IN THE CCU DR VISWANATHAN V CARDIOLOGIST, ICVD,MMM www.anaesthesia.co.in anaesthesia.co.in@gmail.com

  2. NBG CODE FOR PACING

  3. PACEMAKER COMPLICATIONS • IMPLANT RELATED + ECCHYMOSIS + PUNCTURE RELATED + HEMATOMA + INADVERTENT LV PLACEMENT + VENTRICLE PERFORATION + THROMBOSIS • LEAD RELATED + DISLODGEMENT + INSULATION BREAK + LOOSE CONNECTOR PIN + CONDUCTOR COIL FRACTURE + EXIT BLOCK

  4. PACEMAKER COMPLICATIONS contd………….. • PACEMAKER SYNDROME • ELECTROMAGNETIC INTERFERENCE • CROSS TALK • OTHERS

  5. EVALN OF PACING SYSTEM

  6. ASSESSMENT IN THE CCU-HISTORY AND EXAMN • PALPITATIONS • GIDDINESS • SYNCOPE • NECK PULSATIONS • FEVER • HEART RATE • JVP • BLOOD PRESSURE • ACIDOSIS

  7. ASSESSMENT IN THE CCU-ECG • RATE • RHYTHM • PACING SPIKES • PACING CAPTURE • MAGNET RATE • TACHYARRHYTHMIAS

  8. PPI ECG

  9. ASSESSMENT IN THE CCU CXR – PA • PNEMO / HEMO THORAX • LEAD POSN • LEAD FRACTURE • LOOSE CONNECTOR PIN • MIGRATION OF GENERATOR • CARDIAC PERFORATION

  10. OTHER INVESTIGATIONS • CBC • RFT • ABG • ELECTROLYTES • ECHOCARDIOGRAM- LEAD POSITION, CARDIAC PERFORATION, EFFUSION, LVEF

  11. DATA COLLECTION • SEE THE MANUFACTURER / MODEL • PPI DETAILS – NASPE CODE / NO. • DATE OF IMPLANT • PROCEDURE DETAILS • CONTACT COMPANY PERSONNEL

  12. PPI INTERROGATION • MAGNET RATE • END OF BATTERY LIFE • PACING THRESHOLD • PACING OUTPUT • PREVIOUS CHANGES MADE NOTED

  13. EMERGENCY SITUATIONS • ACUTE – COMPLICATIONS POST PROC. • LOSS OF PACING – T.P.I IF SYMPTOMATIC. • EMERGENCY DRUGS ON STAND BY • ADVICE – DEVICE INTERROGATION

  14. IMPLANTABLE DEFRILLATORS (AICD ) • DEFINITION – ELECTRONIC DEVICES USED TO TREAT VENTRICULAR ARRHYTHMIAS AUTOMATICALLY WITH ELECTRICAL SHOCKS OR PACING • KEY FEATURES – + MOST ARE PLACED SUBCUT IN THE PECTORAL REGION AND CONNECTED TO ENDOCARDIAL LEAD SYSTEMS. + WHEN THE PRESET DETECTION CRITERIA OF VENTRICULAR ARRHYTHMIAS IS MET THE DEVICE AUTOMATICALLY DELIVERS PROGRAMMED THERAPIES FOR ARRHYTHMIA TERMINATION. + ICD THERAPIES INCLUDE BRADYCARDIA PACING / ANTITACHYCARDIA PACING / CARDIOVERSION AND DEFRILLATION

  15. COMPONENTS OF AICD • PULSE GENERATOR • BATTERY • CAPACITORS • SENSING AND AMPLIFICATION SYSTEM • BRADYCARDIA PACING AND PACING CIRCUITS • HIGH VOLTAGE OUTPUT CIRCUITS • LEAD SYSTEMS • ICD PROGRAMMER

  16. CXR –PA IN A C/O AICD

  17. CXR-LAT IN C/O AICD

  18. AICD AT WORK

  19. AICD PT IN CCU • CONNECT TO MONITOR • SEE THE RHYTHM • ASK FOR H/O RECENT PALPTN/ DC • NO OF EPISODES OF SHOCK RECD • LOSS OF CONSCIOUSNESS/ CONVULSIONS • IMMEDIATE ECG

  20. EXAMINATION IN CCU • HEART RATE • BLOOD PRESSURE • CONSCIOUSNESS LEVEL • KEEP EXT DEFIBRILLATOR READY • ADVICE – DEVICE INTERROGATION • PTS WITH RECURRENT VT / DC , INACTIVATE THE DEVICE TO PREVENT BATTERY DEPLETION. • STEP UP DRUG THERAPY AND CONTROL WITH EXT DEFIB

  21. CONCLUSIONS • IMPORTANT LIFE SAVING DEVICES • PROPER CARE AND F/U REQUIRED • TO ENSURE OPTIMAL UTILIZATION OF DEVICE WITH MIN BATTERY DEPLETION • PERILS KEPT IN MIND AND ACT ACCORDINGLY.

  22. THANK YOU www.anaesthesia.co.inanaesthesia.co.in@gmail.com

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