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Single Chamber Temporary Pacing Operations & Troubleshooting

Single Chamber Temporary Pacing Operations & Troubleshooting. Temporary Pacing Indications. Sick Sinus Syndrome (Patient Must Be Symptomatic and Documented with ECG). Symptomatic sinus bradycardia Symptomatic sinus arrest Suppression of ventricular ectopy resulting from bradycardia

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Single Chamber Temporary Pacing Operations & Troubleshooting

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  1. Single Chamber Temporary PacingOperations & Troubleshooting

  2. Temporary Pacing Indications Sick Sinus Syndrome (Patient Must Be Symptomatic and Documented with ECG) • Symptomatic sinus bradycardia • Symptomatic sinus arrest • Suppression of ventricular ectopy resulting from bradycardia • Atrial fibrillation • Bradycardia/Tachycardia syndrome

  3. Temporary Pacing Indications Heart Blocks • Type I and Type II second degree AV block • Acute bifascicular or trifascicular block • Complete AV block • Cardiac arrest with ventricular asystole

  4. Other Temporary Pacing Indications Drug-Refractory Dysrhythmia • Overdrive ventricular pacing to suppress or prevent VEA (Ventricular Ectopic Activity) • Overdrive atrial pacing to “break” SVT, atrial flutter

  5. Other Temporary Pacing Indications Cardiovascular Surgery • Coverage for anesthesia and surgery in patients with positive cardiac history • Treatment for CHB development during surgery • Augment cardiac output post operatively

  6. Other Temporary Pacing Indications Diagnostic Uses • SSS pacing studies to determine SA node recovery • Stress testing for Coronary Artery Disease • Electrophysiologic (EP) studies

  7. Insertion Sites Internal Jugular Vein External Jugular Vein Subclavian Vein Brachial Vein Femoral Vein

  8. Lead Types

  9. Lead Types • Endocardial/Transvenous lead • Transvenous lead is introduced into a vein and advanced into the heart • Epicardial/Myocardial lead • An epicardial lead attached to the outside of the heart is introduced through the chest wall

  10. Lead Types • Bipolar lead system • The negative and positive electrodesare in contact with the heart

  11. Lead Types • Unipolar lead system • The negative electrode is in contact with the heart and the positive (or ground) electrode is located elsewhere on the body

  12. Cable Connectors • Connector pins on the lead(s) must be fully inserted in the patient connector block • Observe polarity • Distal = negative • Proximal = positive • Finger tighten only – no tools!

  13. Temporary Pacing Parameters • Pacing rate (heart rate) • Output/stimulation threshold • Sensitivity

  14. Pacing Rate Paced Interval Paced Interval

  15. Output Output Pulse • The output dial regulates the current or movement of electrons Output/Current(ma) Pulse Width(ms)

  16. Capture Depolarization of cardiac musclefollowing an electrical stimulus

  17. Stimulation Threshold The minimum output pulse neededto consistently capture the heart 3 mA 2 mA 1 mA

  18. Lead Maturation x3 x2 Threshold Amplitude Initial 1 2 3 4 5 10 15 Days Since Leads Applied

  19. Sensitivity The degree that the pacing system “sees” or senses signals, controlled by the sensitivity setting which is graduated in millivolts (mV) Sensitivity (mV) 5 (mV) 2.5 (mV) 1.25 (mV)

  20. Sensitivity The lower the setting, the more sensitive the pacemaker is to intracardial signals

  21. NBG Codes 1st Letter 2nd Letter 3rd Letter Chamber(s) Paced A = atrium V = ventricle D = dual (both atrium and ventricle) Chamber(s) Sensed A = atrium V = ventricle D = dual O = none Response to Sensing I = inhibit (Demand mode) T = triggered D = dual O = none (Asynch) Chamber paced Chamber sensed Action or response to a sensed event V V I

  22. VVI Demand/Inhibited • Pacemaker senses intrinsic depolarization • Paces the heart when the patient’s own rate becomes slower than the pacemaker

  23. Ventricular Inhibited Mode (VVI)

  24. VOO Asynchronous (Fixed) Pacemaker will emit an output at a fixed rateregardless of intrinsic activity

  25. Ventricular Asynchronous Mode (VOO)

  26. Single Chamber Troubleshooting Process 1. Gather information 2. Identify the problem and possible cause 3. Identify the solution and carry outcorrective procedures

  27. Information Gathered • Patient data • Pacemaker information • Lead information • Non-invasive tools

  28. Undersensing Failure of the pacemaker to senseintrinsic R-waves or intrinsic P-waves

  29. Undersensing

  30. Oversensing Inhibition of the pacemaker by events thepacemaker should ignore, e.g. EMI, T-waves,and myopotential

  31. Oversensing

  32. Loss of Capture

  33. Loss of Output

  34. Fusion/Pseudofusion Beats Intrinsic Beat Paced Beat Intrinsic Beat Paced Beat Fusion Beat Pseudofusion Beat Fusion Beat Pseudofusion Beat

  35. Electromagnetic Interference (EMI) Radiated or conducted energy – either electrical or magnetic – which can interfere with the function of the pacemaker in the Demand mode (EMI) Should havepaced 2.5 mV 80 80

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