Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  53

Transcutaneous Electrode Placement

SURGICAL AND OTHER PROCEDURES Cardiac Pacing

For a noninvasive temporary pacemaker, the two pacing electrodes are placed at heart level on the patient’s chest and back, as shown. This type of pacemaker can be quickly applied in an emergency but is uncomfortable for the patient.

Cardiac pacemakers are utilized when there is interruption of the electrical conduction necessitating restoration of heart rate. Pacemakers are effective in the treatment of a variety of bradycardic and tachycardia arrhythmias. Utilization of cardiac pacemakers can restore circulation and hemodynamics which are compromised by a slow heart rate. Temporary Pacing Temporary pacemakers are utilized in emergency situations. Temporary pacemakers contain external, battery- powered pulse generators, a lead, or electrode system which can be transcutaneous or transvenous. Temporary cardiac pacing can be performed in a variety of ways: • Internally using transvenous endocardial leads • Externally via transthoracic patches • Internally using atrial or ventricular epicardial leads placed at the time of surgery

HANDS ON

Monitoring electrode

Posterior pacing electrode

Anterior pacing electrode

Monitoring electrode

Pacer wires to pulse generator (defibrillator)

• Internally via an esophageal electrode, which is primarily used for atrial pacing and recording

for patients with symptomatic bradycardias. Transvenous pacing requires expertise in both venous and cardiac anatomy in order to effectively access the vasculature and advance the electrode into the heart.

Transvenous cardiac pacing is the preferred method to of pacing

Transvenous Pulse Generator

Pace meter registers every pacing stimulus delivered to the heart.

Rate control sets the minimum heart rate at which point the pacemaker takes over. Sensitivity control adjusts pacemaker sensitivity to the patient’s heart rate. When the dial is set on ASYNC the pacemaker delivers a set rate regardless of the patient’s intrinsic rate.

Sense meter registers every time the patient’s heart beats.

Left subclavian vein access site for pacing wire Transvenous pacing wire in right ventricle

Output control determines the number of milliamps of electricity sent to the heart.

Connector

Pulse generator

Battery compartment

Connector attaches the pacing wires to the pulse generator.