Transvenous Pacing (Emergency Medicine)

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Bradyarrhythmias resulting from acute reversible causes
  • Cardiac conduction abnormalities
  • Overdrive pacing of tachyarrhythmias
  • Failure of other pacing devices
CONTRAINDICATIONS
  • No absolute contraindications
  • Hypothermia
EQUIPMENT
  • Sterile mask, gown, gloves; sterile half-sheet **STERILE TECHNIQUE** **UNIVERSAL PRECAUTIONS**
  • Central line kit with a venous introducer system (see Central Venous Catheterization: Internal Jugular Approach for further details)
  • Sterile sleeve
  • Transvenous bipolar pacing catheter
  • Pacemaker generator with battery and cable
  • Transcutaneous external pacer (see Transcutaneous Pacing for further details)
  • Telemetry or ECG machine
  • Crash cart with resuscitation equipment and defibrillator
  • Transvenous bipolar pacing catheter11
  • Pacemaker generator
ANATOMY
  • The right internal jugular is the preferred approach.
  • The left subclavian approach may be used if the right internal jugular cannot be accessed.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Obtain a chest radiograph.
    • Assess for proper placement of the pacing wire and any complications.
  • Obtain a 12-lead electrocardiogram.
    • The electrocardiogram should show captured pacer spikes before every QRS.
    • The QRS should be in a left BBB pattern.
    • Right BBB morphologies suggest coronary sinus pacing or septal perforation.
  • Obtain a cardiology consultation.
  • Reassess the pacemaker.
COMPLICATIONS
  • Pacemaker malfunction
    • Absence of stimulus
    • Failure to capture
    • Oversensing (inappropriate inhibition of the pacemaker)
    • Undersensing (inappropriate pacing when there should be inhibition)
  • Cardiac perforation
  • Arrhythmias
  • Thromboembolic complications
  • Intrathoracic trauma
  • Infectious complications
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