心臟植入性電子儀器(cied )護理照護指引- cathroom troubleshooting_20130907北區
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CIED implant trouble shoot in cath room
台北榮民總醫院
護理師 郭宜蘭
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Venogram
Subclavian vein
cephalic vein
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Acute Venous Stenosis Limiting Access
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Implantation Techniques - Acute
Pneumothorax
Hemothorax
Pneumo- hemothorax
Brachial plexus injury
Arterial puncture
Chylothorax
Infection
Pocket Hematoma / Seroma
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Pneumothorax
In PASE Trial: 1.97%
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Management for Pneumothorax
withdraw the needle, wait a moment or two to make certain that a rapid-onset, large, markedly symptomatic pneumothorax is not occurring, and then proceed
If a pneumothorax does develop, it may do so in this setting over a matter of hours and may not even be apparent radiographically at the end of the procedure.
If a lung puncture has occurred, obtaining another upright chest radiograph 6 hours after completion of the procedure is advisable. If a pneumothorax has developed, a chest tube or catheter evacuation procedure may be necessary, although frequently, a small to moderate pneumothorax that is not expanding can be managed conservatively without evacuation.
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Avoid air embolism (esp. for large-bored sheaths)
press proximal end of sheath and instruct patient to hold breath during pacing lead insertion
use of introducer sheath with hemostatic valve
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Myocardial Perforation
When recognized, lead MUST be pulled back
Be prepared for tamponade
May require open procedure to manage but heart usually seals itself.
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Diaphragmatic Stimulation Lead in Cardiac Vein
Lead inadvertently placed into Post.Cardiac V
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Management of Pocket Hematoma
Observation and close follow-up – Soft
– Minimal to no tenderness
Surgical evacuation – Tense pocket threatening suture
line
– Weeping suture line
– Severe pain
– Immunocompromised host
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Causes of Open Circuit Due to Implant Technique
Loose set screw
Improperly seated lead terminal pin
Conductor fracture – Rib Clavicle Crush
– Tight ligature
“Dry” pocket - air in pocket with unipolar configuration – Replacement
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Pulse Generator Pocket Chronic
Pain - pocket neuralgia
– Incorrect tissue plan – Incorrect location - too lateral – Smoldering infection
Erosion
– Pressure necrosis – Smoldering infection
Migration Twiddler’s Syndrome
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Pressure Necrosis
Thinning and discoloration at lateral margin
Total breakdown and 2° Infection
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Smoldering Pocket Infection with draining fistula
Presented 2 years post implant
Eschar and draining fistula at edge of incision, surrounding erythema
Waxed and waned on oral antibiotics
Local cultures were negative
January 24, 2002
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Improper Location of Pulse Generator
If the pacemaker is placed too lateral, it will cause discomfort every time the patient rotates arm forward
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Loose Anchoring Sleeve Twiddler’s Syndrome
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Conductor Fractures
Occurs at stress points – Rib-Clavicle Crush – Tight Anchoring sleeve
ligature – Angulation of lead – Traction on lead
If external conductor of bipolar lead, conversion to unipolar will allow for elective management
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Tight Anchoring Sleeve Damage to Lead
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Conductor Coil Fracture
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Insulation Damage
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Thanks for your listening:)
See you next time.
It’s time to wake up!!