transcutaneous pacing
TRANSCRIPT
By Isra Al-Lawati R2
Transcutaneous Pacing Transcutaneous Pacing
OutLine
Procedure principle Procedure principle IndicationIndicationContra-Indication Contra-Indication Material & pre –Procedure Material & pre –Procedure
requirementsrequirementsProcedure & TechqunicProcedure & TechqunicComplicationComplication
Procedure principle
Transcutaneous pacing (TCP) electrical Transcutaneous pacing (TCP) electrical stimulation from electrode pads to stimulation from electrode pads to induce cardiac depolarization.induce cardiac depolarization.
Rapid, safe, and Non invasive.Rapid, safe, and Non invasive.
Increase HR and improves cardiac Increase HR and improves cardiac outputoutput
Short periodsShort periods
IndicationsHemodynamically significant
Bradydysrhythmias unresponsive to atropine .
Witnessed Asystole
Contraindications
VFAwake, hemodynamically stable
patientsSevere hypothermiaNonintact skin at the site of
pacemaker pad placement
Material & pre –Procedure Material & pre –Procedure requirementsrequirements
ECG monitor/defibrillator/pacerECG monitor/defibrillator/pacer
ECG electrodes and pacing padECG electrodes and pacing pad
Resuscitation suppliesResuscitation supplies
Drugs for sedation & analgesia Drugs for sedation & analgesia
Explain the procedure (Benefit /risk and Complication)
Procedure & Technique Procedure & Technique
Pacer pads Skin prep cleaned/dried or shaved
Anterior –Posterior “sandwiches”Anterior pad: just to the left of the sternum or
below the left breastPosterior pad: to the left of the spine, just
below the inferior pole of the left scapula
AnterolateralRight anterior pad: right of the sternal
margin, at the second or third intercostal space
Left lateral pad: left fourth or fifth intercostal space, at the midaxillary line
Set The MachineSet The MachineMode:
Fixed (asynchronous) Demand (synchronous) avoids electrical
impulse output during the repolarization phase which could cause VT/VF
Rate Rate Set the rate 20 Bpm above Pt intrinsic rate. If no intrinsic rate, set to 100 Bpm.
Energy Energy Pacemaker initial output of 0 mA.Pacemaker initial output of 0 mA.
Increase the output until each pacer spike is Increase the output until each pacer spike is followed by a wide QRS complex (electrical followed by a wide QRS complex (electrical capture).capture).
Decrease the output mA to maintain capture Decrease the output mA to maintain capture at the lowest possible energy . at the lowest possible energy .
In cardiac arrest start at max energy and In cardiac arrest start at max energy and decrease the output after capture is achieveddecrease the output after capture is achieved
Post Pacing Assess Pt
pulse : right femoral, right brachial, or right radial artery
Observe for signs of improved Co e.g mental status, blood pressure & O2 Sat
Evaluate pads every 30 minutes to avoid skin burns and change place after few hrs
Assure adequate sedation and analgesia if hemodynamics allows
Treat arrhythmia & plan for definitive pacing if medical intervention is not successful.
ComplicationComplication
Failure to detect VF Failure to detect VF VF/VTVF/VTPainPainSkin BurnSkin Burn
Thank You
Symptomatic sinus bradycardia, sinus arrest, or brady-tachy syndrome
Mobitz II second- and third-degree heart blockSymptomatic AF with slow ventricular responseEscape rhythms not responding to drug
therapyBBB in the setting of AMI
New-onset left bundle branch blockRight bundle branch block with left axis deviationBifascicular blockAlternating bundle branch block