Pacemaker
Pacemaker
A pacemaker is a small device used to treat
some arrhythmias.
A small battery-operated device that helps the heart beat
in a regular rhythm. There are two parts: a generator and
wires (leads).
Pacemakers send electrical pulses to help the heart beat at
a normal rate and rhythm.
Pacemakers can also be used to help the heart chambers
beat in sync so the heart can pump blood more efficiently
to the body.
The generator is a small battery-powered unit.
It produces the electrical impulses that stimulate the heart to
beat.
The generator may be implanted under the skin through a small
incision.
The generator is connected to the heart through tiny wires that
are implanted at the same time.
The impulses flow through these leads to the heart and are
timed to flow at regular intervals just as impulses from the
heart's natural pacemaker would.
Some pacemakers are external and temporary, not surgically
implanted
Types
Temporary (short-term) is normally inserted through
a vein in the neck and remains outside the body.
Permanent (long-term) pacemaker is placed in the
chest or abdomen
Pacemakers use low-energy electrical pulses to
control the rate and rhythm of the heartbeat.
single chamber pacemakers have one lead
dual chamber pacemakers have two leads
biventricular have three leads.
Temporary pacing is necessary for short-term
management of dysrhythmias until the patient’s
rhythm is stabilized or a permanent pacemaker can
be inserted.
Normally, all types of temporary pacing are by
demand, in which the pacemaker delivers electrical
current only when the heart’s rate falls below the
preset rate.
They are typically used for less than three days.
Types of temporary pacing include:
Transcutaneous
Transvenous
Epicardial
Transesophageal
Transcutaneous external pacing is primarily for
unstable rhythms in emergency situations, requiring
two electrodes on the chest, either in the
anterior/lateral position or the anterior/posterior
position.
Transvenous pacemaker, the pacer wire is inserted
through a large vein into the right ventricle, with the
leads attached to an external pulse generator box.
Epicardial pacing is most commonly used with cardiac
surgery patients undergoing an open thoracotomy.
Temporary lead wires are sutured loosely to the
outermost layer of the heart, exposed through the
skin, and connected to an external pulse generator
similar to transvenous pacing.
Transesophageal pacing involves placing an electrode
in the esophagus through the nose or by a pill-
electrode that is swallowed. The electrode connects
to an external pulse generator by a wire.
This type of pacing is commonly used only for atrial
pacing in sinus bradycardia, supraventricular
tachycardia, or for diagnostic studies.
Pacemakers generally treat two types of arrhythmias:
1. tachycardia
2. Bradycardia
It replaces the heart's defective natural pacemaker
functions.
How does a Pacemaker work?
The heart’s sinus node is the natural pacemaker
(found in the upper right chamber of the heart. It
sends an electrical impulse to make your heart beat.
The job of a pacemaker is to artificially take over the
role of the sinus node if it's not working properly.
Electrical impulses are sent by the pacemaker device
to make the heart contract and produce a heartbeat.
Most pacemakers work just when they’re needed –
on demand.
Some pacemakers send out impulses all of the time
and they are at fixed rate.
Pacemakers don't give your heart an electrical shock.
Nursing Care
Assess the patient’s tolerance of the heart rhythm
Continuous ECG monitoring, and assessing the
patient’s mental status, blood pressure, pulse, heart
sound, lung sound, skin color, warmth, and urinary
output.
Check the system for proper functioning
Secure all connections, secure generator box to the
patient, check the pacing threshold every 12 hours,
replace the battery generator or connecting cable for
failure to pace, and adjust sensitivity for under sensing
or over sensing (and notify the physician).
Monitor for complications at insertion site
Assess the site daily for infection, change dressing
every 48 hours using central line dressing sterile
technique.
Assess patient safety and comfort
Explain the purpose of the pacemaker to decrease
anxiety, position patient comfortably to avoid tension
on the external wires and generator, provide pain
medication or sedation as needed
Patients’ Education on Discharge
Placement of the pacemaker generator and leads, how it
works, and the rate at which it is set.
Monitor site for bleeding and infection for the first week.
Bruising may be present.
Avoid immersing the site in water for 3 days.
Minimize arm and shoulder activity of affected arm and
wear loose covering over incision for 1-2 weeks, to prevent
dislodgement of new leads.
Avoid contact sports and heavy lifting for 2 months after
surgery.
Contact physician with fatigue, palpitations, or recurrence
of symptoms (may indicate pacemaker malfunction or
battery depletion).
Take radial pulse daily before arising and notify
physician for rates outside those programmed (may
indicate pacemaker malfunction or battery
depletion).
Wear a MedicAlert bracelet (pacemaker will trigger
some airport security alarms).
Household appliances such as, radios, telephone and
gardening tools will not affect the pacemaker.
Avoid high voltage electrical post or appliances
Signs of Pacemaker Malfunction
Dizziness
Fainting
Fatigue
Weakness
Chest pain
Palpitations