PACEMAKER
INTRODUCTION
Pacemakers are the electrode devices that can be used to initiate the
heartbeat when the hearts intrinsic electrical system cannot effectively
generate a rate adequate to support cardiac output.
PACEMAKER
Pacemakers is an electronic device used to pace the heart when the
normal conduction pathway is damaged or diseased.
COMPONENTS OF PACEMAKER
Pise generator
Pacemaker electrode
How a pacemaker works ?
A pacemaker consists of battery,
computerized generator and wires with sensors
their tips(called as electrodes). The battery
powers the generator and both are surrounded
by a thin metal box. The wires connect the
generator to the heart.
A pacemaker helps monitor and control the
heartbeat. The electrodes detect heart's electrical
activity and send data through the wire
computer in the generator. If heart rhythm is
abnormal, the computer will direct the generator
to send electrical pulses to heart. The pulses
travel through the wires to reach the heart.
TYPES OF PACEMAKER
a)Permanent pacemaker
b)Temporary pacemaker
Permanent pacemaker
Implanted totally in the body.
power source is implanted subcutaneously
usually over the pectoral muscle on the
patient non dominant side.
Types of permanent pacemaker
Single-chamber pacemaker.
In this type, only one pacing lead is placed into a chamber of the heart,
either the atrium or the ventricle
Dual-chamber pacemaker.
Wires are placed in two chambers of the heart One lead paces the atrium
and one paces the ventricle Closely resembles the natural pacing of the
heart.
Rate-responsive pacemaker.
It has sensors that detect changes in the patient's physical activity and
automatically adjust the pacing rate to fulfill the body's metabolic needs.
Indication of permanent pacemaker therapy
Chronic atrial fibrillation with slow ventricular response.
Hypersensitive carotid sinus syndrome.
Fibrosis or sclerotic changes of cardiac conduction system.
Sick sinus syndrome.
Tachyarrhythmia.
Third degree AV block.
Temporary pacemaker
It is one that has the power source outside the body.
TYPES OF TEMPORARY PACEMAKER
There are 3 types of temporary pacemaker. Transvenous invasive
pacemaker (endocardial)
It consists of lead or leads that are threaded transvenously to the right
atrium and or right ventricle and attached to external power source.
Transthoracic invasive pacing (Epicardial pacing)
It is achieved by attaching an atrial and ventricle and attached to
epicardium during. heart surgery. The leads are passed through the chest
wall and attached to the external power source.
Trans cutaneous pacemaker(Non-invasive pacing)
It is used to provide adequate heart rate and rhythm to the patient in and
emergency situation.
INDICATIONS OF TEMPORARY PLACING
Maintenance of adequate heart rate and rhythm during special
circumstances such as surgery and postoperative recovery, cardiac
catheterization ог coronary angioplasty.
Before implantation of a permanent pacemaker.
As prophylaxis after open heart surgery.
Acute anterior MI with second degree or third degree AV block or bundle
branch block.
▸ Acute inferior MI with symptomatic bradycardia and AV block.
Nursing management
Preoperative care
▸ Financial
Explain the procedure, type and technique of pacemaker to the patient
Explain Cost of the procedure and Hospital stay.
Psychological Explain the Process of the pacemaker insertion
Reassure the patient.
Physical
Obtain written consent from the patient and from nearest relative
Remove dentures jewellery and contact lens.
Clean and shave the area.
Check vital signs: temperature, BP, pulse and respiration
Intraoperative care
Check serology: HIV, HbsAg, HCV and others Start an IV line with 5%
Dextrose solution or normal saline solution.
Check the battery in pulse generator Prepare the emergency cart, the
defibrillator.
and jelly, and the ECG monitor Set up all equipment for the insertion of
the pacemaker.
The nurse should know about the pacemaker generator including the
power switch, indicator light for pacing and sensing, stimulus output dial,
sensitivity dial, and their proper settings.
Assist the doctor and the scrub nurse during the procedure step by step.
Observe vital signs and observe ECG monitor carefully for arrhythmias and
other complications.
Post operative care
Receive the patient.
Keep the patient in comfort position Record the pacing parameters.
-Receiving time
-patient's heart rate
-Other routine care
Immobilize the affected part and keep in supine position but allow the
movement of finger and ankle joint.
Monitor heart rate and rhythm.
Monitor vitals signs and level of consciousness of patient.
Prevent infection.
Take ECG and X-ray chest.. Watch for complications.
Patient and family teaching
Maintain follow up care with a physician to check the pacemaker site and
begin regular pacemaker function checks Watch for signs of infection at
incision site redness, swelling dressing.
Keep Incision dry for 1 week after implantation.
Avoid lifting operative side arm above shoulder level until approved by
care provider.
Avoid direct blows to generators or to large magnets such as MRI scanner.
These device can reprogram a pacemaker. Microwave oven are safe to use
and do not
threaten pacemaker function. The patient should be taught how to take
the
pulse Carry pacemaker information card at all the times.
Complications
Hematoma
Pneumothorax
Failure to sense or capture
Perforation of atrial or ventricle septum
Ventricular atrophy and tachycardia
Movement or dislocation of lead Cardiac perforation
Infection (endocarditis)
A study done on "Pacemaker Endocarditis:
Clinical Features and Management of 60 Consecutive Cases" 89% cases
were found to be endocarditis related to pacemaker and the causative
agent was staphyloccus.
NURSING DIAGNOSIS
Acute pain related to insertion site and prescribed post procedure
immobilization.
Disturbed self concept related to perceived loss of health and dependence
on pacemaker.
Impaired physical mobility related incisional site pain, activity restrictions.
Risk for infection related to operative site.
Risk for ineffective therapeutic regimen management related to
insufficient knowledge of activity restrictions, precautions.
