Makindo Medical Notes

Related Subjects: Atropine |Acute Anaphylaxis |Basic Life Support |Advanced Life Support |Adrenaline/Epinephrine |Acute Hypotension |Cardiogenic shock |Distributive Shock |Hypovolaemic or Haemorrhagic Shock |Obstructive Shock |Septic Shock and Sepsis |Shock (General Assessment) |Toxic Shock Syndrome

A temporary wire is always a dirty procedure. If the patient is stable then it is better to wait and place an elective permanent pacing system. Take senior advice if unsure

Indications

• Asystolic cardiac arrest with P wave activity
• High-degree atrioventricular (AV) block in the setting of an acute myocardial infarction
• High risk for developing symptomatic bradycardia during an interventional or surgical cardiac procedure.
• Where Transcutaneous pacing with electrode pads applied to the chest wall is not successful
• Maintain a rate of 85-100 beats per minute in order to suppress torsades de pointes

Method

• Need central venous access. Choices are
  • Right Internal Jugular vein
  • Right Subclavian vein
  • Right femoral vein
• Place a central venous line sheath with a lumen large enough to take the pacing wire. Aim is to place the tip in the apex of the right ventricle. Needs some trial and error.
• The rate is set to 70/min and the voltage slowly increased. It is usual to need 3-4 Volts. Once capture then often pace at double that or at least some number greater than the threshold.
• Check the threshold regularly at least daily to ensure still working. Once placed switch on pacer and see if one can achieve capture.
• The threshold tends to rise post-procedure. It may need repositioning to ensure good contact.

Complications

• Failure and need help
• Pneumothorax
• Infection and Sepsis - use strict asepsis
• Cardiac perforation
• Pacing failure: from loss of capture, wire problems or placement

Diagrams

References

• Cardiac Pacing