Temporary Transvenous Cardiac Pacing
30/11/10
PY Mindmaps
USES – bradyarrhythmia
DESCRIPTION
3 types of pacing equipment:
(1) semi-rigid, bipolar pacing lead (under II guidance)
(2) paceport PA catheter
(3) balloon flotation leads (ECG or pressure guided)
METHOD OF INSERTION AND/OR USE
- supine and head down
- U/S guided or landmarks (apex of sternomastoid sternal and clavicular heads)
- insert sheath
(1) Flotation Catheter
- can be inserted by ECG guidance as follows:
- connect pacing wire to pacing box (black to negative, red to positive)
- set to demand
- check box and batteries are OK
- turn rate to 30bpm greater than intrinsic rate
- set voltage to 4mA
- insert wife to 15-20cm
- inflate balloon
- advance observing ECG for changes in ECG morphology and capture of pacing rate (if using II direct wire to RV apex)
- approximate depth 35-40cm
- once pacing captured deflate balloon and decrease mA to find threshold and double.
- get patient to cough to check that wire doesn’t dislodge.
- tape wire securely so it doesn’t move
(2) Semi-rigid wire
- insert under II guidance until leads up against right ventricular wall
- connect to control box
- set output and sense to minimum and to an appropriate rate
- gradually increase output until capture takes place (ideal capture @ 2mA)
(3) Paceport on PA
- insert PAC
- attach pressure transducer to RV port to insure in RV
- attach adaptor to TV port and insert probe to the reference mark
- attach ECG monitoring and advance until ST elevation indicates contact with epicardium
- secure and connect side port to a saline flush
- commence pacing
OTHER INFORMATION
- dress to ensure wires are not exposed
- suture
- perform CXR
COMPLICATIONS
- arrhythmia
- microshock
- CVL insertion complications
- myocardial perforation
- infection
Jeremy Fernando (2010)