Transcutaneous Pacing

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