Liverpool Hospital
Intensive Care: Learning Packages Intensive Care Unit
Pacemaker Learning Package
LH_ICU2016_Learning_Package_Pacemaker_Learning_Package
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P a g e
TYPES OF PACING
TRANSCUTANEOUS PACING
Is only used in emergency situations due to the discomfort felt by the
patient.
The electrodes are incorporated into the pads and cover
a large
surface area over the skin. The pads are connected to an external
pulse generator which delivers energy through the pads to the chest
wall muscles.
Figure 4:
Pacing pad placement for trancutaneous pacing. Lippincott’s
Nursing centre.com 2011
By continuously monitoring cardiac rate and rhythm and delivering
pacing impulses through the skin and chest wall muscles as needed,
trancutaneous pacing causes electrical depolarization and
subsequent cardiac contraction to maintain cardiac output until
the patient receives a transvenous pacemaker
The pacing stimulus travels through
chest wall, pectoralis and
intercostals muscle, ribs pericardial fluid and fat before finally
reaching the heart. Therefore a
much higher energy level is
needed to deliver the correct energy to the heart. One side effect
of this is chest muscle contraction
from the electrical
stimulus. Therefore giving the patient some sedation for comfort is
high priority
Pacing or defibrillation pads must be in good contact with chest
wall
Once capture has been verified on monitor by a spike before every
QRS, patient’s haemodynamics must also be assessed ensuring
electrical and mechanical capture.