Summarize the importance of the interprofessional team in the management of the patient with pacemaker malfunction and the preoperative assessment of patients with pacemakers.Review the underlying mechanisms of malfunction of the pacemaker.Outline different ways in which a pacemaker typically malfunctions.Describe the basic functioning of a pacemaker.This activity outlines different ways a pacemaker can malfunction and highlights the role of the interprofessional team in managing the patient with pacemaker malfunction. These pacemakers can often malfunction and produce a set of symptoms that require timely assessment and rectification. Learn more about transcutaneous packing from these resources.Pacemakers are implanted in patients with rhythmic cardiac problems. When the patient's heart rate is improved with pacing, give the patient a few minutes to improve hemodynamically before deciding to give large amounts of fluid. Check the patient’s peripheral pulse manually and observe the patient’s condition. Remember to evaluate the complex to determine if it is a QRS-T or just a wide artifact. If the patient is unresponsive, slow the pacemaker to look for the presence of ventricular fibrillation, which can be masked by TCP artifact. Artifact can trigger the pulse and rate indicators on the monitor, showing a rate faster than the actual heart rate.Įvaluate the patient's blood pressure after two minutes of a normal pulse rate before treating hypotension with fluids, as correcting the rate may be all you need. When pacing with a TCP, do not rely on electronic vital-signs measurements and heart-rate monitoring to determine the patient’s condition. When a QRS complex with T wave are seen, evaluate the patient’s extremity pulses manually to determine that they match the pacemaker rate. Remember to warn the conscious patient as you increase current. Increase the current until a QRS and T wave are seen and peripheral pulses match the TCP rate. If the limb electrodes are located near the pacing electrodes, move them as far away as possible on the limbs. What should I do if I see artifact instead of electrical capture? If you have mechanical capture, the pulse ox waveform should show definite pulses and the patient's ETCO2 should increase because of increased perfusion. The pulse oximeter and ETCO2 monitor can help a lot, too. Mechanical capture will cause palpable peripheral pulses and usually a noticeable improvement in patient condition. How to recognize electrical and mechanical captureĮlectrical capture will result in a QRS complex with a T wave after each pacer spike. Remember to check the pulse peripherally, as the muscle contraction of the chest wall from the pacing makes it difficult to determine pulse at the carotid artery. Your patient will not have a pulse that corresponds to the pacing stimuli. If you increase the current, the size of the artifact will increase. There will be no T wave following the QRS. With pacing artifact, the wave may look like a wide QRS, or it may look bizarre. How to tell artifact from electrical capture Occasionally, we can even see some artifact after the blanking period. If this mechanism is not present, for instance if the monitor being used is not part of the pacemaker device, the pacer artifact will show up immediately after the spike. The downside is a loss of data for 40-80 ms. In most cases, this blanking period allows the device to avoid showing the pacing artifact on the ECG. The monitor will blink, or stop showing information, for approximately 40-80 ms (1-2 small blocks) after the pacing stimulus is delivered. If the pacemaker and monitor is one unit, the monitor will probably have a mechanism for avoiding this artifact. The pacing stimulus can be picked up by the ECG electrodes and cause a deflection that may look like a QRS complex.
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