Maintaining Temporary Pacemaker Function

Equipment
Battery
Oscilloscope
Procedure
1. Observe for failure to sense.
a. Observe the oscilloscope for
presence of pacemaker artifact
(spikes). Artifact before QRS
complex in ventricular paced or
preceding the P waves and QRS
waves in AV sequential pacing.
b. Check connections for secure,
tight fit.
c. Observe that pace-sense
needle deflects to right,
indicating pacing is occurring.
d. Check sensitivity dial to
determine if sensitivity
threshold is set correctly.
2. Observe for failure to pace.
a. Check that external generator
is ON.
b. Check battery to ensure it is
functioning.
c. Check lead connector sites.
d. Check pace-sense indicator.
(Absence of or slight deflection
of the pace-sense indicator
reveals battery failure.)
3. Observe for failure to capture.
a. Observe for pacing artifact not
followed by QRS complex.
Rationale: This indicates
a failure of the stimulus
to trigger a ventricular
response.
b. Check the setting of the mA, or
output dial, to determine if
setting should be increased.
Rationale: The
myocardial threshold
may be altered as a
result of disease or
drugs.
c. Check all connector sites for
secure, tight fit.
4. Observe that sutures are intact.

5. Assess insertion site for bleeding,

hematoma formation, or infection.
6. Obtain chest x-ray post insertion.
CLINICAL ALERT
Observe for pacemaker failure:
Decreased urine output
ECG pattern change
Decreased blood pressure
Bradycardia
Shortness of breath
7. Monitor clients response to therapy.
a. Assess urine output.
Rationale: Decreased
urine output indicates
poor cardiac output.
b. Observe for dyspnea, crackles,
heart rate, decreased blood
pressure.
c. Monitor temperature.
d. Observe client for signs of
anxiety. Complete pacemaker
teaching as necessary.
8. Obtain and analyze a strip for
functioning of pacemaker.
9. Observe for battery failure.
10. Observe for electrical interference and
development of microshocks.
a. Ground all electrical equipment
in close proximity to client.
b. Cover exposed wires with
nonconductive material.
c. Wear gloves when handling
generator/lead wires.
11. Complete pacemaker teaching as
necessary.

Providing Permanent Pacemaker Client Teaching

Equipment
Audiovisual aids
Written material
Procedure
1. Ascertain what client already knows and
understands.
2. Determine clients ability and level of
interest in learning about pacemaker.
3. Recognize clients fears, and provide
opportunity to talk about them.
4. Review facts: heart anatomy and
physiology and pacemaker information.
Use illustrations and audiovisual aids.
5. Clarify misconceptions and allay fears.
6. Provide rationale for any mobility
restrictions.
7. Answer questions, and provide
additional opportunities to discuss
procedure.
8. Check pacemaker function regularly per
instructions.
9. Instruct client in clinical manifestations
related to pacemaker failure and when
to contact physician or pacemaker clinic.
PACEMAKER CLINICS
Many clients use telephone transmission of the
generators pulse rate to determine status of
pacemaker function. Special equipment is used
to transmit information concerning function of
the pacemaker over the telephone to a receiving
system in a pacemaker clinic. The equipment
converts information to electronic signals that
are permanently recorded on ECG strip.
Physicians monitor clients record and can
intervene quickly when abnormalities appear on
ECG strip. This type of clinic is very common in
outlying areas where clients are unable to go to
a clinic easily.

10. Provide client with pacemaker

information ID card (provided by
manufacturer) and instruct to carry in
wallet.
11. Suggest a Medical Alert band be worn
at all times.
Note: Inform client of electromagnetic
interference restrictions:
a. No MRI; do not place cell phone or
cardiovert over generator.
b. Avoid airport hand wand, highvoltage areas, and diathermy.
c. If dizziness experienced, move
away from area.