pacemakers and icds

Management of Patients with Dysrhythmias and Conduction Problems:

Management of Patients with Dysrhythmias and Conduction Problems Karen Larson, MBA/TM, MSN, RN

Pacemakers:

Pacemakers An electronic device that provides electrical stimuli to the heart muscle Types: Permanent Temporary NASPE - BPEG code for pacemaker function

Temporary Pacemaker:

Temporary Pacemaker Used to pace the heart when the normal conduction pathway is diseased or damaged Power source outside the body Transcutaneous - emergency Transvenous Epicardial

Permanent Pacemaker:

Permanent Pacemaker Implanted totally within the body Power source implanted SQ Can stimulate atrium, ventricles, or both

Slide 5:

Ventricular pacemaker Atrial & Ventricular pacemaker

Complications of Pacemaker Use:

Complications of Pacemaker Use Infection Bleeding or hematoma formation Dislocation of the lead Skeletal muscle or phrenic nerve stimulation Cardiac tamponade Pacemaker malfunction

Common problems with Pacemakers::

Common problems with Pacemakers: Battery failure Usually prevented by regular checks at physicians office Failure to “capture” A pacemaker spike will be visible, but is not followed by a QRS Failure of sensing device If a demand pacemaker fails to correctly sense normal beats, it can fire at a bad moment (relative refractory period) causing V-tach or V-fib

Failure to Capture:

Failure to Capture

Failure to Sense:

Failure to Sense

Cardioversion and Defibrillation:

Cardioversion and Defibrillation Treat tachydysrhythmias by delivering an electrical current that depolarizes a critical mass of myocardial ceils. When cells repolarize, the sinus node is usually able to recapture its role as heart pacemaker. In cardioversion, the current delivery is synchronized with the patient’s ECG. In defibrillation, the current delivery is unsynchronized.

Cardioversion / Defibrillation:

Cardioversion / Defibrillation Cardioversion ‘timed’ electrical current Synchronizes with the ECG so that electrical impulse discharges during ventricular depolarization (QRS complex) causing a momentary delay in discharge of current once the unit is charged Defibrillation Treatment of choice for pulseless VT and V fib Electrical current is not ‘timed’ (no QRS complex is present) Current discharges immediately when charged

Safety Measures (cardioversion/defibrillation):

Safety Measures (cardioversion/defibrillation) Ensure good contact between skin and pads or paddles Use a conductive medium and 20 -2 5 pounds of pressure. Place paddles so that they do not touch bedding or clothing and are not near medication patches or oxygen flow. If cardioverting, turn the synchronizer on. If defibrillating, turn the synchronizer off. Do not charge the device until ready to shock. Call “clear” three times; follow checks required for clear and ensure that no one is in contact with the patient, bed, or equipment.

Paddle Placement for Defibrillation:

Paddle Placement for Defibrillation

Implantable Cardioverter-Defibrillator (ICD):

Implantable Cardioverter -Defibrillator (ICD) Inserted in patients with spontaneous VT or VT and patients at risk for life threatening dysrhythmias Lead place via subclavian vein to the myocardium A battery powered pulse generator is implanted subcutaneously Identifies VT or VF and after 25 seconds, delivers a shock the patients heart

Implantable Cardioverter Defibrillator (ICD):

Implantable Cardioverter Defibrillator (ICD) A device that detects and terminates life-threatening episodes of tachycardia or fibrillation NASPE-BPEG code Antitachycardia pacing

Nursing Process: The Care of the Patient with an Implanted Cardiac Device : Assessment:

Nursing Process: The Care of the Patient with an Implanted Cardiac Device : Assessment Device function; ECG Cardiac output and hemodynamic stability Incision site Coping Patient and family knowledge Goals include absence of infection, adherence to self-care program, effective coping, and maintenance of device function.

Interventions for Patient’s with ICDs:

Interventions for Patient’s with ICDs Risk for ineffective coping Support of patient and family coping Setting of realistic goals Allow patient to talk, share feeling and experiences Support groups or referral Stress reduction techniques Knowledge deficiency Patient and family teaching