1.pptx power point presentation on pacemaker

Pacemaker and cardiac

1. Presentation on pacemaker Therapy

2. INTRODUCTION A pacemaker is an electronic device that provides repetitive electrical stimuli to heart muscles when the patient’s intrinsic pacemaker fails to provide a perfusion rhythm. Artificial pacemaker replace natural electrical stimulation of heart(SA node).

3. CONDUCTION SYSTEM OF HEART

4. Parts of pacemaker Pulse Generator It is the power source which provides electrical impulses. Lithium battery with life span of 6 -8 years Or nuclear battery with life span of 20 years can be used

5. 2. Leads – Wires that conduct electrical impulses from pulse generator to heart. There are two type of leads i.e. Unipolar and Bipolar. Unipolar leads are for single chamber pacemaker and bipolar leads are for dual chamber pacemaker.
Pacemaker leads can be endocardial ( placed inside the heart) or epicardial (placed outside heart during open heart surgery)

6. 3 .Electrodes Placed in the end of the leads to sense the heart electrical activity.

7. Normal Pacemaker ECG

8. CLASSIFICATION of pacemaker 1. Temporary pace maker (external pacemaker) 2.Permanent pacemaker(internal pacemaker)

9. Temporary pacemaker

10. CLASSIFICATION OF TEMPORARY PACEMAKERS : Transcutaneous pacing or non invasive pacing. Endocardial or trans venous invasive pacing. Epicardial or Transthoracic invasive pacing.

11. INDICATION FOR TEMPORARORY PACING 1.Before permanent pacing. 2. Post MI. 3. Major Cardiac Surgery. 4. Suppuration of ectopic activity. 5. During diagnostic test like cardiac catheterization, PCTA, Electrophysiological studies.

12. Indications for Permanent PACiNG Sinus node dysfunction Atrioventricular block Tachydysrhythmias Chronic Bifasicular block Left ventricular Heart Failure (CRT) Hypertrophic cardiomyopathy Congenital Heart disease Carotid sinus syndrome

13. TYPES OF PERMANENT PACE MAKER: Single chamber Dual chamber Biventricular Another Classification Leadless Pacemaker Rate Responsive pacemaker

14. Classification according to pacemaker modes The classification originally is three letter code The first letter-chamber to be paced The second letter –chamber to be sensed The third letter-type of response to occur is, “ sensed myocardial electrical activity “which will cause pacemaker’s impulse to be triggered T or “inhibited(I) or both/Dual(D)

15. For example VVI pacemaker,:
V- ventrical paced
V- ventrical sensed
I-the pacemaker will inhibit pacing when patients own impulse is sensed.
Two more categories were added that is programmability and rate modulation ® ,and antitachydysrthymic functions.

16. Symbols A-Atrium V-ventricle O-none D-dual (both chambers) T-triggered I-inhibited

17. PACEMAKER TYPE NBG CODE ATRIUM VENTRICLE Atrial asynchronous AOO Pace ….. Ventricular asynchronous VOO Pace …… Atrial synchronous VAT Sense Pace Atrial synchronous Ventricular inhibited VDD Sense Pace and sense Av sequential DVI/DVIR Sense Pace and sense Atrial demand AAI/AAT/ AAIR Pace and sense …… Ventricular demand VVI/VVT/ VVIR ……. Pace and sense

18. Procedure of pacemaker implantation Pre procedure care Explain the Procedure to patient and family. Get Informed Consent for Procedure Notify sensitivity to any medication, iodine, latex , or anesthestic Eat or drink nothing overnight ( 8-12hrs) Remove Jewelry, Dentures and contact lens Shave Area depending on the site selected

19. Provide clean gown Start good IV access with heparin lock Record ECG before procedure Administer premedication and send patient to cardiac catheterization lab with record Reassure the patient during procedure

20. PACEMAKER IMPLANTATION Permanent pacemaker implantation is a surgical procedure done in Cathlab OT. The generator is placed under the skin in the infra clavicular area in the left side. Patient will be connected to ECG monitor that records cardiac activity during procedure Vital signs are monitored Venogram done to check the anatomy of veins Procedure lasts about 1 to 2 hours.

21. Patient is placed on back during the procedure. Sedative medication will be given to relax the patient . But patient will remain awake during the procedure. Pacemaker insertion site is cleaned with antiseptic solution A local anesthetic will be injected into the skin near the insertion site. A small incision ( 6-7cm) will be made at the insertion site A sheath will be inserted into the blood vessel under the collar bone Lead will be inserted into the heart through the sheath Once the lead wire is inside the heart, it will be tested to verify proper location and it works . Fluoroscopy will be used to test the location of leads .

22. Pacemaker generator is placed under the skin in a pocket after the lead wire is attached to the generator Skin incision will be closed with sutures. A sterile bandage or dressing is applied to the insertion site

23. Check vital sign frequently.
Obtain chest x-ray to check lead wire position Clean and dress incision site Keep the pulse generator clean and dry and prevent mishandling. Keep patient in supine position and ask to maintain adduction of affected extremity for 12 hours. Stabilise arm, catheter and pacemaker to an arm board and avoid movement of arm above shoulder level to prevent dislodgement, when brachial artery is used for catheterization.

24. If the leg is the insertion site limit movement especially flex on and outward rotation Explain bed rest for 24 hours and reduced activity for another 48 hours is required Connect patient to cardiac monitor and monitor rhythm. While checking BP , the arm without pacemaker to be used

25. ACTIVITY GUIDELINES FIRST 24 HOURS Avoiding moving shoulder on the side of insertion . You can bend the elbow of affected side gently You can bend your elbow on the side of the insertion FIRST 48 HOURS Do not lift your affected arm over your head You can sit in the bed and walk with help

26. FIRST TWO WEEKS Do not lift your affected arm over your head No vigorous activities No BP checking in the affected arm Can move the arm below shoulder FIRST 4 WEEKS Do not lift anything heavier than 5 kg Do not raise your elbow higher than your shoulder of the affected side for first four weeks

27. FIRST 8 WEEKS Avoid any kind of sudden pushing or pulling

28. DON’TS Do not carry kids at side of pacemaker implant Don’t overdo the exercises and physical activities Do not play full contact sports. Such as football, basketball, volleyball etc. that could damage the pacemaker Avoid sudden, jerky or violent actions.

29. Care of INCISION site Sterile dressing done on alternate days Sutures removed usually on 10 th or 12 th day

30. Complications Pacemaker site infection Bleeding and hematoma at lead entry sites Failure to sense. Failure to capture Hemothorax and pneumothorax from puncture of subclavian vein Atelectasis Pericardial fluid accumulation Pacemaker Syndrome

31. Maintenance Of Self Vital Chart monitor pulse and temperature two times a day and record it on the chart. Always monitor the vital signs at possibly same time of the day daily. If any deviation from the normal is there, notify the nurse/Doctor
Normal Pulse rate is between 60-100bpm and normal body temperature 37 degree Celsius or 98.6 degree Fahrenheit.

32. Importance of Pacemaker card:- Always carry pacemaker card with you. The card has information about pacemaker model also tells others what to do in case of an emergency. Show pacemaker card in the hospital/OPD, when needed. Show pacemaker card to security and ask for manual checkup

33. Pacemaker and electronic gadgets Gadgets that cause little or no risk Refrigerator, washing machine , computer, Radio, fax machines Microwave , Hair dryer , Blender , Toaster, CD player , type writer Electric blanket, Electric shaver, Stove

34. Devices or Gadgets that are not safe Metal detectors for security , Welding equipment,Electric chain saws Products that use magnets, such as some mattresses, pillows, and massagers Microwaves>10 years old, Loud Speakers, Restricted areas of radio/TV stations Powerful magnets Radio transmitters, High-voltage power lines,Nerve stimulators (i.e. TENS units) Large motors, generators,Stereo speakers Construction sites

35. Gadgets that has to be kept 12 inches away from site Induction top, Hand used security wands, Electric lawn movers, MP3 player head phones, big magnets , metal detectors for security, radio transmitters, high voltage power lines , loud speakers, MRI machines. Cell phones not to put in the pocket on the same side of pace maker . Use the ear which is not on the side of pacemaker

36. When to seek immediate medical help:- Call health care provider if incision looks infected (redness, increased drainage, swelling, pain). Having the same symptoms you had before the pacemaker was implanted. Chest pain,Hiccups that do not go away., Following symptoms appear: Unconscious for a moment, Difficulty breathing. Gaining weight and legs and ankles swell. Pulse rate suddenly drops below the accepted rate or increases dramatically Fainting or have dizzy spells. Consult cardiologist immediately if sign and symptoms of pacemaker site infection

37. Exercise protocol for affected extremity Immobilse the affected extremity for 24 hours It is important to move shoulder joint each day to prevent shoulder from becoming stiff

38. Pacemaker malfunction Failure to pace properly Failure to capture Failure to sense Oversensing

39. When to seek immediate help Symptoms are not resolving after pacemaker implantation Chest pain Incision looks infected Hiccups that do not go away Fainting Difficulty Breathing Unconsious for a moment

40. SPECIAL CONSIDERATION If external defibrillation is required ,it is essential that defibrillation paddles not to be placed directly over an implanted device , anterior posterior paddles positions may be used.

41. Thank you