Transcutaneous Pacing

1. - 2
By Isra Al Lawati R

TranscutaneousPacing

TranscutaneousPacing

2. OutLine

Procedureprinciple

Procedureprinciple
IndicationIndication
 -
ContraIndication
-
ContraIndication
 –
Material&pre Procedurerequirements
–
Material&pre Procedurerequirements

Procedure&Techqunic

Procedure&Techqunic
ComplicationComplication

3. Procedure principle
 ( )
Transcutaneouspacing TCP electrical
( )
Transcutaneouspacing TCP electrical

stimulationfromelectrodepadstoinducecardiac

stimulationfromelectrodepadstoinducecardiac
.
depolarization
.
depolarization
 , , .
Rapid safe andNoninvasive
, , .
Rapid safe andNoninvasive

Increase HRandimproves cardiacoutput

Increase HRandimproves cardiacoutput

Shortperiods

Shortperiods

4. Indications

Hemodynamicallysignificant

Bradydysrhythmias

Bradydysrhythmias
.
unresponsivetoatropine

WitnessedAsystole

5. Contraindications
VF
 ,
Awake hemodynamicallystablepatients

Severehypothermia

Nonintactskinatthesiteofpacemakerpad
placement

6. –
Material&pre Procedurerequirements
–
Material&pre Procedurerequirements
 / /
ECGmonitordefibrillatorpacer
/ /
ECGmonitordefibrillatorpacer

ECGelectrodesandpacingpad

ECGelectrodesandpacingpad

Resuscitationsupplies

Resuscitationsupplies

Drugsforsedation &analgesia

Drugsforsedation &analgesia
Explain the procedure (Benefit /risk and
Complication)

7. Procedure&Technique

Procedure&Technique

Pacerpads
Skin prep cleaned/dried or shaved
Anterior –Posterior “sandwiches”

Anteriorpad
: just to the left of the sternum or below the left
breast

Posteriorpad
: to the left of the spine, just below the inferior
pole of the left scapula

8. Anterolateral

Rightanteriorpad
: right of the sternal margin, at the
second or third intercostal space

Leftlateralpad
: left fourth or fifth intercostal space, at
the midaxillary line

9. 
SetTheMachine

SetTheMachine
 :
Mode

Fixed
(asynchronous)

Demand
(synchronous) avoids electrical impulse output
during the repolarization phase which could cause VT/VF

Rate

Rate
Set the rate 20 Bpm above Pt intrinsic rate.
If no intrinsic rate, set to 100 Bpm.

10. 
Energy

Energy
 0 .
Pacemaker initialoutputof mA
0 .
Pacemaker initialoutputof mA

Increasetheoutputuntileachpacerspikeisfollowedbya

Increasetheoutputuntileachpacerspikeisfollowedbya
( ).
wideQRScomplex electricalcapture
( ).
wideQRScomplex electricalcapture

DecreasetheoutputmAtomaintaincaptureatthelowest

DecreasetheoutputmAtomaintaincaptureatthelowest
.
possibleenergy
.
possibleenergy

Incardiacarrest startatmaxenergyanddecreasethe

Incardiacarrest startatmaxenergyanddecreasethe

outputaftercaptureisachieved

outputaftercaptureisachieved

11. Post Pacing
Assess Pt
 pulse : right femoral, right brachial, or right radial artery
Observe for signs of improved Co e.g mental status,
blood pressure & O2 Sat
Evaluate pads every 30 minutes to avoid skin burns
and change place after few hrs

12. Assure adequate sedation and analgesia if
hemodynamics allows
Treat arrhythmia & plan for definitive pacing if
medical intervention is not successful.

13. ComplicationComplication

FailuretodetectVF

FailuretodetectVF
/
VFVT
/
VFVT
PainPain

SkinBurn

SkinBurn

14. Thank You

15. Symptomatic sinus bradycardia, sinus arrest, or brady-
tachy syndrome
Mobitz II second- and third-degree heart block
Symptomatic AF with slow ventricular response
Escape rhythms not responding to drug therapy
BBB in the setting of AMI
New-onset left bundle branch block
Right bundle branch block with left axis deviation
Bifascicular block
Alternating bundle branch block