NURSING MANAGEMENT OF PATIENT WITH PERMANENT PACEMAKER POLICY

Permanent Pacemaker Policy

 

permanent pacemaker policy

Cardiac Pacemaker – is an electronic device that delivers direct electrical stimulation to stimulate the myocardium to depolarize, initiating a mechanical contraction. Pacing may be accomplished through a permanent implantable system, a temporary system with external pulse generator and percutaneously threaded leads, or a transcutaneous external system with electrode pads placed over the chest.

PERMANENT PACEMAKER POLICY

  1. A credentialed physician will oversee the pacemaker management and manipulation.
  2. Only CCU/ICU Registered Nurses who have demonstrated competency may nurse the patient with pacemaker as per physician order.
  3. All patients with permanent pacemaker will be continuously monitored for heart rate and rhythm after pacemaker insertion.
  4. Adequate cardiac output will be ensured with efficient monitoring of vital signs and urine output.
What do be done…? or what are the steps included in Permanent Pacemaker Policy Who should do it…?
Provide postoperative monitoring, analgesia and care as ordered. CCU/ICU Registered

Nurse

Provide an electronically safe environment for the patient that can interfere with pacemaker function or cause pacemaker failure and permanent pacemaker damage. and to follow the steps in the Permanent Pacemaker Policy CCU/ICU Registered

Nurse

Physician

Avoid use of electric razors, direct placement of defibrillator paddles over pacemaker generator and exposure to MRI. CCU/ICU Registered

Nurse

Physician

Alarm limits will be set 5 beats below rate limit and 5 to 10 beats above upper rate limits. CCU/ICU Registered

Nurse

Physician

Monitor pacemaker function with cardiac monitoring and 12 lead ECG. CCU/ICU Registered

Nurse

Record ECG rhythm strip, inspect for pacemaker spikes and evidence for failure to sense or failure to capture according to the Permanent Pacemaker Policy. CCU/ICU Registered

Nurse

Physician

Assess the patient’s vital signs and hemodynamic status with adequate tissue perfusion and cardiac output as evidenced by optimum level of consciousness, free from dizziness, shortness of breath, chest discomfort or lightheadedness. CCU/ICU Registered

Nurse

Assess/Report for dysrhythmias and treat as indicated. CCU/ICU Registered

Nurse

Physician

Monitor for signs and symptoms of pneumothorax. CCU/ICU Registered

Nurse

Restrict movement of affected extremity and resume range of motion of extremity gradually. CCU/ICU Registered

Nurse

Assess the pacemaker pocket in the acute post implant phase for evidence of hematoma / bleeding. CCU/ICU Registered

Nurse

Monitor for evidence of lead migration and perforation of heart by observing for muscle twitching, cough, chest pain and signs and symptoms of cardiac tamponade. CCU/ICU Registered

Nurse

Assess for signs and symptoms of infection, as redness, edema, drainage, elevated white blood cell count, continued pain and elevated body temperature. CCU/ICU Registered

Nurse

Physician

Effective pain management measures will be instituted as ordered. CCU/ICU Registered

Nurse

Physician

Pain Management

Nurse

Provide appropriate teaching on pacemaker placement, how it works, settings and signs of pacemaker malfunction to report. CCU/ICU Registered

Nurse

Physician

Patient Educator

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