Transcutaneous Pacing Procedure

Procedure Guidelines

9.30 TRANSCUTANEOUS PACING PROCEDURE

INDICATIONS:

• Asystole Practice Parameter 4.02
• Supraventricular Bradycardia and A.V. Blocks Practice Parameter 4.09
• PEA with Absolute Bradycardia Parameter 4.04

PROCEDURE:

• Apply monitor and determine rhythm.
• Stop CPR, (if applicable).
• Place electrodes in proper position.
  • Place the negative pad and negative pacer wire on left anterior chest, halfway between the xiphoid process and the left nipple, with the upper edge of the electrode below the nipple line.
  • Place the positive pad and positive pacer wire on left posterior chest beneath the scapula and lateral to the spine.
• Turn the pacer on:
  • Precautions: Pacemaker output may cause excessive pain/distress in the conscious patient. Consider administration of Diazepam 2 -10 mg slow IVP.
• Set the rate at 60 beats per minute.
• Slowly increase milliamps until electrical and mechanical capture is achieved or maximum output is reached.
• Keep checking for a carotid or femoral pulse to determine the response to the pacing, (mechanical capture).
• If no response to maximum pacing output, interrupt pacing and proceed with appropriate protocol. Continue CPR, (if applicable).
• Leave pacing electrodes in place during drug therapy and check every 5 - 10 minutes for capture in maximum output setting if not successful initially.
• If capture present and patient remains hypotensive, increase rate of pacing, (do not exceed 80 BPM).

STANDBY PACING:

• Turn the pacer on.

Precautions: Pacemaker output may cause excessive pain/distress in the conscious patient. Consider administration of MIDAZOLAM 1 -5 mg slow IVP to desired effect.

• Set rate at 60 BPM.
• Set milliamps at 0.
• If patient becomes unstable, slowly increase milliamps until electrical and mechanical capture is achieved or maximum output is reached.