PERMANENT PACEMAKER IMPLANTATION

PERMANENT PACEMAKER IMPLANTATION – Definition, Purpose, Equipment, Pre-PPI Care, Post-PM Care and Patient Education

DEFINITION

Pacemaker is an electronic device that provides repetitive electrical stimuli to heart muscles. Permanent pacemaker implantation (PPI) is a procedure in which pacemaker is implanted surgically in the deltopectoral pouch when conduction defect is irreversible

PURPOSE

  • To transmit impulses from sinus node to ventricles
  • To generate impulses spontaneously
  • To maintain primary control of pacing function of heart

EQUIPMENT

  • Electronic cardiac monitor
  • Pacemaker
  • Catheter
  • PPI tray with articles such as forceps, scissors, retractors
  • Local anesthesia, scalpel blade, cleaning solution
  • Dynaplast and emergency resuscitation equipment

PRE-PPI CARE

  • Explain procedure to patient and relative with help of audiovisual aids and handouts
  • Get consent for procedure
  • Explain that procedure will be performed in cardiac catheterization laboratory and patient will be transferred to CCU for 1 day for close monitoring
  • Explain about starvation required for 8 to 10 hours prior to procedure
  • Enquire whether patient has allergy to drug or food and report to doctor if any
  • Shave following areas:

Anterior chest from neck to umbilicus

Nape of neck to loins of back

Both arms and axillae

  • Advise to take bath with antiseptic scrub and water for 2 days before procedure and on day of procedure
  • Provide clean gown
  • Remove jewelry, dentures/contact lens if any
  • Start IV line with heparin lock
  • Administer pre-medications and first dose of antibiotics
  • Explain that one relative can stay in CCU waiting area
  • Send patient to cath lab with following items:

Normal saline 1 pint, disposable needle 21 G, Dynaplast 1 roll, Betadine solution 100 ml multiply 2 bottles, injection gentamicin and injection cefazolin 1 dose, if not administered with premeditation

POST-PM CARE

  • Keep patient in supine position and ask to maintain adduction of affected extremity
  • Explain about bed rest for 24 hours and reduced activity for another 48 hours
  • Connect patient to  cardiac monitor and check rhythm
  • Take 12 leak ECG with and without magnet
  • Check wound for excess swelling or bleeding
  • Get chest X-rays done
  • Be alert for complications of procedure

Bleeding

Infections

Cardiac tamponade

Diaphragm stimulation

Failure to capture

  • Inform the doctor if any complication occurs
  • Check vital signs and observe wound hourly 4 hours then if stable, 4 hourly for 24 hours
  • Discourage patient from vomiting, coughing or rolling into affected side
  • Patient may gently roll into left side for pressures care
  • Roll a patient immediately onto left side, if failure to capture occurs. If unsuccessful and patient is asymptomatic inform and administer IV atropine 0.6 mg as ordered
  • Allow the patient to sit up slightly to eat (30 to 45 degrees)
  • Administer analgesic as ordered
  • Administer IV antibiotics usually 3 doses then remove IV cannula
  • Transfer to ward after 12 to 24 hours
  • Remove tight bandage after 48 hours and change dressing if required
  • Allow to walk after 48 to 72 hours of rest
  • Assist and encourage beginning range of motion exercises for affected shoulder as ordered, usually 5 to 7 hours after pacemaker insertion
  • Remove sutures after 72 hours and patient is discharged with proper follow-up arranged
  • Patient usually does not require any follow-up drugs

PATIENT EDUCATION

  • Report to physician as recommended, so that rate of pacemaker and its function can be monitored. This is especially important during first month after implantation
  • Check pulse daily. Report immediately of any sudden slowing increasing of pulse rate occurs. This may indicate pacemaker malfunction
  • Resume weekly monitoring when battery depletion is anticipated
  • Wear loose fitting clothing around area of pacemaker
  • Inform reason for slight bulge over implantation site

Notify physician if area becomes red or painful

Avoid trauma to area of pacemaker

  • Study operating instructions and become familiar with pacemaker
  • Resume normal physical activity after 6 weeks, including sexual activity
  • Avoid moving affected hand and shoulder vigorously for 6 weeks
  • Avoid heavy sport
  • Avoid carrying >5-10 pounds weight on affected side
  • Carry an identification card indicating, manufacturer’s name, pacemaker model and hospital where pacemaker was inserted
  • Avoid close exposure to microwave ovens, MRI and other sources of magnetic fields
  • Show identification card and request scanning by hand scanner when passing through security gates, e.g. at airports, government buildings
  • Avoid using cell phone on same side where implantation has been done
PERMANENT PACEMAKER IMPLANTATION – Definition, Purpose, Equipment, Pre-PPI Care, Post-PM Care and Patient Education
PERMANENT PACEMAKER IMPLANTATION – Definition, Purpose, Equipment, Pre-PPI Care, Post-PM Care and Patient Education

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