NURSING MANAGEMENT OF PATIENT WITH 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 Read moreInternal Medicine Department POV 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 Read moreWhat is JCI Accreditation? 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 Read moreHospital Care of Patients Valuables 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 Read moreWhat is Observation Variation Report? 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