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Careofthechildwithpacemaker.pptx

Apr 14, 2018

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    Jane Salvaggio ARNP

    CV Surgery

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    Post-op Goal: Maximize Cardiac Output (CO)

    = HR

    xPRELOADAFTERLOADCONTRACTILITY

    BRADYARRHYTHMIATOO SLOW

    Sinus node dysfunctionA-V block

    TACHYARRHYTHMIASTOO FAST

    Atrial tachycardiasJunctional tachycardiasVentricular tachycardias

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    Rare ! Multiple atrial suture lines?

    Resecting in the sub-aortic region?

    Acute myocarditis ? Corrected TGA (L-TGA) ?

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    Why were pacingwires placed?

    All wires identified?

    What are the

    settings? Are all connections

    tight and secure?

    Is it working as itshould?

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    LABELA =Atrial on the R sideV= Ventricular on the L sideG =Ground through the skin

    Ground is always positive

    Pacing wire in the negative terminal

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    Chambered Paced ?

    Chambered Sensed?

    Response to Sensing?

    A

    A

    I

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    Chambered Paced?

    Chambered Sensed?

    Response to Sensing?

    V

    V

    I

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    Chamber Paced ? D

    Chamber Sensed ? D

    Response to Sensing? D

    AV Interval A V milliseconds

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    mA (milliamperes) ?

    TEMPORARY WIRES !Changes with time !

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    Can your baby go to MRI ?

    Can you disconnect the generator, then go toMRI?

    What if you see this approaching yourbedside?

    DisconnectOr15cm away from leads and pacemaker

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    Check all connections

    Check/change batteryIncrease mALead rearrangementChange pacemaker

    Failure to Capture

    AV sequential pacing

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    Failure to sense

    Check connectionsIncrease sensitivityCheck batteryChange leads (faulty placement or fibrosis)

    AAI pacing

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    `

    Other clues ?

    Decreased UODecreased pulses

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    Way to recapture/control rapid atrialarrhythmias and break it for improved CO

    No ventricular support during RAP Record event Resuscitation fluid, meds, pacing

    Menu 3RAPpick rate 80-800press and hold SELECT to deliver RAP

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    Infections Myocardial injury

    Ventricular arrhythmias

    Perforation Tamponade

    Bleeding

    At time of RemovalMonitor x4 hours

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    Safety first

    protect from liquids

    protect from electricity protect from children

    Check patient

    Check settings vs monitorCheck connections

    Strip recorder @ bedside

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