Forgive me if this is a stupid question. I'm a student in my final semester of a BSN program and doing my preceptorship on a cardiac stepdown unit. We routinely have pts s/p cabg who have temporary, external pacing wires, which I understand. However, most of them are not actually being paced. If a patient is not connected to an external pacemaker, then what is the big hub ub about handling wires with gloves (beyond infxn ctrl), wrapping and isolating? I don't understand how one can be shocked by something that is not hooked up to any electricity...Please enlighten me.
Mar 9, '14
I'm going to make an educated guess about that... As you know, some patients have those temporary external pacing wires and as you know those wires are able to deliver a shock directly to the myocardium. It's also possible to defibrillate/cardiovert a bad rhythm using those wires, and far less joules are needed to accomplish that task when you have wires directly attached to the heart. Think about this: overdrive pacing doesn't require much current. You can build up quite a bit of a charge just walking around. It doesn't bother us because our body's tissues are effectively isoelectric to everything else in the body. If you were to accidentally discharge into the pacer wires... that could easily cause a lethal arrythmia, especially if the timing is considered "R on T" in the relative refractory period.
Now if I'm wrong, so be it. I'll learn from those more experienced/learned than I... but that's my educated, non-ICU experienced guess.
Mar 11, '14
Good guess akulahawk
You need to protect from micro shocks that could potentially cause arrhythmia.
Have you ever walked across the floor and touch the door knob or someone's arm and got shocked?
How much electrical equipment surrounds the patient?
What would happen if those wires accidentally touches that equipment and it shorts out on the patient.?
Where there is power there is danger. Those leads are sewn right on the epicardium of the heart.
That is why you protect the leads....
Epicardial wires | Modern Medicine
Electrical safety for anaesthetists explained simply. Anesthesia Equipment simplified and explained : For anaesthesiology FRCA physics, anaesthesia staff, nurse anesthetist CRNA, Anesthesiology Board : HowEquipmentWorks.com
Mar 11, '14
Exactly right to the above posts. They must stay grounded. We cap ours and gauze wrap them..If they are connected to the external pacer...we rubber gloves them..remember to keep them accessible when dressed in case you need them in a hurry.