Tampanode Precautions after pulling epicardial pacer wires

[cruisin_woodward]

After pulling epicardial pacemaker wires, the patient is always placed on tamponade precautions. I was recently told that they do not need tamponade precautions if they have chest tubes....this doesn't make sense to me. Tamponade is caused by an excess of fluid in the pericardial sac... since the CT are MS and/or plueral...any one else ever heard of this?

[anurseuk]

Epicardial pacing wires very rarely get pulled on my unit as the patients have often been discharged to the step down ward by this time (3-4days post surgery). Chest drains will be removed on the following morning after secession of drainage.

No special precautions are followed in either case, however if removed on the critical care unit the patient will still be nurses 1:1 and will be continuously monitored, usually with an arterial line in situ. We would continue to perform hourly observations until the patient was discharged onto the ward, where they would continue to be on a cardiac monitor for 24hours.

The only thing I can think is that we would know the patients coagulation results before pulling the drains or wires.

We often have patients who have plueral, pericardial or mediastinal drains post cardiac surgery so the nurse would be correct in citing these as a potential risk for tamponade. I myself have never seen this and the biggest risk after pulling drains seems to be pnumothorax. Having seen pacing wires being placed in theatre it actually is amazing how I have not seen a tamponade post removal as they really borrow them in!