transvenous temporary pacers/tape/measuring leangths

  1. We rarely use transvenous temporary pacers,
    but when we do, the issue of keeping track
    of position integrity arises. The wires
    we use are not marked, thus using standard
    markers as are on Swan Ganz catheters does not work. How is is done elsewhere? Our current policy is to measure/record length to VERY distal green line on wire - a long way from the cordis - every shift. This is tedious,and seems unsafe to uncoil a nicely taped wire just to measure. Especially if it
    is working properly.
    Or do you measure at all?
    The second issue is securing the wire - what
    methods have worked elsewhere for securing
    all the extra length of pacer wire?
    Any input would be great - thanks - am trying
    to change our policy on this but need more
    input from other ccu's.
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  2. 3 Comments

  3. by   Bruce
    As long as you have capture, are sensing well, and the threshold hasn't changed, why measure length? Sounds like an OCD kind of thing. Paxel anyone?
  4. by   williserrn
    I am looking for a policy on how to secure them as well, any luck?
  5. by   SEOBowhntr
    Quote from Bruce
    As long as you have capture, are sensing well, and the threshold hasn't changed, why measure length? Sounds like an OCD kind of thing. Paxel anyone?
    OCD??? Not quite, it's a patient safety thing. I'm not sure what kind of pacers they use, but ours are nicely labelled so you can look at it and tell it is about 36cm into the patient. There should be no measurement difference between the "Distal or Proximal" wire, as they should both be contained in the same lead, just one electrically protected from the other. We have "Life Science" branded Swan Ganz Pacing Catheters, and they have a nice arrangement. I've seen 2 catheters that "were" 35 or 36cm in, but when looked at more closely, because they were pacing the Atrium, it was found that they were closer to 38 and 40 cm. Now I know of a situation in which a doctor tried to float 2 Transvenous pacers, then tried to synchronize them to EMERGENTLY AV pace a patient who was not doing well (BAD Inferior MI), and he was unable, BUT.......... had he floated both into place, the atrial in the right atrium, and the ventricular into the right ventricle, and use an EPICARDIAL PACER, with both an atrial and ventricular sensing and pacing system, he probably could have done this. The patient ended up surviving despite a horrible intial 4 days in the hospital in which they repeatedly tried to transvenously AV pace her, unsuccessfully, but she rebounded pretty well in the end. Probably more info than you may have wanted, but if your pacers aren't clearly marked, you need to be looking into another supplier!!!!

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