Re: Tampanode Precautions after pulling epicardial pacer wires

Epicardial wires exist post OHS (open heart surgery) exclusively. An intact pericardium is not an absolute assumption in this setting because some surgeons do not close (or only losely approximate) the pericardial sac post OHS. Thus, the pericardial space communicates with the pleural space. A pleural CT could then drain both medi and pleural spaces.
I feel that your collegue's description could lead certain others to a false assumption that a CT effectively prevents tamponade. To split hairs, I feel it's necessary to closely watch any pt with freshly pulled epicardial wires. Tamponade can take less than 50 ml of blood in just the right place (compressing the right atrium alone could nearly shut down all cardiac output at it's worst, for one example) To negate this, some docs just cut the wires at the skin and leave the reminant in-situ.

Re: Tampanode Precautions after pulling epicardial pacer wires

Originally Posted by Wile E Coyote

Epicardial wires exist post OHS (open heart surgery) exclusively. An intact pericardium is not an absolute assumption in this setting because some surgeons do not close (or only losely approximate) the pericardial sac post OHS. Thus, the pericardial space communicates with the pleural space. A pleural CT could then drain both medi and pleural spaces.
I feel that your collegue's description could lead certain others to a false assumption that a CT effectively prevents tamponade. To split hairs, I feel it's necessary to closely watch any pt with freshly pulled epicardial wires. Tamponade can take less than 50 ml of blood in just the right place (compressing the right atrium alone could nearly shut down all cardiac output at it's worst, for one example) To negate this, some docs just cut the wires at the skin and leave the reminant in-situ.

Thanks...I've seen one surgeon cut the wire at the skin, but we all (nurses, NPs, PAs, etc) all looked at him like he was totally nuts!! I've never worked in another ICU, so I am limited to what I've seen there...

I am going to continue my usual practice....

Thank you!
Amy

Re: Tampanode Precautions after pulling epicardial pacer wires

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!