by blasl

I realize these are a rarity, but still we
have occasion to place temporary transvenous
pacers in our unit. A recent 'sentinel event' was reported regarding perforation with a central line. This created the question of temporaries and our policy regarding consistent checking for possible migration of the wire at its' entry point.
Is there a measurement, procedure, etc. that
your unit follows to assure the wire has
not migrated from its' original seating in the cordis?
Thanks for any input you have. Please be
gentle - my last responder suggested Paxil.....

I am somewhat confused. We use temporary
pacemakers frequently. Usually ours are
sutured to the site and covered with a sterile dressing. I would think you would be able to tell if it migrated with the continuous ekg monitoring. A gross amount of migration would most likely move the tip of the lead. The temporay pacemakers at our facillity are just that temporay and we have not had much of a problem with this. A daily
CXR would also confirm this

Besides a change in pacing, loss of capture, failure to sense, etc..., you can document the length of external catheter, or you can use the marks on the catheter itself, it should be marked every 10 cm at least. (It's been a while since I've worked with swans and temp pacer wires) check the insert with the kit for the interpretation of these marks on the catheter. I once had a surgeon accuse me of dislodging the catheter on a very sick patient with an open chest. Of course he didn't realize that when he was just IN the chest removing clots and lifting the heart to get the clots behind it that this could possibly contributed to the loss of capture. Of course not! Luckily I had documented the length of the external catheter and saved myself a lot of heat. Tara is correct too, a CXR will easily confirm this info.