[Booty Nurse]

I work in GI endoscopy (within an OR), but thought the OR forum may be a better place for this thread. My hospital has no policy on care of patients with pacer/defibrillators during procedures. I'm confused about use of magnets during electrocautery, and it seems that everyone else in the department is also. A rep from Medtronix gave an inservice, but our anesthesiologist said that the information she gave us was wrong. Basically, the rep said we should call the company and ask them what to do, but we couldn't hurt anything with the newer pacers by placing a magnet during cautery if we weren't sure. The anesthesiologist disagreed and said that yes, we could cause problems (major ones!) by using a magnet on certain pacers, and we had to find out from the company exactly what to do. This seems the safest route.

I'm wondering what other hospitals do about this situation. Who is responsible for finding out how to manage the patient with a pacer/defibrillator? It seems that I should have this information before the patient gets to the procedure room; as the sedation nurse, I have maybe 5 minutes to get the patient all set up before the doctor comes in and wants to get going. Sometimes I have info from the cardiologist on the chart, which is great; sometimes the only info I have is "ICD" written on the medical history.

I don't want to reset the programming in a pacer by using a magnet, and I sure don't want to have a defibrillator go off because I didn't use one! Thanks for any advice.

[MereSanity]

Go to Medtronic dot com and click on the "physicians/nurse" link. There a lot of info there.

[wtbcrna]

Originally Posted by zebras

I work in GI endoscopy (within an OR), but thought the OR forum may be a better place for this thread. My hospital has no policy on care of patients with pacer/defibrillators during procedures. I'm confused about use of magnets during electrocautery, and it seems that everyone else in the department is also. A rep from Medtronix gave an inservice, but our anesthesiologist said that the information she gave us was wrong. Basically, the rep said we should call the company and ask them what to do, but we couldn't hurt anything with the newer pacers by placing a magnet during cautery if we weren't sure. The anesthesiologist disagreed and said that yes, we could cause problems (major ones!) by using a magnet on certain pacers, and we had to find out from the company exactly what to do. This seems the safest route.

I'm wondering what other hospitals do about this situation. Who is responsible for finding out how to manage the patient with a pacer/defibrillator? It seems that I should have this information before the patient gets to the procedure room; as the sedation nurse, I have maybe 5 minutes to get the patient all set up before the doctor comes in and wants to get going. Sometimes I have info from the cardiologist on the chart, which is great; sometimes the only info I have is "ICD" written on the medical history.

I don't want to reset the programming in a pacer by using a magnet, and I sure don't want to have a defibrillator go off because I didn't use one! Thanks for any advice.

I tried to post this yesterday, but I was having trouble with the site. Anyways I looked this up in two different anesthesia books (Clinical Anesthesiology 4th ed and The Handbook of Nurse Anesthesia 3rd ed) and here is what I found: Newer pacemakers are designed to have less trouble with electromagnetic interference/EMI, routine magnet placement is not needed for electocautery use, when EMI occurs a doughnut shaped magnet can be placed over the pacemaker, most pacemakers though will automatically convert to asynchronous mode if EMI is detected ("so magnet intervention is rarely needed").
Here are the recommendations for dealing with pacemakers & electrocautery: Heart rate should be continually monitored by precordial or esophageal stethoscope; a continual arterial pulse wave should be monitored (art line, plethysmogram, or pulse ox) and is considered mandatory when dealing with electrocautery and patients with pacemakers; other recommendations--use the electrocautery in short bursts, limit its power output, place the grounding plate as far from the pacemaker as possible/use bipolar cautery.

Hope this helps.

[Booty Nurse]

Thanks for looking that up for me. Unfortunately, we use monopolar cautery in the endoscopy room. I have never heard anyone mention monitoring with a stethoscope! Interesting.

I have read about this, and the more I read, the more confused and nervous I get! The ASA practice advisory makes it sound so complicated. I don't think that I, as the RN, should be the one making the decision about whether or not to use a magnet. I just don't have the expertise. *sigh* I think I need to have a talk with my manager.

[wtbcrna]

Originally Posted by zebras

Thanks for looking that up for me. Unfortunately, we use monopolar cautery in the endoscopy room. I have never heard anyone mention monitoring with a stethoscope! Interesting.

I have read about this, and the more I read, the more confused and nervous I get! The ASA practice advisory makes it sound so complicated. I don't think that I, as the RN, should be the one making the decision about whether or not to use a magnet. I just don't have the expertise. *sigh* I think I need to have a talk with my manager.

No you shouldn't have to worry about placing the magnet or not from what I read it should be totally up to the anesthesia provider. Your main job would be to ensure that the grounding pad is placed as far away from the pacemaker as possible.

[Booty Nurse]

Most of the time I don't have an anesthesia provider -- I do all the sedation and monitoring. There are anesthesia providers around, but they may all be in another case. That's why I think it should all be figured out before the patient gets to the procedure room, either at the pre-op visit with the surgeon or during the admission process.

[wtbcrna]

Originally Posted by zebras

Most of the time I don't have an anesthesia provider -- I do all the sedation and monitoring. There are anesthesia providers around, but they may all be in another case. That's why I think it should all be figured out before the patient gets to the procedure room, either at the pre-op visit with the surgeon or during the admission process.

I see...I wasn't thinking about that. I apologize for overlooking that. What are they using electocautery for in the GI clinic especially during conscious sedation w/o anesthesia provider?

[Booty Nurse]

We use cautery to remove polyps and to stop small bleeds. I'm not sure why we need to use monopolar -- something to look into, I suppose. I'm still new to this job and have a lot to learn!