Removal of Pacing Wires

Following my wife's open heart the pacer wires were pulled by the PA who is in the group for the surgeons. Her's came out on
Day 7 post-op. Of course, she had some major work done (when isn't open heart). She had rings place on her tricuspid and mitral valves, a patch for a ASD and a MAZE done. The MAZE fixed the A-FIB but she has remained in a junctional rhythm. Her post-op period would have been a great time to be ignorant about medical procedures and such!
As far as I can recall, there was no special observation period, other than on telementry, and definately no one from the floor taking vitals. She was not told to stay in bed either. Sometimes you wonder if many of the tried and true methods are done away with because nothing ever happens...and we are setting ourselves up for some major grief.

bob

Dear Dyno
I know this is a really late reply - did you get any interesting information relating to this subject.
At our hospital we are currently looking at developing a guideline in relation to epicardial wire removal. The literature is minimal and no one appears to have policies in place.We currently have a policy where by only those nurses whp have undergone specific training can removal wires and they follow strict observational guidelines on removal. I unfortunately have seen 'tamponade' following wire removal and don't see the observations required as over-kill!
Any more information required let me know
Cheers
Sharron68

Don't ya just hate the ignorance or doctors..pulling wires with a INR of 3.4..duh what an [language edited by moderator]

I too have found little written about nurses removing epicardial pacing wires and am in need of a policy. Other nearby facilities are doing this with a checklist and no policy. Currently we will be removing them post openheart 24 hours prior to discharge to allow time for monitoring. Complications are not only tamponade (from coring the ventrical) but also electrically irritating the ventrical resulting in some mean dysrhythmias, as well as fragmentation and migration of the wire parts. (oops)
At this point I have found that the INR should be less than 2.4, the patient should be on bedrest for 30 minutes, VS X2 30 min apart, observing for SXS tamponade and monitoring X 24 hours. If pacer wire is sutured internally, pull the wire and cut off at the skin with sterile scissors. We are considering having only the APN or CNS doing this procedure. I'll be watching for more on this.....there's not much!

No, the protocol your hospital requires is not overkill. I am a RN who witnessed her mother go into cardiac tamponade 1 1/2 hours following the resident pulling her epicardial wires in the room. She died as a result of a tear of the right atrium. It does happen and I would not wish it on anyone. By the time she was rushed to surgery it was too late. She had been doing great following her procedure was expecting to go home the next morning. I watched her suffer until she went unconscious on the floor. As a result I am trying to find written protocols and information regarding the removal and care of a patient following the removal of the epicardial wires? Are all of the patients usually on a telemetry unit? I would appreciate any info that I can acquire regarding this procedure.

Thanks,

Emmynurse

Where I work as an RN patients wires are removed any day after day 4 post surgery only patients with irregular heart rhythms such as af are on telemetry. an ecg is performed and as long as there are P waves it is ok to either remove or cut the wires. However, one SHO after i gave him an ecg was concerned tht a patient was in af he said if he is a known af then it would b ok but if it was a new onset of af then he wouldnt b happy, however wen spking to another RN they said af isnt an indication for keepin wires in as the pacing wires are usually used to treat bradycardia post op via pacing box. so i asked the consultant who identified P waves on the ecg and said it was fine to remove the 2 RA wires and cut the 2 RV as the two RV were stitched to the heart whilst the RA were just resting on the surface. if patient on warfarin they require an INR of ethier < 2.5 or <2.0 depending on surgeon preference before removal. baseline obs are required proir to removal in order to identify cardiac tamponade in any changes post removal with 2 x 15 min obs post removal, patients are required to lie flat or reasonably flat for 30 mins post removal and require to remain in hosp overnight post removal. wires are only removed during theatre hours incase of cardiac tamponade which may mean tht chests would have to b opened on the ward if it was to happen. if a wire tht is meant to be pulled is resistant then dont force it, spk to dr if they wanna pull it fine, i have seen some RNs cut the wire cos it is not budging.