DNR and pacing.

[Jenni811]

The other DNR-DNI thread got me thinking about this scenerio i had last week. I had a patient that was a DNR/DNI and was in our telemetry unit with syncope. he was found unresponsive by some bypassers. Anyway...telemetry showed he would occasionaly brady down to low 30's. I paged MD in house that was covering- continue to monitor, page back if symptomatic. Then patient started having pauses. Anywhere from 2-8 seconds or so. MD came to look at telemetry strips and told me to place pacer patches on patient in the off chance we need to pace. I asked MD "Is this something we do for DNR patients?" she thought about it and said Yes! because we are not resucitiating we are preventing. This is just the MD that is covering, not the patient's own attending.

So patients attending showed up really early (this was on a night shift) so i was able to catch her before i headed out and told her what happened. I too asked if she wanted pacer patches on the patient. Her reply? "No! Take them off. Who told you to do this?" "Dr X was on call last night, i spoke with her."

i was so confused. I asked my nurse educator, she had no clue.

So...do you PACE a DNR?? I never got a clear answer from anyone i talked to. I feel like we should all know this. Some of nurses on my unit say Yes and some say no. I could see this being a HUGE issue if it ever occured on our unit. Which being a telemtry unit im surprised it hasn't come up yet.

[Been there,done that, ASN, RN]

If the issue of external pacing is not addressed in the DNR LEGAL form, and your nursing education department can't answer your question.. consider taking it to your ethics committee.

Personally, I would not pace a DNR patient. If the direction is to not interfere with the conduction system chemically, then I could be assured that electrical treatment is included.

Now, don't get me started on .... partial DNR's!!

You know... the ones where we can administer atropine, epi.. etc., but not do CPR to circulate it?

[Been there,done that, ASN, RN]

What is the patient's underlying morbidity?

Of course if the patient is suffering from the bradycardia and dizziness,and there is a chance they could walk out of the hospital, treating the pauses by pacing makes perfect sense.

I'm getting a mental picture of an alert and oriented patent.. bradying into the 30's.. grasping for the temporary leads....

And there is a nurse, doctor and lawyer all fighting whether or not to hand 'em over!

[caryrey02]

we do not pace DNR patients in my unit, it is part of the DNR form "No external pacer", "no transvenous pacer".