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Discussion

New Pacemaker Implant Question

Our pre-procedure order set for implantable devices includes an order for a saline lock in each arm for new implants (one on side of device only if generator change).

Does anyone know the reason why 2 IVs are needed? I know the EP lab staff told me in orientation but I can't remember!

I currently have TWO patients going for new devices in the morning and BOTH of them have PICC lines for other reasons and really poor peripheral veins. Just trying to figure out whether I really need to try to start a saline lock in the other arm for each of them.

Thanks in advance for any insight!

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    • Expert

    I would think it depends on your facility....ask your co-workers or your supervision.

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    An IV in each arm is often necessary in the event that the physician has difficulty implanting the leads. Radiopaque dye can be injected into the veins so that he or she may better visualize the venous system for the implant.

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    Great question. One IV is for the drugs to be given, such as fentanyl and midazolam or whatever sedatives you may use. The other cannula site is for contrast (radioactive dye) that will be used to check placement.

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    • Admin

    Hi, old-timer Cath Lab nurse here!

    New implants:

    Most of the Cardiologists use some sort of imaging to locate and cannulate the subclavian vein.

    Some use ultrasound and some have iodine contrast (radiopaque "dye") injected IV (same side as the vein they want to see).

    The contrast is injected in the IV and we watch under fluoroscopy as it travels up the arm to the subclavian vein.

    This is a venogram.

    The Cardiologist then uses a needle to gain access to the subclavian vein (he now knows where it is and how big it is), and the leads may then be placed into the heart via the vein.

    The second IV is used for administration of sedation and other meds.

    In general, with a generator change the leads are already in the heart so no need to do a venogram.

    One IV is all that is needed, for administration of sedation and other meds.

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    Our cardiologists used to require an IV in each side but so many patients have contraindications ( AV fistula, breast CA) or just plain crappy veins. Cases ended up being delayed because staff were unable to get access.

    Now they only require one IV in the side that the pacer will be placed.

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