Nursing care for pacemaker patients

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · May 15, 2003

Are you talking about patients that recently have had a pacer placed or those who have had a pacer for a while.

Recently placed should always be cared for a RN who is telemetry trained. Some of the complications of post pacer placement is: infection, hematoma of site, failure to capture, failure to pace, failure to sense all leading to an arrythmia, hemodynamic instability related a multitude of factors, etc. An RN is needed to assess, document, implement and re-evalute the patient.

If the patient has had a pacer and they are stable with no complaints that could be related to an arrythmia, hemodynamic issues, etc. They could go to a regular floor, otherwise, they too almost always come to our floor because they have a heart history that causes them to be cardiac monitored.

Plus, RN's should be doing teaching if the pacer is new.

I don't know otherwise what you are really asking. Feel free to pm me.

Good luck.

lindalee · May 16, 2003

If you are talking about management of pacemakers after implantation, there are pacemaker centers where nurses manage the pacemaker patients. There are guidelines about how often the devices need to be checked. The pacemaker can be checked by telephone for basic function using a transmitter. This is done every one or two months depending on the age of the device. The telephone check is done in two parts. The first part transmits the cardiac rhythm; the second part is transmitted using a pacemaker magnet. The magnet rate of the device will indicate if the device is reaching the end of the battery life.

The patients come into clinic for a full pacemaker check either every six months or every year. The guidelines vary if the pacemaker is a single chamber or a dual chamber device.

Our pacemaker clinic also follows ICD devices. The nurses are trained to check the devices, ensure safe thresholds for pacing capture, and check charge time and battery life as well as other functions. The devices have memories so if a patient receives a shock; they come into clinic where the rhythm before and after the shock can be examined to see if the shock was appropriate. It is a very interesting field--constantly changing as the devices get more abilities all of the time.

Salpicovalentim · May 16, 2003

Dear moonshadeau,

Thank's for your reply.

I talking about patients with a Pacemaker implanted for a while, and I'm glad RN can do all that.

Are any nurse fully commited to pacemaker patients only, or in general all RN do care of these patients?

Which resposibilities?

Is it Pacing an attractive area for nurses?

Because in Portugal is dificult to find nurses with knowledge in pacing, and with skills, and just a few would like to invest in this area.

I have experience in Pacing ( both taqui and brady, also experience in Bi-ventricular implants and follow up), and I´m looking for reasons why portuguese nurses do not care about pacing.

Originally posted by moonshadeau
Are you talking about patients that recently have had a pacer placed or those who have had a pacer for a while.

Recently placed should always be cared for a RN who is telemetry trained. Some of the complications of post pacer placement is: infection, hematoma of site, failure to capture, failure to pace, failure to sense all leading to an arrythmia, hemodynamic instability related a multitude of factors, etc. An RN is needed to assess, document, implement and re-evalute the patient.

If the patient has had a pacer and they are stable with no complaints that could be related to an arrythmia, hemodynamic issues, etc. They could go to a regular floor, otherwise, they too almost always come to our floor because they have a heart history that causes them to be cardiac monitored.

Plus, RN's should be doing teaching if the pacer is new.

I don't know otherwise what you are really asking. Feel free to pm me.

Good luck.

Salpicovalentim · May 16, 2003

Thank's Linda.

Is the nurse performing these tasks wil full responsibility?

Is there Proctocols for each problem?

which can be the nerses motivations to devote the attention to pacing?

In general, portuguese nurses are not involved in late post op care. This is even more important, because the implant ratio (brady) is 400 new implants per million hab. and more and more the pacemaker patient is subjected to other comorbidities, needing nursing actions to troubleshoot issues, and there are no prepared nurses for that.

My experience is very unusual, because it cames from my previous job in the Industry.

Originally posted by lindalee
If you are talking about management of pacemakers after implantation, there are pacemaker centers where nurses manage the pacemaker patients. There are guidelines about how often the devices need to be checked. The pacemaker can be checked by telephone for basic function using a transmitter. This is done every one or two months depending on the age of the device. The telephone check is done in two parts. The first part transmits the cardiac rhythm; the second part is transmitted using a pacemaker magnet. The magnet rate of the device will indicate if the device is reaching the end of the battery life.

The patients come into clinic for a full pacemaker check either every six months or every year. The guidelines vary if the pacemaker is a single chamber or a dual chamber device.

Our pacemaker clinic also follows ICD devices. The nurses are trained to check the devices, ensure safe thresholds for pacing capture, and check charge time and battery life as well as other functions. The devices have memories so if a patient receives a shock; they come into clinic where the rhythm before and after the shock can be examined to see if the shock was appropriate. It is a very interesting field--constantly changing as the devices get more abilities all of the time.

:)

catlabrn · May 17, 2003

You asked about pacing being a good area for nurses.

Answer: ABSOLUTELY!!

I work in a cath/EP lab where we do angiography, interventions, and all electrical procedures. All of us are trained to assist in the procedures, and three of us (I am one of them) have been trained to do the stimulation during electrophysiology studies and ablations. We also do the programming for new pacemakers and defibrillators, as well as the follow-up and troubleshooting while the patient is in the hospital.

I like the challenge. It's also another skill to add to the old resume. Many EP nurses become pacemaker company representatives, although I'm not interested in that right now.