I had a patient yesterday that caused a bit of a stir on the OR. Data: 74 yo F, IDDM, hypothyroid, htn, PONV: severe. Allergies: ASA, tape, codeine. In for R mastectomy.
Problem; pacemaker for atrial fib
The CRNA I was with, talked to our supervising MDA and she suggested the surgeon use bipolar instead of the bovie. If he insisted on using the bovie, only in short bursts. Also, a magnet was brought in in case we had to re set her pacemaker to factory settings.
At one point I lost her pulse. It did come back without doing anything, but...
My question is: What is all of the details about a pacemaker and the bovie. Does it really matter. Does it cause problems often or very rarely? I had 7 months to go in school and have not run into this before.
I am an EP nurse too, but soon to be off to crna school!! EP is a different ball game, and it is amazing what you learn in the lab! You learn about the heart in a whole different light.
I'm trying to get to NASPE, but my manager is being a pain. It's nice to see other EP types out there, especially lurking on an anesthesia forum. I,too, am considering anesthesia school.
I started reading this thread with interest but skimmied it thinking that the info may be dated . I and I bet others would love a review as succint and informative as the first page. Perhaps just an update? Thanks. Ed
WOW! I just re-read this info. When I wrote this question I was a student and I do not remember asking this question. It is so weird to read something that was written/asked 5 years ago.
Thanks to all the responses.
PS: Now I do pacer insertions daily. A lot of Guidant in our facility.
Who else is out there? Any new and interesting stuff lately that I haven't seen?
Not only is their mailbox full, but chances are they haven't even been on this site since 2004. This forum used to discuss interesting things like this, but not really any more. I believe the people with this kind of interest, experience, and knowledge have found other places to share their info.
The problem with the bovie is when a pt has an ICD (defibrlilator). With a defib (all ICDs can also pace, but not all pacemakers are ICDs) you should turn off by placing a magnet due to ICD can read bovie interference as tachycardic activity & shock the pt when not needed. You only do this with bovi use & CVC placement, If you disable w/ a magnet you must put an external defib on pt in case they actually do have an event where shock is needed. Also, must have device interrogated after surg to make sure ICD wasnt perm disabled by magnet. You dont have to put a magnet on if just a pacemaker. Have it in room if pacemaker has failure to capture, etc.. Then u can place & hopefully get asynch pacing. You have to be careful putting a magnet on a pacemaker willy nilly, some older pacemakers can be perm disabled. And you send your pt home w/ nonfunctioning pacemaker. If your pt has a pacemaker card you should call the company to see what a magnent will do if anything. Read the chapter in Miller over pacemakers & ICDs.
pghfoxfan
221 Posts
catlabrn!!!!!!! I'm a EP nurse too...good to meet ya.
Are you going to NASPE?