Pacer Placement

[NeuroNP]

A friend of mine told me today that her father-in-law was having a pacermaker implanted and that she talked to the anesthesiologist before he went to the OR. Now, a few years back, I worked on a cardiac telly floor as a CNA/EKG Tech and almost all of our placers got placed in the Cath Lab.

The hospital that her father-in-law is in is a different hospital, but I know the cardiologist and he used to put in pacers in the cath lab at the hospital where I worked.

Anyone know if there is a reason that you'd do this in the OR vs the Cath Lab? Why would a cardiologist consult a CT surgeon to place it in the OR instead of just doing it himself in the Cath Lab? Does it have to do with the type of patient?

I'm a nursing student now and it's been a few years since I was in Cardiac, and I'd like to learn the ins and outs. Any info would be greatly appreciated.

[eprn]

Not all cardiologists may implant pacers. A cardiologist either needs to have gone through device training or an entire electrophysiology fellowship to be an implanter. Otherwise, they will have to refer it to another implanting cardiologist, an EP, or a surgeon.

Where to implant the device is a subject of much debate. Some doctors and facilities believe that the infection rate is higher in the cath lab and for this reason they prefer to have it done in the OR. I haven't seen any hard data concerning this and, for that matter, I've seen just as many infections in the OR as I have in the cath lab.

Secondly, there are some who think that the cath lab staff just isn't as good as the OR staff at these implants. This shouldn't be a problem for a properly trained and experienced team in the cath lab.

Then, there's the politics. In some facilities, the cath lab will compete with the OR for these implants for the $$ (although this is more of an issue with ICDs than with pacers). In other facilities, the OR believes that these cases are more of a hassle and would rather shunt them to the cath lab.

Finally, there's the physician's preference. Surgeons tend to feel more comfortable in the OR, while cardiologists/EPs are more at home in the cath lab.

I hope this helps, and I hope I didn't bore you.

[NeuroNP]

You didn't bore me at all! It does help. I'm still confused as to why this Cardiologist would have a surgeon do it in the OR when he has lots of partners who regularly implant these things in the Cath Lab (including at least one EP that I know of). I guess I was thinking that there might be some rationale for this particular pt. (older, Hx of DM, HTN, etc.) that might necessitate going to the OR vs the Lab. Maybe not?

[eprn]

That is interesting. Maybe there's a scheduling conflict. On the other hand, there could be some political intrigue as well.

[papawjohn]

Hey Brian

Interesting question. My Pt last nite illustrates the peculiar uncertainty. 80yr old lady has bleeding ulcer, gets partial gastrectomy & vagotomy. Has SickSinusSyndrome in ICU post op (maybe had had it pre op but undiagnosed, eh?) Cardiology consult--heart cath--finally the Cardiology Doc takes her to Cath Lab for a temporary TransVenous Pacer. Then a 2d surgeon is consulted for the PermPacer. He takes her to OR for the PermPacer.

I dunno what goes on in the strata that MDs move around in. I've always suspected (being a cynical sort of guy) that they have relationships among themselves and shift insured Patients around and un-insured Patients around like passing cards in a game of bridge to benefit their pals and in-laws or aggravate fellow Drs they don't like.

But I have to say, I always suspected it none of my business. They do their thing, I do my thing.

Papaw John

[suzanne4, RN]

Depends on the cardiologist, not all feel comfortable doing actual surgical procedures, making a pocket under the skin for the pacemaker, etc.

Last facility where I worked OR at, we did all of the pacemakers in the OR......the cardiologists on staff there deferred them to the CV surgeons.

All AICDs should be done in the OR because full anesthesia is required for testing.

It could have also have been a re-do, these require the OR because you can get into trouble by needing to reposition wires, etc.