Pacer spikes not showing up monitor

canigraduate · Nov 8, 2015

Sometimes they just dont show up consistenty. Any way to trouble shoot this/ position the leads?

It's usually a problem with the monitor settings. The monitors I've used have had different pacer settings. The default one doesn't always work. You can also look at a different lead than II. Sometimes the spikes show better in one of the V leads.

Another thing you can do is move the leads around. I'll put the LA on the left upper back if it's a lefty, or the RA on the upper back if it's a righty.

The AHA has specific recommendations.

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Lev, MSN, RN, NP · Nov 8, 2015

Thank you! Will try these out.

canigraduate · Nov 8, 2015

Thank you! Will try these out.

Sorry, I tried to post a pic but it didn't work. The AHA guidelines show the arm lead on the pacemaker side at the 2 ICS at the midclavicular line instead of between the collarbone and first rib at the midclavicular line.

Looking at my post, it looks like half is missing, LOL!

BlueChocolateCat · Nov 9, 2015

I'm sorry if this doesnt pretain to your monitors, but on our monitors we are able to turn "pacemaker monitoring" on and off. Maybe certain monitors have this turned to OFF as a default?

Lev, MSN, RN, NP · Nov 9, 2015

Even with pace 2 turned on the pacer spikes dont always show especially with wide ventricular paced beats.

UmmIbrahim · Nov 10, 2015

Id trouble shoot the monitor and when in doubt then ask someone with more experience with the monitors but usually a bit of trouble shooting on the monitors works...now if everything is done and pacer spikes arent showing then maybe something is fishy with a pacer lead or the pacer itself...call the MD they can get someone up there to check the pacer.

PaSSiNGaS, MSN · Nov 12, 2015

Honestly what does it matter? As long as the rhythm is there and the pacer is capturing and/or sensing appropriately it doesn't matter if you can see spikes or not.

Lev, MSN, RN, NP · Nov 13, 2015

Well things look scary sometimes and its comforting to know they went into their paced rhythm and not something else.

Burphel · Dec 10, 2015

Are you using Phillips monitors with telemetry, perchance?

I've worked at two different hospitals with this setup, and Philips tele packs just plain suck at picking up pacer activity. Before I started traveling, my old hospital switched to Phillips and we tried almost every lead configuration possible with no luck. They do a pretty decent job if you hard-wire the patient. So if you are concerned about sensing/capture, or think they've dislodged a pacer lead, just hard wire 'em and be done with it. If it's not really a concern, just look for a bundle branch block that stays right at 60 or 70.

Pheebz777, BSN, RN · Dec 28, 2015

What is the reason for the pacemaker? If the patient's inherent beat is normal, rate WNL then the pacemaker could just be doing its job and not pacing when it does not need to.