Questions about patients with pacemakers

[IsseyM]

What policies, procedures or guidelines does your hospital have for patients with pacemakers requiring surgery? Does the ESU interfere with the pacemaker? What other OR equipment might interfere with a pacemaker?

I remember we talked about it briefly in our peri-op class but i don't remember the details. Thanks.

IsseyM

[crackerjack]

In our facility we are to have a rep from the pacemaker mfr there for the procedure. As far as the ESU intereference, yes it can. From my periop class I remember that you are supposed to place the bovie pad as close to the surgical site as possible and in such a way as to divert the electrical path such that it does not cross the normal electrical path of the pacemaker to the heart to reduce interference and draw the conductive path away from the pacer. The problem I've had with that during my orientation is that the old time nurses think I'm bonkers when I try to observe this. For that matter, they seem to think that you should place the bovie pad on the opposite side of the operative site on all cases...mostly because they don't want to have to take extra precautions to ensure it doesn't get wet with prep solution. In all cases the pad should be as close to the operative site as possible and on the operative side. Granted, when doing a hip the opposite hip is closer to the operative site than using the deltoid of the operative site so you use the hip rather than shoulder for the pad site. You have to just think logical about it and give the current the shortest exit path...and avoid pathing through the pacer, of course

[jwk]

Why on earth would you need the pacemaker rep?

Your anesthesia people should have their handy pacemaker magnet available and use it as indicated.

[Rose_Queen, BSN, MSN, RN]

We don't have a rep present, but the pre-op nurse calls the rep to make sure magnets are ok, and then documents this on the chart. As for the bovie pad, we try to keep it on the opposite side of the pacemaker.

[ewattsjt]

Why on earth would you need the pacemaker rep?

Your anesthesia people should have their handy pacemaker magnet available and use it as indicated.

This is what we do. The ok for the magnet should have been received from the operating physician prior to scheduling the procedure.

At least at our facility.

[chartleypj]

IsseyM,

AORN has a position statement on care of the patient with implanted cardiac devices.

You might be able to view it @ AORN Online

I know it is also in their yearly Recommended Practices and Standards book.

I wonder if any equipment that utilizes lectricity; i.e., a ligasure or harmonic scalpel could interfere with ICD's and Pacers.

good luck,

Pj

[ewattsjt]

i searched aorn online and found these similar articles. while it is not exactly what the question asks; it does give insight.

http://www.aorn.org/journal/2002/septci.htm

more interesting article about pacemakers and other equipment.

http://www.aorn.org/journal/1999/janci.htm

thanks chartleypj!!!