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Sinoatrial node hearts main pacemaker Sense capability of the pacemaker to see the patients electrical impulses Capture pacemaker becomes in control of the heart; occurs during heart blocks Threshold the minimum amount of electricity for the pacemaker to produce and effect on the heart Pacing pacemaker produces impulses

Purpose of a Pacemaker maintain adequate heart rate regulate irregular contractions resets heart rate to an appropriate pace

Indications arrhythmia sick sinus syndrome MI AV block cardiac surgery

Contraindications patients who have freely regained normal heart rate and rhythm

Type of Pacemakers Single Chamber o one lead to carry an impulse

Dual Chamber o leads on the right ventricle & atrium Triple Chamber o leads on the right atrium & both ventricles

Types of Pacing Permanent o pacemaker is implanted to heart Temporary o pacemaker is placed temporarily, usually prior to insertion of a permanent one

Methods of Pacing Synchronous o pacemaker only produces impulses when heart falls below normal rate Asynchronous o pacemaker continuously produces impulses

Pacing Failures Failure to Capture o pacemaker isnt able to stimulate the heart Failure to Pace o ECG shows no pacemaker activity when there should be Undersensing o pacemaker is unable to properly detect hearts impulse Oversensing o over sensitive pacemaker which may recognize muscle contraction surrounding the heart as impulses

Sites of Insertion transvenous via jugular vein transcutaneous pads are placed on the chest like a defibrillator

transthoracic wires inserted during cardiac surgery, control box is outside

Complications infection at site bleeding at site hemothorax from puncture of surrounding blood vessels dislocation of transvenous pacemaker

Nursing Responsibilities o keep site dry o tell patient to avoid magnets o carry identification at all times o make sure electrical equipment are grounded properly o review ECG to check for pacemaker function o observe for any complications make sure wirings are water proof