Pacemaker Implantation

By:
Hannah Jones
Lindsay Murphy
Becky Bevacqua
Micaela Kaban

What is a pacemaker?
Natural Pacemaker
The Sinoatrial node is a small bundle of specialized cells located
at the top of the right atrium. The SA node is stimulated and
sends a signal to the right and left atria causing them to
contract. The signal then continues along specialized muscle
fibers to the AV node. This node is responsible for contracting
the right and left ventricles. The combined contraction of the
atria and ventricles is one heartbeat.

Artificial Pacemaker
An implanted pacemaker mimics the function of
the natural pacemaker. It consists of two parts; the
pulse generator and the leads, or electrodes. The
pulse generator is basically a small battery
operated computer. The generator is connected to
the electrodes which are then connected to one or
two different locations in the heart depending on
the type needed.

Indications For a Pacemaker

Arrhythmias
Bradycardia
Damage due to
medications
Genetic anomalies
Heart failure
MI
Natural aging

Diagnostic Testing/Pre-op Preparation

Stress test
Echocardiogram
Holter monitor
Electrocardiogram

Pre-op Nursing Considerations

Assess knowledge and understanding of procedure
Provide information and clarification as needed
Provide emotional support to reduce anxiety and fear
Teach ROM
Place EKG electrodes away from potential incision site to promote skin
integrity

Pre-op Care
Bring list of all medications including herbal supplements and over the counter
medications
Stop taking any blood thinners or NSAIDs per MD orders
Notify MD of handedness (left or right)
Do not eat or drink anything after midnight with the exception of a small
amount of water for medication

Day of Procedure
Arrive on time
Sign informed consent (with MD)
IV placement and fluid administration
Any pre-op medications

Surgical Procedure
Pacemaker implantation is often a minor surgery
performed in hospital or outpatient setting.
A small incision is made into a major vein near
the clavicle. The leads are inserted and are
brought to the heart via the help of an x-ray.
Once the leads are in place, they are attached to
the pulse generator which is placed beneath the
skin.
The patient is connected to an EKG monitor and
vital signs are monitored continuously.

Pacemak
er

Post-op
X- ray is taken to ensure correct placement
Monitor incision site
Monitor VS- Assess for any chest pain, SOB,
twitching or hiccups
Patient given sling to prevent excessive movement
of arm
Length of stay is usually one day

Discharge Teaching
Avoid heavy lifting for one month after
procedure
Avoid contact sports
MD will check pacemaker every three months
Pacemaker battery can last from 5-15 years
with an average of 6-7

Complications
Bleeding
Nerve damage at incision site
Severe bruising or swelling
Pneumothorax
Puncture of heart muscle
Tearing of vein or artery wall
Thrombus
Air embolus
Anaphylaxis due to contrast medium
Heart attack, stroke, or death (rare)

Special Precautions
Include wallet card
If traveling, inform security of device
Avoid equipment such as welding devices, heavy equipment or motors because they inhibit pulse
generator
Turn off large motors when working on them
Do not place a phone or MP3 player in pocket over pacemaker
Avoid use of headphones
Avoid medical procedures such as MRI, shockwave lithotripsy, electrode cauterization
Notify MD/dentist prior to any procedures
The following devices can disrupt signaling: microwaves, high tension wires, metal detectors,
industrial welders, electrical generators

Five Must Know Facts

1.

Teach patient to take their pulse daily.

2.

Maintain regular exercises 30 minutes daily

3.

Maintain regularly scheduled check ups and notify

MD of any symptoms that concern you (i.e.
palpitations)

4.

Be aware of devices that may interfere with

pacemaker

5.

Carry ID card at all times.

Work Cited
Heart pacemaker - discharge: MedlinePlus Medical Encyclopedia. (2014, August 12). Retrieved August 11, 2015, from
http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000097.htm
Living With Your Pacemaker. (2014, October 23). Retrieved August 11, 2015, from
http://www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Living-With-YourPacemaker_UCM_305290_Article.jsp
Woodruff, J., & Prudente, L. (2005). Update on Implantable Pacemakers. The Journal of Cardiovascular Nursing, 20(4),
261-268.
Pacemaker. (2013, April 10). Retrieved August 27, 2015, from http://
www.mayoclinic.org/tests-procedures/pacemaker/basics/definition/prc-20014279
Pacemakers. (n.d.). Retrieved August 12, 2015, from https://www.nhlbi.nih.gov/book/export/html/4845
Artificial Pacemaker. (n.d.). Retrieved August 27, 2015, from http://
www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Artificial-Pacemaker_UCM_448480_Ar
ticle.jsp
Lewis, Dirksen, & Heitkemper. (2014). Dysrhythmias. In Medical Surgical Nursing Assessment and Management of
Clinical Problems (9th ed., pp. 803-805). St. Louis, Missouri: Elsevier Mosby.