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Ateneo de Zamboanga University College of Nursing

NUSING SKILLS OUTPUT (NSO) Report No. _11_ PACEMAKER IMPLANT I. DESCRIPTION: Pacemaker implant is the procedure of placing the pacemaker under the skin of your chest. A pacemaker is a match box sized electronic device that is placed under the left collarbone. This device is powered by lithium iodide battery and has a tiny computer to monitor heartbeat. Usually, battery life typically ranges from seven to 15 years depending on the number of wires used. These wires are those that are inserted in the heart through a vein. This is one end thats inserted and the other end is attached to the pacemaker. A pacemaker is implanted by giving local anesthesia. In the operation theatre, the surgeon is accompanied by a cardiologist to monitor the proceedings. The surgeon makes an incision above the collar bone. Then, the insulated wire is inserted into the heart through a large vein into the chambers of heart. These wires deliver an electrical charge to regulate an asymmetrical heartbeat. They are placed in the areas of the heart requiring stimulation. Finally, the wire or wires are attached to the pacemaker and its placed under the skin of patients chest. II. MATERIALS/ EQUIPMENT NEEDED: Fluoroscopic Imaging Patient Hemodynamic Monitors EKG Blood Pressure Pulse Oximeter External Defibrillator External Pacemaker Sterile Table and Instruments

III. PROCEDURE

Your procedure will take place in the electrophysiology (EP) lab. You will lie on a bed and the nurse will start an IV (intravenous) line to deliver medications and fluids during the procedure. An antibiotic will be given through your IV at the beginning of the procedure to help prevent infection. You will receive a medication through your IV to make you drowsy. The medication will not put you to sleep. If you are uncomfortable or need anything during the procedure, please let the nurse know. The nurse will connect you to several monitors. The monitors allow the doctor and nurse to monitor your condition at all times during the procedure. Because it is very important to keep the area of insertion sterile to prevent infection, your chest will be shaved (if necessary) and cleansed with a special soap. Sterile drapes will be used to cover you from your neck to your feet. A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field. The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then the area will become numb. Once this occurs, an incision will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse. After the pocket is made, the doctor will insert the leads into a vein and guide them into position using a fluoroscopy machine.

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After the leads are in place, the doctor tests the leads to make sure lead placement is correct, the leads are sensing and pacing appropriately and the right and left ventricle are synchronized. This is called "pacing" and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. Any pain should be reported immediately. After the leads are tested, the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a "programmer." The pacemaker implant procedure lasts about 2 to 5 hours.

IV. DIAGRAM/ ILLUSTRATIONS:

V. NURSING RESPONSIBILITIES: 1. BEFORE PROCEDURE Your doctor may ask you to stop certain medications one to five days before your test (such as aspirin products). If you are diabetic, ask your doctor how you should adjust your diabetic medications. DO NOT eat or drink anything after midnight the evening before your test. If you must take medications, drink only with a sip of water. Wear comfortable clothes. You will change into a hospital gown for the procedure. You will lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand to provide medications and fluids during the procedure. You will be given a medication through your IV to relax you and make you drowsy, but it will not put your to sleep. The nurse will connect you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure and other measurements during the pacemaker implant. Your left or right side of your chest will be shaved and cleansed with a special soap. Sterile drapes are used to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

2. DURING PROCEDURE

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The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then, it will become numb. Once this occurs, an incision will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse. After the pocket is made, the doctor will insert the leads into a vein and guide them into position using the fluoroscopy machine. After the leads are in place, their function is tested to make sure they can increase your heart rate. This is called "pacing" and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. Any pain should be reported immediately. After the leads are tested the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a "programmer."

3. AFTER PROCEDURE You will be admitted to the hospital overnight. The nurses will monitor your heart rate and rhythm. The morning after your implant, you will have a chest x-ray to ensure the leads and pacemaker is in the proper position. Keep your wound clean and dry. After five days, you may take a shower. Look at your wound every day to make sure it is healing. Call your doctor if you experience: o Redness o Swelling o Drainage o Fever o Chills

Reference: https://www.facebook.com/photo.php?fbid=662033787143700&set=a.662033537143725.10737 41833.178857452128005&type=3&theater https://www.metrohealth.org/body.cfm?id=277&oTopID=C http://mybeautycarelab.blogspot.com/2010/02/biventricular-heart-pacemakerimplant.html#ixzz2eCeQ10xN

SEPTEMBER 5, 6, 7, 2013 Date

MS. CLARISA P. ALVIAR RM, RN Clinical Instructors Initials EIREES JOY A. MENDOZA BSN III-D

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