Cardiology In Critical Care


NAME ___________________________ POSITION _________UNIT _________

EVALUATOR ______________________ POSITION ________ DATE _________

***=Critical Performance Elements



COMPETENCY STATEMENT: To provide care for the patient requiring transcutaneous pacing.    
1. Identifies indications for transcutaneous pacing.    
2. Identifies patient, explains procedures if not emergency situation.    
3. Considers O2, IV, VS, rhythm strip with EKG if time allows.    
4. *** Prepares equipment for pacing:
  1. Turns "ON" monitor/defibrillator/pacer
  2. Connects ECG electrodes to ECG cable and applies to patient. (Prep skin if time allows.
  3. Select LEAD I, II, or III on monitor.
  4. Connect pacing cable to PACE connector port.
  5. Connect pacing electrodes to pacing cable and position electrodes on patient. The preferred position is ANTERIOR-POSTERIOR.
  6. Press "PACER" on:
  7. Indicator light illuminates. Demand pacing message appears in upper right corner of the monitor screen. Press NON-DEMAND button on back of defibrillator/monitor/pacemaker if non-demand pacing desired.
  8. The heart rate will show "---", because the heart rate meter and heart rate alarms are inactive during pacing.
  9. Select desired pacing rate. (Pacemaker powers up at rate of 60ppm and CURRENT of 0mA.)
5. Observe monitor screen. Sense marker should appear on each QRS complex. If sense marker not present on QRS or appears elsewhere, adjust ECG SIZE for optimal sensing. If fails, select another lead or reposition the ECG electrode and readjust ECG SIZE. If intrinsic beats are not present, or if non-demand pacing has been selected, omit this step.    
6. *** When defibrillator/pacemaker is sensing properly, activate pacing by turning the CURRENT dial clockwise, increasing slowly until monitor screen shows evidence of electrical pacing capture.    
7. Consider sedation or analgesia. Palpate patient’s pulse or check blood pressure to assess for perfusion (mechanical capture).    
8. When activated, recorder will document pacing parameters. Each pacing stimulus is marked with an arrow on the lower edge of the ECG paper.    
9. To stop pacing, press "PACER" again. The indicator light will go out. Alternately, reduce pacing current to zero (indicator light stays on).    
10. *** Describe electrical safety measures, normal pacing, failure to sense and failure to capture.    
11. Explain nursing care, documentation requirements, potential complications.    

*** Must perform these critical elements for successful completion.

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This page last updated 07/25/10

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