| NAME
___________________________ POSITION _________UNIT
_________ EVALUATOR
______________________ POSITION ________ DATE _________
***=Critical
Performance Elements
|
Yes
|
No
|
| 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:
- Turns
"ON" monitor/defibrillator/pacer
- Connects
ECG electrodes to ECG cable and applies
to patient. (Prep skin if time allows.
- Select
LEAD I, II, or III on monitor.
- Connect
pacing cable to PACE connector port.
- Connect
pacing electrodes to pacing cable and
position electrodes on patient. The
preferred position is ANTERIOR-POSTERIOR.
- Press
"PACER" on:
- 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.
- The
heart rate will show "---",
because the heart rate meter and heart
rate alarms are inactive during pacing.
- 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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