Page 209 - Critical Care Nursing Demystified

194 CRITICAL CARE NURSING DeMYSTIFIED

TABLE 4–6 Types of Pacers
Description Placement Invasive?
Temporary Pacers
Transcutaneous Large electrode Anterior and pos- No: Used in emer-
pads attached to terior chest gency until more
chest in anterior invasive mode/
and posterior permanent type of
position pacing can be
instituted. Acti-
vates heart from
electrical stimulus
from outside to
inside chest.
Epicardial Wires that exit Above mediastinal Yes: Placed on the
the chest inserted chest tubes atria, ventricles
surgically during OHS and
removed before
discharge.
Transvenous Catheter inserted Inserted through Yes: Usually
venously. Distal vein (subclavian, inserted through
wires attached to antecubital) or a a central line
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ative pole of eter that can pace can be inserted
external genera- the heart from peripherally.
tor box. inside the right
atrium or right
ventricle
Permanent
Permanent Implanted Near the right Yes: Wires passed
through surgical pectoral muscle through a vein
incision done (subclavian space) and attached to a
under local anes- generator box.
thesia

Table 4–6 summarizes the types of pacers, their descriptions, how they are
placed, and how they are used.
There are programmable functions/terms of pacers that you need to know.
First, some terminology that will help you understand:
• Rate – what you will set the pacemaker at to fire; usually around 60 to 80.
• Mode (demand) – synchronous is when the pacer only fires when it needs
to; think of it like a thermostat for heat—it only comes on when the heat
is below a preset level. Asynchronous (fixed) means the pacer will fire all