Page 213 - Critical Care Nursing Demystified

198 CRITICAL CARE NURSING DeMYSTIFIED

Redress the wires according to hospital protocols to prevent infection.
Assist the health care provider with removal before the patient goes home.
The wires will be pulled out of the chest and a dry, sterile dressing will be
applied.
Teach the patient signs/symptoms of wires site infection and how to redress
them, to give the patient a sense of control and increase observation for
complications.
Assure the patient that the wires will be removed prior to discharge, so the
patient does not worry about care of the wires at home.

Nursing Interventions for Transvenous Pacing

Assist with insertion of the catheter. The physician will ask the nurse to inflate
the balloon for proper placement.

Document the rhythm on the monitor to determine the patient’s baseline
rhythm.

Set the rate, mA, and mode of pacing to individualize the settings for the
patient.

Redress the site, maintaining electrical safety as with the epicardial wires to Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
prevent dysrhythmia from outside electrical energy traveling along the cath-
eter to the heart.

NURSING ALERT

The nurse must always be aware that a pacing catheter or epicardial wires, unless
grounded, can carry large amounts of energy into the heart. Always secure them
away from electrical interference, make sure the ends of the wires are completely
covered with protective devices (according to manufactures’ directions), AND wear
gloves when touching them!

Permanent Pacemakers
Permanent pacemakers are implanted surgically, usually beneath the clavicle in
the right chest. The generator box is small, about the size of an Oreo cookie,
and easily overlooked, so look for a telltale horizontal surgical incision in that
area. The surgery is done under local anesthesia and does not take long. One
end of the pacemaker catheter is implanted or screwed into the chamber(s) of
the heart to be paced; the other end is tunneled to the generator box. Since this
is a permanent device usually for heart blocks and SA node dysfunctions, it
requires much more patient education.