Page 690 - Cardiac Nursing

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5. Set the sensitivity at 2 mV and adjust according to sensitivity
threshold.
See the section “Nursing Considerations” for the procedure for
performing stimulation and sensitivity threshold tests.
Epicardial Pacing
The number and location of epicardial leads placed in surgery de-
termine connections for epicardial pacing. There may be one or two
Proximal atrial or ventricular leads with a ground or no ground lead. If only
Dis ltalal
one lead is on a chamber, then unipolar pacing is performed. If
there are two leads on a chamber, then bipolar pacing can be per-
formed.
Pacing cable To initiate unipolar atrial or ventricular pacing (Fig. 28-12A):
2
2
1. Connect the pacing cable to the top of the pulse generator (if
using an older pacemaker with positive and negative connec-
tions on top, make sure cable is connected positive to positive
and negative to negative).
2. Connect the other end of pacing cable to pacing wires: negative
terminal of the cable to the atrial or ventricular wire to be
■ Figure 28-11 Initiating temporary transvenous pacing. The dis- paced, positive terminal of the cable to the ground wire.
tal tail of the pacing lead is connected to the negative terminal of the 3. Set the rate at 70 to 80 bpm or as ordered by physician.
pacemaker, and the proximal tail of the pacing lead is connected to 4. Set the output at 10 mA for atrial pacing and 5 mA for ven-
the positive terminal of the pacemaker. tricular pacing, then determine stimulation threshold and set
two- to three-times higher.
5. Set the sensitivity at the lowest possible number for atrial pac-
ing and at 2 mV for ventricular pacing.
1. Connect the pacing cable to the top of the pulse generator (if To initiate bipolar atrial or ventricular pacing (see
using an older pacemaker with positive and negative connec- Fig. 28-12B):
tions on top, make sure cable is connected positive to positive
and negative to negative). 1. Connect the pacing cable to the top of the pulse generator (if
2. Connect the other end of the pacing cable to the tails of the using an older pacemaker with positive and negative connec-
pacing wire: proximal tail to positive terminal of pacing cable, tions on top, make sure cable is connected positive to positive
and distal tail to the negative terminal of pacing cable. and negative to negative).
3. Set the rate at 70 to 80 bpm or as ordered by physician. 2. Connect the other end of the pacing cable to pacing wires: for
4. Set the output at 5 mA and adjust according to stimulation atrial pacing, connect one atrial pacing wire to the negative ter-
threshold. minal of the pacing cable the other atrial pacing wire to the

A B

■ Figure 28-12 Initiating epicardial
pacing. (A) Unipolar epicardial pacing.
The ventricular lead (or atrial lead for
atrial pacing) is connected to the negative
terminal of the pacemaker and the ground
lead is connected to the positive terminal.
(B) Bipolar epicardial pacing. One ven-
tricular lead is connected to the positive
terminal and one to the negative terminal
of the pacemaker. (For atrial pacing, ei-
ther atrial lead is connected to the positive
terminal and the other atrial lead to the
negative terminal of the pacemaker.)