PacemakersPacemakersPresented by: Katie CramerPresented by: Katie Cramer

OutlineOutline

Electrical System of HeartElectrical System of Heart Indications for a PacemakerIndications for a Pacemaker The ProcedureThe Procedure Post procedural Care and Follow-Post procedural Care and Follow-

upup History of the pacemakerHistory of the pacemaker

Electrical SystemElectrical System

Sinoatrial nodeSinoatrial node

-heart’s natural -heart’s natural pacemakerpacemaker

-located in the -located in the right atriumright atrium

-stimulates right -stimulates right and left atria to and left atria to contract & pump contract & pump blood into blood into ventriclesventricles

Electrical SystemElectrical System

Atrioventricular Atrioventricular NodeNode

-located between -located between the atria and the atria and ventriclesventricles

-transfers -transfers electrical signal electrical signal from SA node to from SA node to Bundle of HisBundle of His

Bundle of HisBundle of His

-located in the -located in the interventricular interventricular septumseptum

-splits into right -splits into right and left and left branchesbranches

-stimulates -stimulates ventricles to ventricles to contractcontract

Electrical SystemElectrical System

Electrical impulses are documented Electrical impulses are documented and monitored on an and monitored on an electrocardiogram (EKG)electrocardiogram (EKG)

Indications for a Indications for a PacemakerPacemaker

Symptomatic BradycardiaSymptomatic Bradycardia

Complete Heart Block Complete Heart Block

The ProcedureThe Procedure

Patient PrepPatient Prep

NPO at midnight before examNPO at midnight before exam Arrive in Cath LabArrive in Cath Lab Vitals continuously monitoredVitals continuously monitored Skin scrubbed with betadineSkin scrubbed with betadine

Doctor’s RoleDoctor’s Role

Injects lidocaineInjects lidocaine Makes incision Makes incision

-inferior to clavicle-inferior to clavicle

-through skin and subcutaneous -through skin and subcutaneous layerslayers

Threads catheter through subclavian Threads catheter through subclavian vein and into the heartvein and into the heart

The lead connects to the pacemaker The lead connects to the pacemaker and allows it to pace the heart’s and allows it to pace the heart’s electrical activityelectrical activity

Technologist’s RoleTechnologist’s Role

Assists DoctorAssists Doctor Washes out pocket with Washes out pocket with

neomycin/polymicinneomycin/polymicin Sews incision back together after Sews incision back together after

pacemaker insertionpacemaker insertion

Post-procedural carePost-procedural care

Chest x-ray Chest x-ray -checks:-checks:

-placement of leads-placement of leads

-look for pneumothorax-look for pneumothorax

Post-procedural carePost-procedural care

Inpatient Care:Inpatient Care: 1-2 night stay in 1-2 night stay in

hospitalhospital Check site for Check site for

bleeding and bleeding and infectioninfection

Patients treated Patients treated with antibioticswith antibiotics

Outpatient Care:Outpatient Care: Pacemaker Pacemaker

checked every 2 checked every 2 weeks after 1weeks after 1stst month of month of insertioninsertion

Assessed every Assessed every other monthother month

Thorough testing Thorough testing every six months every six months

HistoryHistory

11stst pacemakers date back to the pacemakers date back to the early 1900s were external devicesearly 1900s were external devices

1959 11959 1stst implantable pacemaker implantable pacemaker 1970s 11970s 1stst programmable programmable

pacemakerpacemaker 1980s 11980s 1stst steroid-eluting lead used steroid-eluting lead used Pacemakers now more like a mini Pacemakers now more like a mini

computercomputer The sky is the limit! The sky is the limit!

ConclusionConclusion

Pacemakers are useful tools that aide Pacemakers are useful tools that aide in treatment of heart arrhythmiasin treatment of heart arrhythmias

They can extend a patient’s quantity They can extend a patient’s quantity and quality of lifeand quality of life