Device Safety: Take the lead on safety with temporary cardiac pacing
Diane Dwyer BSN, RN
Kelly Bauer BSN, RN

March 2010 
Volume 40  Number 3
Pages 63 - 64
  PDF Version Available!

TEMPORARY CARDIAC PACING is indicated for emergency treatment of some bradyarrhythmias and tachyarrhythmias, and prophylactically for patients at risk for bradyarrhythmias during cardiovascular surgery.1 A variety of temporary pacing leads are available, including transvenous and epicardial leads. A temporary transvenous pacing lead may be needed by some patients while they're waiting for permanent pacemaker implantation. A temporary epicardial pacing lead is placed on the pericardium at the end of cardiac surgery. Several epicardial and transvenous lead designs are available. Some balloon temporary pacing catheters have an extra lumen for infusion, hemodynamic monitoring, or blood sampling.2The preferred routes for emergency transvenous pacing wire insertion are the right internal jugular vein and the right subclavian vein because these routes allow for ease of manipulation.1 Regardless of the placement route or type, once a pacing lead is connected to an external pulse generator or pacemaker, the heart's electrical activity can be sensed and the myocardium paced as needed. An extension cable between the pacing lead and pacemaker is frequently used. According to the medical literature, epicardial leads are typically removed 3 to 5 days after surgery; transvenous leads should be removed as soon as possible or electively changed after 7 days. They should be changed by a new puncture and wire to limit the risk of local and systemic infection.1Pacing lead wire disconnections, fractures, and misconnections are only some of the problems known to be associated with temporary transvenous pacing leads. The following case examples were reported to the FDA through the Medical Device Reporting Program.Disconnection. Hospital staff reported many inadvertent disconnections associated with a new reusable extension cable. This problem hadn't occurred with the old model. Healthcare providers used surgical tape to maintain the extension between the pacing wire and extension

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