Transcutanous Pacing


INDICATIONS
  • Treatment of hemodynamically unstable brady-dysrhythmias that have not responded to atropine
  • Initial stabilization of the patient in the ED while arranging for transvenous pacemaker
  • May be used to treat refractory tachydysrhythmias by overdrive pacing
  • May be preferable to transvenous pacing in patients who have received thrombolytic agents

CONTRAINDICATIONS
  • In conscious patients with hemodynamically stable bradycardias, transcutaneous pacing is unnecessary.

 TECHNIQUE 
  1. The anterior electrode is placed at the point of maximal impulse on the left chest wall. The second electrode is placed directly posterior to the anterior electrode.
  2. Set the RATE to 60-70 bpm.
  3. Then slowly increase the output CURRENT from the minimal setting until capture is achieved on ECG monitor, usually 42-60 mA.

 COMPLICATIONS 
  • Dysrhythmia induction
  • Soft tissue discomfort with the potential for injury

 INTERPRETATION OF RESULTS 
  • Feel for a pulse and check BP to confirm that the electrical capture seen on the monitor results in improved perfusion.

NOTE
- With transcutaneous pacing, increase to 40 to 60 mA to get capture. With transvenous pacing, get capture at 5 mA, then decrease the amps. Once you lose capture, increase by 2.5 times to ensure consistent capture
- When pacing, always confirm electrical capture seen on the monitor by palpating a pulse. Electrical capture without a pulse equals PEA.
- When a magnet is placed over a permanent pacemaker, the pacemaker will temporarily revert to an asynchronous, fixed-rated pacing usually at a rate of 60 bpm.