Nursing patients after they’ve had a pacemaker insertion is rather critical as you’ll need to pay close attention to ensure that the pacemaker is in fact working as it should. So apart from the General Post-Operative nursing care, you’ll need to add in a few more skills.
But before we get into that, have you understood the Cardiac Conductive System, and how a Pacemaker Insertion works? If you think you’re all covered there, then let’s get started.
Nursing Care After a Pacemaker Insertion – Assessment
When nursing patients after their pacemaker insertion, you need to closely monitor their heart rate and rhythm by using a continuous ECG monitor. In the patient’s file you should find a record of the device used in the procedure and the settings applied, so take a look at that and check if the details match the ECG waves you’re seeing on the monitor. If you notice any abnormal changes in the frequency of pacing and the rhythm you should alert the cardiology team right away. In addition, the blood pressure, oxygen saturation, respirations and temperature should be checked regularly to assess the patient’s hemodynamic stability.
The next priority is to assess the incision site, look out for bleeding, haematoma (blood collection), or any signs of infection. Symptoms such as swelling of the wound, extreme tenderness or warmth and pus or drainage oozing from the wound are all indicators for an infected wound.
A Chest X-ray is usually done after the procedure to confirm the position of the pacemaker leads. Moreover, the medical team will check the Chest X-ray to ensure that the procedure did not cause a pneumothorax.
Lastly, as part of your holistic care, you should assess your patient’s psychological and emotional state. Look out for signs of depression, anger or anxiety which can often arise due to ineffective coping with the implantation procedure. Along with that, you should assess your patient’s level of knowledge about the pacemaker’s care upon discharge.
Nursing Care After a Pacemaker Insertion – Patient Education
Much like after any other surgery, a pacemaker insertion requires specific patient education to facilitate home management and help the patients gain back their independence.
The first thing that your patient has to understand is that there are certain areas that they need to avoid because a strong electromagnetic field can interfere with the pacemaker and cause it to malfunction. These areas include MRI Machines, TV or Radio Transmission Towers and Electrical Substations. There are also a few small objects like phones or hand held security devices that contain magnets inside them and can trigger the pacemaker to malfunction. So it’s important to tell your patient to never carry their phone in their shirt pocket.
In some cases, the pacemaker might trigger security alarms in shops, airports or libraries, so it’s important that your patient tells the security personnel beforehand. And it’s advisable that your patient wears a medical identification alert about their pacemaker.
Lastly, ensure that your patient is coping effectively with the change and allow time for them to express their concerns and fears.
Potential Complications after Pacemaker Insertion
Infection, bleeding or hematoma at the incision site
Pneumothorax
Hemothorax from puncture of the subclavian vein or internal mammary artery
Ventricular ectopy or Ventricular Tachycardia from irritation of the ventricular wall by the endocardial electrode
Perforation to the myocardium from movement or dislocation of the lead placement
Pericardial effusion or Cardiac Tamponade from cardiac perforation
Twiddler syndrome if the patient manipulates the generator
Pacemaker syndrome causing hemodynamic instability caused by ventricular pacing and loss of AV synchrony
Adding these things to the general post-operative nursing care should help you provide an all-rounded holistic care program to your patient 🙂
Next up: Cardioversion & Defibrillation for Nursing Students