In the previous chapters we spoke about the Anatomy of the Heart, the Cardiac Conduction System and Nursing Patients with Dysrhythmias. In this article we’ll be going over the basics of Pacemaker Therapy.
What is a Pacemaker Device?
A pacemaker is a small electronic device that sends electrical impulses to the heart muscle cells. Typically, we’re all born with two natural pacemakers, the SA Node and the AV Node, but in cases where either of these are damaged, one requires the electronic device to do its job. So an electronic pacemaker is used if the patient has a:
Slow impulse formation (temporary or permanent)
Disturbance in the Ventricular Conduction
Uncontrolled tachydysrhythmia that does not respond to medications
Pacemakers are usually permanent, as the patient will become entirely dependent on the device. However, in hospital settings such as after an Acute MI or during an open heart surgery, the medical team would make use of a temporary pacemaker. While different brands have small variants in the models, pacemakers generally consist of two important parts:
An electronic pulse generator containing the circuitry and batteries that determine the rate and strength of the delivered electrical stimulus.
Electrodes in the form of leads or wires
How is a Pacemaker Device Inserted?
The most commonly used method to insert a pacemaker is called Transvenous Implantation, which literally means “Implanting it through the vein”. It’s typically done under local anaesthesia with some sedation, so the patient will be awake during the insertion. And it takes around one hour to complete.
After securing all monitoring equipment, IVI and ensuring sterility, the cardiologist makes a small incision (aprox. 5cm) under the left collarbone. The pacing leads (the wires) are then inserted into the subclavian or cephalic vein and threaded all the way to the heart chambers. A continuous x-ray machine is used to help the cardiologist visualise the process, until the leads are lodged into the endocardium (heart tissue). Once secured, the other ends of the leads are connected to the pacemaker generator, and fitted into a small pocket created by the cardiologist between the skin and the chest muscle.
The cardiologist will run some tests, to ensure the pacemaker is functioning well and then the patient is closely monitored by the nurses.
Click Here To Read the Nursing Care Following a Pacemaker Insertion
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