SCCM Resource Library-Transvenous Pacemaker Procedural Considerations

Pdf Summary

This document is a guide for clinicians on the procedural aspects of temporary cardiac pacing, focusing on transvenous pacemaker insertion, which is typically used to manage bradyarrhythmias. Authored by Dr. Raymond A. Pashun from the NYU Langone Medical Center, it outlines the protocols for both transcutaneous and transvenous pacing methods.

<strong>Transcutaneous Pacing</strong>:
1. Apply anterior/posterior pads and telemetry electrodes to the patient.
2. Begin sedation for patient comfort.
3. Use a cardiac monitor or defibrillator:
   - Set the device to the pacer mode and initially to an output of 70 mA.
   - Adjust the pacing rate to 30 bpm above the patient’s current heart rate.
   - Increase output until both electrical and mechanical capture are achieved.

<strong>Transvenous Pacing</strong>:
1. Start with placing a 6 Fr introducer and confirm the integrity of the balloon.
2. Ensure the sheath cover is properly placed.
3. Use ECG guidance:
   - Attach ECG limb leads, and ensure the negative electrode is connected to V1.
   - Monitor for a current of injury.
   - Test the capture threshold for confirmation.

<strong>Blind/Firing Method</strong>:
1. Connect the electrodes to the pacing generator V port.
2. Use VVI mode with an output set at 10 mA and pacing rate between 60-80 bpm.
3. Once capture is achieved, verify the threshold.

The transvenous pacemaker generator components include:
- Power (A)
- V pacing port (B)
- Rate knob (C)
- Output knob (D)
- Sensitivity adjustment (E)

Medications like Atropine, Dopamine, Dobutamine, and Isoproterenol are suggested for managing bradyarrhythmias. This guide aims to facilitate the procedure with safety and efficacy in clinical settings.

Asset Subtitle

Cardiovascular, 2025, 0:05:00

Asset Caption

This one page guide provides information helpful for preparing and through placement of a transvenous pacemaker and includes common issues and how best to troubleshoot them.

Meta Tag

Content Type Infographic

Knowledge Area Cardiovascular

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Cardiovascular

Year 2025

Keywords

temporary cardiac pacing

transvenous pacemaker

bradyarrhythmias

transcutaneous pacing

pacemaker insertion

Dr. Raymond A. Pashun

NYU Langone Medical Center

pacing methods

ECG guidance

capture threshold

Infographic

Cardiovascular

2025

Associate

Professional

Select

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