PACEMAKER INSERTION
Submitted by: BOHAYO, BIANCA P. (BSN4A - Group 4)
++++++++++++DEFINITION+++++++++++ blood pooling under the skin or deeper
A pacemaker is a small, battery-powered tissues, causing swelling or bruising.
device implanted under the skin via surgery Pneumothorax (lung collapse)
to regulate abnormal heart rhythms Pneumothorax or lung collapse can occur
(arrhythmias) by generating electrical during pacemaker insertion if the needle or
impulses that stimulate cardiac contractions. catheter accidentally punctured the lung
while accessing the veins, allowing air to
enter the chest cavity and cause the lung to
collapse.
Nerve damage
Pacemaker insertion can lead to nerve
damage if the leads irritate or damage
nearby nerves, if infection spreads to
nerves, or if scar tissue forms around the
leads, although such complications are rare.
There are three types of pacemakers:
● Single chamber pacemaker. This Pacemaker malfunction
type usually sends electrical signals Pacemaker malfunctions during insertion
to the lower right chamber of the can occur due to improper lead placement,
heart. lead dislodgement, lead damage, infection,
● Dual chamber pacemaker. This poor electrode contact, device malfunction,
type sends electrical signals to the or complications like bleeding.
upper and lower right heart
chambers. Lead displacement or fracture
● Biventricular pacemaker. This type Lead displacement or fracture can occur
also is called a cardiac due to improper placement, physical
resynchronization pacemaker. It's for movement, mechanical stress, or damage
people who have heart failure and a during implantation, leading to pacing failure
slow heartbeat. The device or ineffective stimulation.
stimulates both lower heart
chambers. It helps make the heart +++++++++++PROCEDURE+++++++++++
muscle stronger.
+++++++++++INDICATIONS+++++++++++
● Symptomatic bradycardia (heart rate
<60 bpm)
● Atrioventricular (AV) block
● Sick sinus syndrome
● Heart failure
● Tachy-brady syndrome
● Post-myocardial infarction (MI) 1. Pre-procedure preparation:
complications a. Patient education
b. Informed consent
++++++++++COMPLICATIONS+++++++++ c. Antibiotic prophylaxis
Infection d. Sedation and local
Pacemaker insertion can lead to infection anesthesia
if bacteria enter the body during surgery, 2. Surgical procedure:
contaminate the surgical site or leads, or if a. Incision in the chest wall
the device becomes infected over time, b. Insertion of pacemaker leads
potentially causing localized or systemic into the heart
infections like endocarditis. c. Pacemaker device
implantation
Bleeding or hematoma d. Lead connection and testing
Bleeding or hematoma can occur after 3. Post-procedure:
pacemaker insertion if blood vessels are a. Wound closure
damaged during the procedure, leading to b. Pacemaker programming
and testing
PACEMAKER INSERTION
Submitted by: BOHAYO, BIANCA P. (BSN4A - Group 4)
+++++NURSING RESPONSIBILITIES++++ 5. Laboratory Results Review:
PRE-OPERATIVE a. Assess electrolyte levels:
1. Patient Education on Procedure and Review electrolyte levels,
Device: especially potassium, as
a. Explain the procedure: imbalances can affect
Clearly describe the purpose cardiac function.
of the pacemaker, the b. Evaluate coagulation
surgical process, and the status: Review coagulation
expected duration of the studies (PT, INR, aPTT) to
procedure. assess bleeding risk.
b. Discuss the device: Explain 6. Prepare Patient for Surgery:
the components of the a. Shaving: Shave the insertion
pacemaker, how it works, site to reduce the risk of
and its limitations. infection.
c. Address concerns: Provide b. Skin preparation: Cleanse
a platform for the patient to the skin with antiseptic
ask questions and express solution to minimize bacterial
concerns. contamination.
d. Expectations: Discuss c. Positioning: Position the
potential risks, benefits, and patient appropriately on the
expected outcomes. operating table, ensuring
2. Informed Consent Verification: comfort and access to the
a. Review the consent form: insertion site.
Ensure the patient or their d. Monitor vital signs:
legal representative has Continuously monitor vital
signed the informed consent signs (heart rate, blood
form. pressure, oxygen saturation,
b. Verify understanding: temperature) to assess the
Confirm that the patient patient's overall condition.
understands the procedure,
risks, benefits, and INTRA-OPERATIVE
alternatives. 1. Monitor Vital Signs and Oxygen
c. Address questions: Answer Saturation:
any remaining questions or ○ Continuously monitor the
concerns the patient may patient's heart rate, blood
have. pressure, respiratory rate,
3. Medical History Review: oxygen saturation, and
a. Identify relevant electrocardiogram (ECG) to
conditions: Review the assess their hemodynamic
patient's medical history, stability.
focusing on cardiac 2. Assist Surgeon with Lead
conditions, bleeding Placement and Device
disorders, allergies, and Implantation:
previous surgeries. ○ Assist the surgeon by
b. Assess medication use: preparing the necessary
Document current equipment, handing
medications, including instruments, and holding
anticoagulants and retractors as needed.
antiplatelet agents, which 3. Maintain Sterile Field:
may need to be adjusted or ○ Maintain the sterile field
discontinued before the around the surgical site to
procedure. prevent infection. This
4. Allergy Assessment: involves ensuring that sterile
a. Identify allergies: Document instruments and supplies are
any allergies to medications, used, and that sterile
latex, or other substances technique is followed.
that may be used during the 4. Monitor Anesthesia and Provide
procedure. Sedation as Needed:
PACEMAKER INSERTION
Submitted by: BOHAYO, BIANCA P. (BSN4A - Group 4)
○ Collaborate with the information on scheduled
anesthesia provider to follow-up appointments with
monitor the patient's depth of the cardiologist.
anesthesia and adjust ○ Activity Restrictions: Advise
sedation as required. the patient on any temporary
5. Document Procedure and Device activity limitations, such as
Information: avoiding strenuous physical
○ Accurately document the activity or lifting heavy
type of pacemaker objects.
implanted, lead placement, ○ Device Maintenance: Instruct
programming settings, and the patient on how to care for
any complications that may the pacemaker site and any
arise during the procedure. specific precautions to take.
6. Anticipate and Respond to 5. Perform Pacemaker Checks: Use
Emergencies: a pacemaker programmer to check
○ Be prepared to respond to the device's settings, battery life, and
potential complications such pacing function.
as bleeding, pneumothorax, 6. Document Patient's Response to
or cardiac arrhythmias. Have Procedure and Device: Record the
emergency medications and patient's recovery progress, pain
equipment readily available. management, and any adverse
7. Administer Medications: events or complications.
○ Administer medications as 7. Provide Emotional Support: Offer
ordered by the surgeon or emotional support and reassurance
anesthesia provider, such as to the patient and their family,
anticoagulants, antibiotics, or addressing any concerns or
sedatives. anxieties they may have.
8. Coordinate with the Surgical 8. Discharge Planning: Assist with
Team: discharge planning, including
○ Communicate effectively with providing written instructions,
the surgeon, scheduling follow-up appointments,
anesthesiologist, and other and ensuring that the patient
team members to ensure a understands their post-operative
smooth and efficient care plan.
procedure.
++++++++ ++REFERENCES+++++++++++
POST-OPERATIVE ● Hinkle, J. L., & Cheever, K. H. (2013).
1. Monitor Vital Signs and Oxygen Brunner & Suddarth’s Textbook of
Saturation: Continue to monitor the
Medical-Surgical Nursing. Lippincott
patient's vital signs and oxygen
Williams & Wilkins.
saturation to assess their overall
condition and recovery. ● myUpchar. (2022, December 26).
2. Assess Wound for Bleeding or Pacemaker surgery: Procedure,
Complications: Inspect the surgical Purpose, results, cost, price.
site for signs of bleeding, infection, https://www.google.com/amp/s/www.my
or other complications.
upchar.com/en/surgery/pacemaker-surg
3. Manage Pain and Discomfort:
Administer pain medication as ery.amp
prescribed and assess the patient's ● Pacemaker - Mayo Clinic. (n.d.).
pain level regularly. https://www.mayoclinic.org/tests-proced
4. Educate Patient on: ures/pacemaker/about/pac-20384689
○ Pacemaker Function and
● Pacemaker insertion. (2021, August 8).
Settings: Explain how the
Johns Hopkins Medicine.
pacemaker works, including
its pacing modes and rate https://www.hopkinsmedicine.org/health/
settings. treatment-tests-and-therapies/pacemak
○ Follow-up Care and er-insertion
Appointments: Provide
