pacemaker

1. PRESENTED BY
ABHILASHA CHAUDHARY

2. Pacemakers are the electrode devices that can
be used to initiate the heartbeat when the
hearts intrinsic electrical system cannot
effectively generate a rate adequate to
support cardiac output.

3.  Pacemakers is an electronic device used to
pace the heart when the normal conduction
pathway is damaged or diseased.

4.  Pulse generator
 Pacemaker electrodes

5. HOW PACEMAKER WORKS ?

7.  A pacemaker consists of a battery, a
computerized generator and wires with sensors
at their tips(called as electrodes). The battery
powers the generator and both are surrounded
by a thin metal box. The wires connect the
generator to the heart.
 A pacemaker helps monitor and control the
heartbeat. The electrodes detect heart’s electrical
activity and send data through the wires to the
computer in the generator. If heart rhythm is
abnormal, the computer will direct the generator
to send electrical pulses to heart. The pulses
travel through the wires to reach the heart.

8. a)Permanent pacemaker
b)Temporary pacemaker

9.  Implanted totally in the body.
 Power source is implanted subcutaneously
usually over the pectoral muscle on the
patient non dominant side.

10.  Single-chamber pacemaker.
 In this type, only one pacing lead is placed
into a chamber of the heart, either the atrium
or the ventricle

11.  Dual-chamber
pacemaker.
 Wires are placed in
two chambers of the
heart
 One lead paces the
atrium and one paces
the ventricle
 Closely resembles the
natural pacing of the
heart.

12. Rate-responsive pacemaker.
 It has sensors that detect changes in the
patient's physical activity and automatically
adjust the pacing rate to fulfill the body's
metabolic needs.

13. Chronic atrial
fibrillation with slow
ventricular response
Hypersensitive
carotid sinus
syndrome

14. Fibrosis or
sclerotic changes
of cardiac
conduction system

15.  Sick sinus syndrome
 Tachyarrhythmia
 Third degree AV block

16.  It is one that has the power source outside
the body.

17.  There are 3 types of temporary pacemaker.
 Transvenous invasive pacemaker
(endocardial)
 It consists of lead or leads that are threaded
transvenously to the right atrium and or right
ventricle and attached to external power
source.

18.  Transthoracic invasive pacing(Epicardial
pacing )
 It is achieved by attaching an atrial and
ventricle and attached to epicardium during
heart surgery . The leads are passed through
the chest wall and attached to the external
power source.

19.  Trans cutaneous pacemaker(Non-invasive
pacing)
 It is used to provide adequate heart rate
and rhythm to the patient in and emergency
situation.

20.  Maintenance of adequate heart rate and
rhythm during special circumstances such
as surgery and postoperative recovery,
cardiac catheterization or coronary
angioplasty .
 Before implantation of a permanent
pacemaker.

21.  As prophylaxis after open heart
surgery.
 Acute anterior MI with second degree
or third degree AV block or bundle
branch block.
 Acute inferior MI with symptomatic
bradycardia and AV block

22. Preoperative care
 Financial
 Explain the procedure ,type and technique of
pacemaker to the patient
 Explain Cost of the procedure and Hospital
stay.
 Psychological
 Explain the Process of the pacemaker
insertion .
 Reassure the patient

23.  Physical
 Obtain written consent from the patient and
from nearest relative
 Remove dentures,jewellery and contact lens.
 Clean and shave the area .
 Check vital signs: temperature, BP, pulse
and respiration

24.  Intraoperative care
 Check serology: HIV, HbsAg, HCV and others
 Start an IV line with 5% Dextrose solution or
normal saline solution.
 Check the battery in pulse generator
 Prepare the emergency cart, the defibrillator
and jelly , and the ECG monitor
 Set up all equipment for the insertion of the
pacemaker

25.  The nurse should know about the
pacemaker generator including the power
switch, indicator light for pacing and
sensing, stimulus output dial, sensitivity
dial, and their proper settings.
 Assist the doctor and the scrub nurse
during the procedure step by step

26.  Observe vital signs and observe ECG
monitor carefully for arrhythmias and other
complications.

27.  Post operative care
 Receive the patient
 Keep the patient in comfort position
 Record the pacing parameters.
 -Receiving time
 -patient’s heart rate
 -Other routine care

28.  Immobilize the affected part and keep in
supine position but allow the movement of
finger and ankle joint.
 Monitor heart rate and rhythm.
 Monitor vitals signs and level of
consciousness of patient.
 Prevent infection.
 Take ECG and X-ray chest..
 Watch for complications

29.  Maintain follow up care with a physician to
check the pacemaker site and begin regular
pacemaker function checks .
 Watch for signs of infection at incision site
redness, swelling dressing.
 Keep incision dry for 1 week after
implantation.
 Avoid lifting operative side arm above
shoulder level until approved by care
provider.

30.  Avoid direct blows to generators or to large
magnets such as MRI scanner . These device
can reprogram a pacemaker.
 Microwave oven are safe to use and do not
threaten pacemaker function.
 The patient should be taught how to take the
pulse .
 Carry pacemaker information card at all the
times.

31.  Hematoma
 Pneumothorax
 Failure to sense or capture
 Perforation of atrial or ventricle septum
 Ventricular atrophy and tachycardia
 Movement or dislocation of lead
 Cardiac perforation

32.  Infection (endocarditis)
A study done on “Pacemaker Endocarditis:
Clinical Features and Management of 60
Consecutive Cases “ 89% cases were found to
be endocarditis related to pacemaker and the
causative agent was staphyloccus .

33.  Acute pain related to insertion site and
prescribed post procedure immobilization.
 Disturbed self concept related to perceived
loss of health and dependence on pacemaker.
 Impaired physical mobility related to
incisional site pain,activity restrictions.
 Risk for infection related to operative site.
 Risk for ineffective therapeutic regimen
management related to insufficient
knowledge of activity restrictions,precautions.

34. -Definition
-Components of pacemaker
-Working of pacemaker
-Types of pacemaekr
-Permanent pacemaker
-Temporary pacemaker
-nursing management
• Preoperative
• Intraoperative
• Postoperative

35.  A pacemaker is an electronic device that
provides repetitive electrical stimuli to heart
muscle when the patient’s intrinsic
pacemaker fails to provide perfusing rhythm.

36.  Topic : Trends in the incidence and prevalence of
cardiac pacemaker insertions in an ageing
population.
 Journal name : journal list open heart
 Year of publication: 2014(Jan)
 Author name: Pamela J Bradshaw, Paul Stobie
,Matthew W Knuiman, Thomas G Briffa,
and Michael S T Hobbs
 objectives:
 To determine the prevalence of cardiac
permanent pacemaker (PPM) insertions.

37.  Methods
 A population-based observational study using linked
hospital morbidity and death registry data from
Western Australia (WA) to identify all incident cases of
PPM insertion for adults aged 18 years or older.
Prevalence rates were calculated by age and sex for
the years 1995–2009 for the WA population.
 Results
 There were 9782 PPMs inserted during 1995–2009.
 Prevalence rose across the study period, exceeding 1
in 50 among people aged 75 or older from 2005

38.  This was underpinned by incidence rates which
rose with age, being highest in those 85 years or
older; over 500/100 000 for men throughout,
and over 200/100 000 for women. Rates for
patients over 75 were more than double the rates
for those aged 65–74 years. Women were around
40% of cases overall.
 Conclusions
 Rates of insertion and prevalence of PPM
continue to rise with the ageing population in WA

39.  Smeltzer Suzanne C, Barebrenda G, Hinkle Janice L, Cheever
Kerry H. Textbook of medical surgical nursing, 12th ed.
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 Lewis Sharan mantik, Heitkemper Margaret Mclean, Shannon
Ruff Dirksen,Obrien Patrical, Giddens Jean Foret, Bucher
Linda. Medical surgical nursing. 6th ed.Mosby; p.874-78
 Best practices A guide to excellence in nursing care.
lippincott William and wikins. P.252-53.
 Pamela J Bradshaw, Paul Stobie ,Matthew W Knuiman, Thomas
G Briffa, Michael S T Hobbs. Trends in the incidence and
prevalence of cardiac pacemaker insertions in an ageing
population. 2014; 1(1)
 www.nhlbi.nih.gov/health/healthtopics/topics/pace/howdoes
.