INDEX

SL CONTENT PAGE
NO: NO:
1 AIMS AND OBJECTIVES 3
2 INTRODUCTION 4
3 DEFINITION 4
4 PACEMAKER DECIGN 4
5 PACEMAKER METHODS 5
6 TYPES 7
7 MODES 9
8 COMPLICATIONS 11
9 NURSING MANAGEMENT 13
10 COCLUSION 20
11 BIBLIOGRAPHY 20

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AIMS AND OBJECTIVES

CENTRAL OBJECTIVES

At the end of the seminar, the group get adequate knowledge regarding the pacemakers and
apply this knowledge in caring patients with pacemakers, before during and after the
implantation

SPECIFIC OBJECTIVES

After the completion of teaching learning activity the group will be able to

1. Define the term pacemaker

2. Identify the pacemaker design

3. Describe the methods of pacemakers

4. Identify the types of pacemakers

5. Describe the complications and its prevention

6. Identify the nursing management of patient with pacemaker therapy

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INTRODUCTION

Pacemakers provide an artificial SA node or Purkinje system. Pacemakers can be

permanent or temporary. An artificial pacemaker is indicated if the conduction system fails to
transmit impulses from the sinus node to the ventricles, to generate an impulse
spontaneously, or to maintain primary control of the pacing function of the heart. Many
conditions may affect the ability of the heart's conduction system to function normally,
creating circumstances that warrant pacing. Pacemakers can be used temporarily or
prophylactically until the condition underlying the disturbance resolves. Pacemakers also can
be used on a permanent basis if the client's condition persists despite adequate therapy.

DEFINITION

The cardiac pacemaker is an electronic device used to pace the heart when the
normal conduction pathway is damaged or diseased.

PACEMAKER DESIGN

An artificial pacemaker provides an external source of energy for impulse formation

and delivery, and stimulation of myocardial tissue. Whereas numerous pacemaker models are
available, each with unique capabilities, every pacemaker consists of a pulse generator with

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circuitry, the lead, and the electrode system. The basic pacing circuit consists of a power
source (battery-powered pulse generator) one or more conducting leads (pacing leads) and the
myocardium. The electrical signal (stimulus) travels from the pacemaker through the leads to
the wall of the myocardium. The myocardium is “captured” and stimulated to contract.
Ventricular capture (depolarization) secondary to signal (pacemaker spike) from pacemaker
lead in the right ventricle.

The pulse generator is essentially the pacemaker's power source. It houses the
electronic circuitry responsible for sending out appropriately timed signals and for sensing
cardiac activity. The output circuit controls the current pulse delivery rate, pulse duration, and
refractory period. The sensing circuit is responsible for identifying and analyzing any
spontaneous intrinsic electrical activity and responding appropriately.

The pulse generator can be external or internal. The external unit is designed for
temporary pacing, primarily for support of transient dysrhythmias that impair cardiac output.

The unit is the size of a small transistor radio and operates by dry-cell batteries . There are
dials for adjustment of power, rate of discharge, and mode. The pulse generator can also be
permanently implanted. The surgeon places the permanent pulse generator into a small tunnel
burrowed within the subcutaneous tissue below the right or left clavicle or in the abdominal
cavity. The pulse generator is a small-about the size of a stethoscope head-hermetically
sealed (to prevent exposure to body fluids) lithium battery.

The lead delivers the electrical impulse from the pulse generator to the myocardium.
The leads consist of flexible conductive wires enclosed by insulating material. The electrode
is the end of the lead that delivers the impulse directly to the myocardial wall. It is usually
made of platinum-iridium, a highly conductive material that also deters the adherence of
platelets. This system not only delivers electrical impulses but also relays information about
spontaneous intracardiac signals back to the sensing circuit within the pulse generator.

Electrodes can be unipolar or bipolar. Unipolar designs incorporate the cardiac

electrode as the negative terminal of the electrical circuit with the metallic shell or second
wire of the impulse generator as the positive electrode. Bipolar systems use two wires, each
ending in an electrode a short distance apart.

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 Single-chamber pacemakers pace either the ventricles or atria and the dual-chamber
pacemakers pace both the ventricles and atria.

PACEMAKER METHODS

Impulses can be delivered to myocardial tissue by three major modes of artificial

pacing: external, epicardial, and endocardial.

External (transcutaneous) pacing.

The heart is stimulated through large gelled electrode pads placed anteriorly and
posteriorly and connected to an external transcutaneous pacemaker. Transcutaneous pacing is
the treatment of choice in emergency cardiac care because it can be started quickly while a
temporary transvenous pacemaker is being inserted or as prophylaxis against dysrhythmias. It
is also the least invasive pacing technique. Because no vascular puncture is needed for
electrode placement, transcutaneous pacing is preferred in clients who are receiving
anticoagulation therapy or who may require thrombolytic therapy.

Because the anterior electrode is placed to the left of the sternum and centered close
to the point of maximal impulse (PMI), excessive chest hair must be clipped or shaved to
ensure good contact, or alternative pacing electrode positions must be used. The pacing
device is usually activated at a rate of 80 BPM. Electrical capture is characterized by
widening of the QRS complex and broadening of the T wave. Many clients feel extreme
discomfort with each paced beat; this is a significant limitation to transcutaneous pacing.

Narcotic analgesia and sedation may be given to clients who are conscious or who
regain consciousness to reduce discomfort and anxiety. Additional complications of external
transcutaneous pacing can include skin burns, muscle twitching, psychological reactions,
failure to "capture" (inability of the impulse to initiate a contraction), and failure to "sense"
(inability of the pacemaker to sense intrinsic electrical activity)

Epicardial (transthoracic) pacing.

With this method of artificial pacing, the electrical energy travels from an external
pulse generator through the thoracic musculature directly to the epicardial surface of the heart
via lead wires. Epicardial pacing is most commonly used during and immediately after open-
heart surgery because there is direct access to the epicardium at this time. Some occasional

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complications may include lead dislodgment, microshock, cardiac tamponade, infection,
psychological reactions, failure to capture, and failure to sense.

Endocardial (transvenous) pacing.

Endocardial pacing is the most common mode of pacing the heart in emergency
situations. The surgeon inserts the pacing electrode via the transvenous route (via the
antecubital, femoral, jugular, or subclavian vein) and then threads the electrode into the right
atrium or right ventricle so that it comes into direct contact with the endocardium. This
procedure can be done at the bedside under fluoroscopic control or in a cardiovascular
laboratory.

PACE MAKER TYPES

Temporary Pacemaker.

A temporary pacemaker is one that has the power source outside the body. There are
three types of temporary pacemakers: transvenous epicardial and transcutaneous.

Temporary Pacing

Temporary pacing may be used in emergent or elective situations that require limited,
short-term pacing (<2 weeks). The pulse generator is external. Temporary pacemakers can be
applied transcutaneously and can be inserted transthoracically or, more commonly,
transvenously.

Indications for Temporary Pacing

 Maintenance of adequate HR and rhythm during special circumstances such as

surgery and postoperative recovery, cardiac catheterization or coronary angioplasty,
during drug therapy that may cause bradycardia, and before implantation of a
permanent pacemaker
 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

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  Electrophysiologic studies to evaluate patient with bradydysrhythmias and
tachydysrhythmias

Nurses responsibility

Before initiating TCP therapy it is important to tell the patient what to expect. The
uncomfortable muscle contractions that the pacemaker creates when the current passes
through the chest wall should be explained. The patient should be reassured that the therapy
is temporary and that every effort will be made to replace the TCP with a transvenous
pacemaker as soon as possible. Whenever possible analgesia and/or sedation should be
provided. Nurses need to assess and to teach to the client and family. Clients with a
temporary pacemaker need the following:

• An explanation about the pacemaker

• Monitoring for response to the pacemaker

• Maintenance of electrical safety

• Monitoring for pacing parameters (sensing, capturing, threshold)

• Protection against injury and infection

Before the procedure

Before the procedure, explain the purpose of the temporary pacemaker to the client
and family. Ensure that a permit for the procedure has been signed and that all questions have
been answered. Necessary equipment is gathered, and the external generator is checked
(battery and sense and pace modes). Assess the client's vital signs, and obtain a rhythm strip.
During the procedure, monitor the client's ECG and vital signs continuously. Large P waves
are seen as the catheter passes through the atrium, and larger QRS complexes are seen in the
ventricles. Set and maintain the stimulus and sensitivity settings according to the physician's
orders. Tape or suture the electrode at the insertion site.

After the procedure

After the procedure, assess vital signs routinely along with heart rhythm and
emotional reactions to the procedure and pacing. Secure and check all connections. Monitor

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battery and control settings. Clean and dress the incision site according to protocols. Keep the
generator dry and protect the controls from mishandling. The client must be protected from
electrical microshocks and electromagnetic interference. Wear rubber gloves when exposed
wires are handled. Check electrical equipment for adequate grounding. Limit motion of the
extremity at the insertion site. Stabilize arm, catheter, and pacemaker to an arm board and
avoid movement of the arm above shoulder level. Do not lift the client from under the arm. If
the leg is the insertion site, limit its motion, especially hip flexion and outward rotation. In
addition to protecting the client from injury, monitor pacemaker function. Document the
location and type of pacing lead. Note the pacing mode, stimulus threshold, sensitivity
setting, pacing rate and intervals, and intrinsic rhythm.

Permanent Pacemaker

A permanent pacemaker is one that is implanted totally within the body. The
permanent pacemaker power source is implanted subcutaneously usually over the pectoral
muscle on the patient's nondominant side. It is attached to pacing leads which are threaded
transvenously to the right atrium and one or both ventricles.

Indications for Permanent Pacemaker Therapy

• Acquired AV block

• Second-degree AV block

• Third-degree AV block

• Bundle branch block

• Cardiomyopathy

• Dilated

• Hypertrophic

• Heart failure

• Hypersensitive carotid sinus syndrome

• SA node dysfunction

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 • Tachydysrhythmias

Permanent pacing is indicated for chronic or recurrent dysrhythmias that are severe,
unresponsive to antiarrhythmic medication, and caused by AV block or sinus node
malfunction. The need for permanent pacemakers is confirmed through ECGS,
electrophysiology studies, and Holter monitoring. Indications for permanent pacemakers have
been grouped into three classes

Nurses responsibility is same as that of temporary pacemaker implantation

PACEMAKER MODES

There are two basic kinds of pacemakers:

1. Fixed-rate (non-demand or asynchronous).

Fixed rate pacemakers are designed to fire constantly as a preset rate without
regard to the electrical activity of the client's heart. This mode of pacing is appropriate in
the absence of any electrical activity (asystole) but is dangerous in the presence of an
intrinsic rhythm because of the potential of the pacemaker to fire during the vulnerable
period of repolarization and initiate lethal ventricular dysrhythmias.

2. Demand pacemakers

Demand pacemakers contain a device that senses the heart's electrical activity and
fires at a present rate only when the heart's electrical activity drops below a predetermined
rate level

Pacemaker codes

In order to communicate all the functions of the individual pacemakers, international

codes were developed. Pacemakers are identified with a five-digit letter code. Although the
last two letters contain pertinent information, commonly a pacemaker is referred to only by
its first three letters.

Pacemaker Function

A simple demand pacing system works in the following manner. The cardiac cycle
normally begins with the client's own beat. The pacemaker's sensor senses whether the

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intrinsic beat has occurred, if not, the pacer sends out an impulse to begin myocardial
depolarization through a pulse generator. The impulse generator is said to "capture" the
myocardium and thereby maintain heart rhythm.

Electrocardiography of Paced Beats

The ECG appearance of a paced rhythm differs from that of a normal sinus rhythm, A
pacing artifact is seen. With atrial pacing, a P wave follows the artifact but may be hidden in
some leads. Examination of leads II and V, is best for deciding whether a P wave follows a
pacer spike. The QRS complex appears normal with atrial pacing; the impulse travels through
usual conduction systems. The ECG with ventricular pacing shows an abnormal QRS
complex because the impulse begins in the ventricle. With right ventricular endocardial
pacing, a pseudo- LBBB ECG wave is created. If the left ventricle is paced, a pseudo-RBBB
is created.

Assess the ECG strip for pacer spikes followed by the expected appearance of a P
wave or QRS complex. Spikės not followed by depolarization waves or paced beats that
appear too early or too late may signal pacemaker failure.

Pacemaker Failure

1. Failure to sense: An inability of the sensor to detect the client's intrinsic beats; as a result,
the pacemaker sends out impulses too early. The failure may be due to improper position of
the catheter, tip or lead dislodgment, battery failure, the sensitivity set too low, or a fractured
wire in the catheter.

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2. Failure to pace: A malfunction of the pulse generator. The ECG shows an absence of any
impulse. Component failure to discharge (pace) can be due to battery failure, lead dislodg-
ment, fracture of the lead wire inside the catheter, disconnections between catheter and
generator, or a sensing malfunction.

3. Failure to capture: A disorder in the pacemaker electrodes; the impulse does not generate
depolarization. This complication can result from low voltage, battery failure, faulty
connections between the pulse generator and catheter, improper position of the catheter,
catheter wire fracture, fibrosis at the catheter tip, or a catheter fracture.

Clinical manifestations associated with pacemaker malfunctioning include syncope,

bradycardia or tachycardia, and palpitations. When these manifestations occur, the
malfunctioning leads or pacemaker must be replaced.

COMPLICATIONS

Complications of invasive temporary ( transvenous) or permanent pacemaker

insertion include infection and hematoma formation at the site of insertion of the pacemaker
power source or leads pneumothorax failure to sense or capture with possible symptomatic
bradycardia perforation of the atrial or ventricular septum by the pacing lead and appearance
of “end-of-life” battery parameters on testing the pacemaker.

 Complications associated with pacemakers relate to their presence within the

body, and improper functioning. The following complications may arise from
a pacemaker:
 Local infection at the entry site of the leads for temporary pacing, or at the
subcutaneous site for permanent generator placement
 Bleeding and hematoma at the lead entry sites for temporary pacing, or at the
subcutaneous site for permanent generator placement
 Hemothorax from puncture of the subclavian vein or internal mammary artery
 Ventricular ectopy and tachycardia from irritation of the ventricular wall by
the endocardial electrode
 Movement or dislocation of the lead placed transvenously (perforation of the
myocardium)

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  Phrenic nerve, diaphragmatic (hiccuping may be a sign of this), or skeletal
muscle stimulation if the lead is dislocated or if the delivered energy is set
high
 Rarely, cardiac tamponade from bleeding resulting from removal of epicardial
wires used for temporary pacing

PREVENTION OF COMPLICATIONS

Several measures are taken to prevent or assess for complications and include
prophylactic IV antibiotic therapy before and after insertion postinsertion chest x-ray to check
lead placement and to rule out the presence of a pneumothorax careful observation of
insertion site and continuous ECG monitoring of the patient's rhythm. After pacemaker
insertion the patient is permitted out of bed once stable. Arm and shoulder activity is limited
to prevent dislodgement of the newly implanted pacing leads. The nurse observes the
insertion site for signs of bleeding and to check that the incision is intact. Any temperature
elevation should be noted and pain at the insertion site should be treated. Most patients are
discharged the next day if stable.

NURSING MANAGEMENT OF CLIENTS WITH PACEMAKERS

ASSESSMENT

Assess the client for :

subjective clinical manifestations of dysrhythmias and alterations in cardiac output.

These include palpitations, syncope, fatigue, shortness of breath, chest pain, or skipped beats
felt in the chest. The client may also feel anxiety about the heart disorder and may manifest
nervousness, fear, sleeplessness, uncertainty, or hopelessness.

Objective clinical manifestations may include diaphoresis, pallor or cyanosis,

variations in radial and apical pulses such as bradycardia or tachycardia, rhythm changes,
hypotension, crackles, and decreased mental acuity. The client may be fearful of being left

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alone. Monitoring is begun, and the heart rhythm is observed continuously by a nurse, a
computer, and an ECG technician. Rhythm strips are examined at least every shift.

After insertion, monitor vital signs and pacemaker function. Pain can usually be
managed with oral analgesics if the transvenous approach has been used. Initially, instruct the
client to avoid excessive extension or abduction of the arm on the operative side. Perform
passive range-of-motion exercises on the arm. Obtain paced and nonpaced ECGS. A magnet
may be placed over the pulse generator, converting it to a fixed- rate pacing mode, so that the
client's intrinsic rhythm can be determined. The location of the pacemaker electrodes is
determined by x-ray. The model and serial numbers of the pulse generator and leads along
with the date of implantation and programmed functions of the initial implant are recorded.

Self-Care

It may be necessary to teach about the nature of the disorder several times, because
the client may have an attention span shorter than normal as a result of severe anxiety. Before
discharge, make certain clients appreciate the importance of taking antidysrhythmic agents as
prescribed. Include details concerning medication administration, dosage, and side effects in
the discharge plan. If discharged too early and in an unstable condition, many clients risk
further exacerbations or additional complications. Make sure that nursing discharge criteria
are met and documented,

When a client is at risk for development of a life threatening dysrhythmia, ascertain

whether the client's housemates and significant others know how to perform CPR. Refer them
to community agencies that provide CPR training. Sometimes clients with serious, chronic, or
potential dysrhythmias use portable telemetry units for self-monitoring at home after
discharge. This allows resumption of daily activities while providing continuous 24-hou
surveillance of cardiac rhythm. Nurses are often responsible for instructing clients in the use
of these units. Ask the client to keep a diary of daily activities so that clinicians can correlate
factors in the client's life that may be contributing to the development of dysrhythmias.
Instruct clients concerning the importance of regular medical follow-up. Advise them to keep
regular appointments with their physician after discharge. Explain to the client and significant
others how to obtain emergency medical attention if necessary.

Living under the constant threat of sudden death provokes anxiety, depression, and,
occasionally, dependent behavior. In some cases, psychological counseling may bolster

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coping resources. Recommend community and private counseling services for the client and
significant others.

Patient Monitoring.

Patients with temporary or permanent pacemakers will be ECG monitored to evaluate

the status of the pacemaker. Pacemaker malfunction primarily is manifested by a failure to
sense or a failure to capture. Failure to sense occurs when the pacemaker fails to recognize
spontaneous atrial or ventricular activity and it fires inappropriately. Failure to sense may be
caused by pacer lead damage battery failure or dislodgement of the electrode. Failure to
capture occurs when the electrical charge to the myocardium is insufficient to produce atrial
or ventricular contraction. Failure to capture may be caused by pacer lead damage battery
failure dislodgement of the electrode or fibrosis at the electrode tip.

NURSING DIAGNOSES

 Ineffective tissue perfusion related to dysrhythmias/ heart block/ pacemaker battery

failure
 Impaired skin integrity related to insertion of pacemaker/ alteration in activity
 Impaired physical mobility related to limb immobilization/pain
 Risk for injury related to pacemaker failure/ puncture or perforation of heart tissue
 Risk for infection related to pacemaker lead or generator insertion
 Risk for ineffective coping related to loss of control of heart function
 Disturbed body image related to presence of pulse generator and battery
 Deficient knowledge regarding self-care program

NURSING INTERVENTIONS

Promoting tissue perfusion

Monitor ECG for changes in rhythm, rate, and presence of dysrhythmias, monitor
vital signs every 15 minutes then every 2 hours. Ensure that all electrical equipment are
grounded. Avoid touching equipment and patient at the same time. Monitor for muscle
twitching or hiccups, insturct to avoid electro magnetic fields

Promote wound healing

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 Inspect pacemaker insertion site for redness, edema, warmth, drainage, or tenderness.
Change dressing daily, or per hospital protocol, using sterile technique.instruct on wound
care to pacer site and to avoid taking showers for 2 weeks post insertion. Instruct patient to
avoid wearing constrictive clothing until site has healed completely.

Regaining physical mobility

Evaluate patient’s perception of his degree of immobility. Maintain bedrest following

pacemaker insertion for 24-48 hrs or depending on protocol. Immobilize extremity proximal
to pacer insertion site with arm board, sling,etc, it prevents dislodgement of leads. Resume
ROM exercises one week after permanent pacemaker insertion to affected extremity. Provide
ROM to unaffected extremity immediately after pacer insertion.

Preventing injury

Monitor patient for bleeding at pacemaker site.Monitor for presence of pulses at site
distal to pacer insertion. Monitor vital signs observe for diaphoresis, dyspnoea, and
restlessness, because this may indicate puncture of subclavian vasculature and potential
hemothorax. Watch for hypo tension also. Instruct patient and family to notify physician for
redness, swelling, or drainage at site of pacemaker battery insertion.

Preventing infection

The nurse changes the dressing regularly and inspects the insertion site for redness,
swelling, soreness, or any unusual drainage. An increase in temperature should be reported to
the physician. Changes in wound appearance are also reported to the physician.

Promoting effective coping

The patient treated with a pacemaker experiences not only lifestyle and physical
changes but also emotional changes. At different times during the healing process, the patient
may feel angry, depressed, fearful, anxious, or a combination of these emotions. Although
each patient uses individual coping strategies (eg, humor, prayer, communication with a
significant other) to manage emotional distress, some strategies may work better than others.
Signs that indicate ineffective coping include social isolation, increased or prolonged
irritability or depression, and difficulty in relationships.

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 To promote effective coping strategies, the nurse must recognize the patient's
emotional state and assist the patient to explore his or her feelings. The nurse may help the
patient to identify perceived changes , the emotional response to the change (eg, anger), and
how the patient responded to that emotion. The nurse reassures the patient that the responses
are normal, then assists the patient to identify realistic goals (eg, develop interest in another
activity) and to develop a plan to attain those goals. The nurse may also teach the patient easy
to-use stress reduction techniques (eg, deep-breathing exercises) to facilitate coping.

PROMOTING HOME AND COMMUNITY-BASED CARE

Teaching Patients Self-Care

After pacemaker insertion, the patient's hospital stay may be less than 1 day, and
follow-up in an outpatient clinic or office is common. The patient's anxiety and feelings of
vulnerability may interfere with the ability to learn information provided. Nurses often need
to include home caregivers in the teaching and provide printed materials for use by the
patient and caregiver.

The nurse must provide patient teaching in addition to observation for complications
after pacemaker insertion. The patient with a newly implanted pacemaker may have questions
about activity restrictions and fears concerning body image after the procedure. The goal of
pacemaker therapy should be to enhance physiologic functioning and the quality of life. This
should be emphasized to the patient and the nurse should give specific advice on activity
restrictions. Patient and family teaching for the patient with a pacemaker is outlined in:

1. Maintain follow-up care with primary care provider to check the pacemaker site and begin
regular pacemaker function checks.

2. Report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever to
the primary care provider immediately.

3. Keep incision dry for 4 days after implantation.

4. Avoid lifting arm on pacemaker side above shoulder until approved by primary care
provider.

5. Avoid direct blows to pacemaker site.

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6. Avoid close proximity to high-output electric generators or large magnets such as an MRI
scanner. These devices can interfere with the function of the pacemaker.

7. Microwave ovens are safe to use and do not interfere with pacemaker function.

8. Travel without restrictions is allowed. The small metal case of an implanted pacemaker
rarely sets off an airport security alarm.

9. Monitor pulse and inform primary care provider if it drops below predetermined rate.

10. Carry pacemaker information card at all times.

11. A Medic Alert ID or bracelet should be worn at all times.

After discharge pacemaker function is checked on a regular basis. This can include
outpatient visits to a pacemaker interrogator/programmer or home monitoring using
telephone transmitter devices. Another method to evaluate pacemaker performance is
noninvasive program stimulation. This procedure is done on an outpatient basis in the
electrophysiology lab.

RELATED RESEARCH STUDIES

1. Safety of Permanent Pacemaker Implantation: A Prospective Study by M Reyes

Carrion Camacho, Ignacio, and Jose Rafael González-Lopez

Although pacemaker implantation is considered to be low risk, it is not exempt from

complications and technical failures during the procedure, both in the short and long term,
and the complications that such patients may present remain unknown. The aim has been to
analyze the complication rates associated with permanent pacing and to identify if these
differ between patients with or without previous antithrombotic therapy. They used a
prospective, single center, observational study of 310 adult patients with indications of
permanent pacing. They were hospitalized from 1 January to 31 December 2014 and
followed up for 6 months after the pacemaker implant. The participants were distributed into
two groups according to the antithrombotic therapy prior to the implant. The most frequent

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major complications were pneumothorax (3.87%) and lead dislodgement (8.39%), while
superficial phlebitis (12.90%) and uncomplicated hematomas (22.58%) were presented as the
most recurrent minor complications. Hematomas were the most frequent minor complication
in the antithrombotic therapy cohort, and shoulder pain was reported as the most recurrent
minor complication in the non-exposed group. Finding out about complications in pacemaker
implants enables a complete view of the process, and hence the prioritization of actions
aimed at improving safety and reducing associated risks

2. Risk Factor for Cardiac Permanent Pacemaker Infection by Hammad Shah et al

Cardiac pacemaker infections have increased globally due to increase in demand and
lack of adequate knowledge about its significantly contributing risk factors. This study was
therefore aimed to determine the prevailing causative microbes and risk factors of both single
and dual chamber permanent pacemaker infections.

This was a retrospective case control study. Cases were selected as culture positive
swab, Temporary pacemaker wire or catheter were matched with three controls for each
variable using chi square test. Multivariate regression analysis was done to determine risk
factors. It is found that Temporary pacemaker/Central line placed >24hours before permanent
pacemaker implantation, remnant pacemaker leads, corticosteroid use, no antibiotic
prophylaxis, diabetes, smoking and use of non-absorbable stitches are risk factors for
permanent pacemaker infection. Staph aureus is the most prevalent microorganism causing
infection.

CONCLUSION

A pacemaker is an electronic device that provides electrical stimuli to the heart

muscle. Pacemakers are usually used when a patient has a slower-than-normal impulse
formation or a conduction disturbance that causes symptoms. They may also be used to
control some tachydysrhythmias that do not respond to medication therapy. Biventricular
(both ventricles) pacing may be used to treat advanced heart failure that does not respond to
medication therapy. Pacemakers can be permanent or temporary. Permanent pacemakers are
used most commonly for irreversible complete heart block. Temporary pacemakers are used
(eg, after MI, after open heart surgery) to support patients until they improve or receive a
permanent pacemaker.

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BIBLIOGRAPHY

 Brunner &Suddarth ‘s Text book of medical surgical nursing 10 th edition wolter

Kluwer India New Delhi page no:690-700
 Joyce M Black, jane hokanson hawks, anabelle m keene. Medical surgical nursing. 8
th edition. Published by Elsevier. Page no: 1220-1240
 Sharon mantik lewis, margarete Mc Lean heitkemper. Medical surgical nursing. 10 th
edition. Published by mosby. Page no: 700-720
 Susan. L. Woods etat, Cardiac Nursing, 6th edition, Wolters Kluwer Publications,
Page no: 680-700
 Mary lou Sole, Klein D G, Moseley M J. “introduction to critical care
nursing”published by Elsevier, page no: 124-127

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