1. Slow heart rates (bradycardias) that produce
unstable hemodynamics (e.g. low BP, stroke
2. Slow heart rates (particularly escape rhythms)
that do not respond to drug therapy.
3. Any condition as a temporary measure in
preparation for a transvenous pacemaker.
4. Non emergent indications.
a. Overdrive pacing (when drugs and electrical
cardioversion have failed).
b. Heart blocks in the presence of myocardial
需求模式(同步):Demand (synchronous) Mode is the preferred means of
pacing as it paces only when the patient's heart rate falls below a
level set by the clinician. This avoids problems such as a pacer
impulse landing on a T-wave and possibly causing a ventricular
固定模式(非同步):Fixed (asynchronous) Mode paces at the rate set by the
clinician regardless of the patient's heart rate. This mode is not the
preferred means of pacing and is usually reserved for when 1) the
pacer cannot sense the heart rate or 2) when motion artifact
prevents the pacer from sensing the heart rate.
Increase the Output (mA) until the pacer spike is seen in
front of the QRS complex.The amount of mA used
varies per patient. Increasingthe output (mA) slightly above
where capture is obtained may help prevent the loss of
capture.The QRS from the pacemaker
will appear wide (much like a PVC or ectopic beat). This is
normal for a TC pacemaker.
The muscle under the pads will contract as the
pacemaker discharges.However, this muscle
contraction does not mean the pacemaker is producing
good cardiac output.
Effective capture of the cardiac muscle is seen by
1.捕獲失敗(failure to capture):
Failure to obtain capture occurs in demand and fixed
mode. Increasing the Output(mA) may obtain capture. Be
sure the pads have good skin contact. Check for correct pad
2.感應失敗(failure to sense):
This problem occurs in Demand Mode only and is
seen when the pacemaker discharges immediately after
the patient's own QRS complex (the discharge occurs
in the refractory period of the heart). In this case, the pads
are not sensing the patient's heartbeat. Select a different
monitoring lead or reposition the pads. Fixed pacing may be
1.Educate patient about possible discomfort with pacing.
2.Instruct patient and family that muscles will
twitch with each pacemaker beat.
3.If sedation is needed (a normal occurrence),
be prepared to initiate when pacemaker is
4.Discomfort may not be noticed until higher
mAs are used.
5.Sedation should be for a targeted level
(e.g. Ramsey of 2-4).
6.Prepare skin for pad placement (cleaning,
shaving if necessary).
7.Be sure to avoid breaking the skin while shaving.
8.Check skin routinely to avoid severe skin
9.Move pad placement (if patient condition
allows) as necessary to protect skin.
1.Evaluate pads for comfort.Pads should be checked
often. Normally they are checked every 30 minutes
(to avoid severe skin irritation).
2.They should not be left in the same place for more than a few hours.
3.Ensure there is a pulse with each QRS complex.Otherwise,
electromechanical dissociation may exist.
4.Routinely ensure that the pacemaker is capturing the
heart rate with each discharge (check for a
pulse with each pacer spike).
5.Identify the length of time the pacemaker is to be
used. Keep in mind TC pacing is only temporary,
usually less than a few hours.
開機-->貼貼片 換接插座-->按 ON-->調MODE
DEMAND (PRN) 或 FIX(一直PACING)-->
按 START-->調 RATE p/min 從60p/min開始-->調輸出 mA (output)