1.緊急適應症:
1. Slow heart rates (bradycardias) that produce
unstable hemodynamics (e.g. low BP, stroke
volume, SvO2).
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
infarction.
2.模式:
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
dysrhythmia.
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.
3.位置:
4.心電圖波型:
正確波型--QRS複合波寬，QRS波前有一尖峰，形狀大部分像是VPC或脫逸性節律~~~
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.
注意事項:
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
improving hemodynamics.
錯誤波型:
如果QRS複合波前無一尖峰(spike)，也許存在下列問題之一
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
placement.
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
indicated.
6.皮膚應注意事項:
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
activated.
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
irritation.
9.Move pad placement (if patient condition
allows) as necessary to protect skin.
7.護理問題:
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.
8.節律器調整:
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)
DEMAND (輕微的)：從最低調起，如無效再往上慢慢調，直到可以的mA再加10%
ex:20mA-->30-->......-->60(有效)再加60*10%--->最後應為66mA
FIX: 從最高往下調，直到無效的時候回到上一個有效的量，再加其10%
ex: 200mA-->190mA-->......-->160mA(有效)-->150(無效)-->最後應160+160*10%--->176mA
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