Wires should be fixed to the skin using sutures and dressings to prevent dislodging during patient movement. Thresholds should be checked with each nursing shift change and entry sites inspected for evidence of infection. After prolonged use, consideration should be given to the insertion of permanent pacing systems. Complications include those of central venous cannulation, sepsis, loss of sensing (leading to inappropriate pacing, and risk of R-on-T arrhythmia), or primary failure to capture (particularly after inferior infarction, where finding an area to pace can be difficult). If pacing is lost, the VOO mode should be selected, the pacemaker output steadily increased to maximum, all connections and power sources checked (or changed), or the pacing wire repositioned. Myocardial perforation may be detected as a stethoscopically audible pericardial rub or complaint of pericardial and/or shoulder pain, and may cause tamponade. Septal perforation leads to a right bundle branch block pattern instead of the usual left bundle branch block in right ventricular pacing. Diaphragmatic pacing may occur, remedied by a reduction in output current or wire repositioning.
Was this article helpful?