Temporary Transvenous Cardiac Pacing
Reviewed and revised 20 August 2014
OVERVIEW
- emergency pacing via an intravenous device
USES
- life-threatening or unstable bradyarrhythmia
DESCRIPTION
3 types of pacing equipment:
(1) semi-rigid, bipolar pacing lead (under II guidance)
(2) paceport PA catheter
(3) balloon flotation leads (ECG or pressure guided)
METHOD OF INSERTION AND/OR USE
- supine and head down
- U/S guided or landmarks (apex of sternomastoid sternal and clavicular heads)
- insert sheath
(1) Flotation Catheter – can be inserted by ECG guidance as follows:
- connect pacing wire to pacing box (black to negative, red to positive)
- set to demand
- check box and batteries are OK
- turn rate to 30 bpm greater than intrinsic rate
- set output to 4mA
- insert wire to 15-20cm
- inflate balloon
- advance observing ECG for changes in ECG morphology and capture of pacing rate (if using II direct wire to RV apex)
- approximate depth 35-40cm
- once pacing captured deflate balloon and decrease mA to find threshold and double.
- get patient to cough to check that wire doesn’t dislodge.
- tape wire securely so it doesn’t move
(2) Semi-rigid wire
- insert under II guidance until leads up against right ventricular wall
- connect to control box
- set output and sense to minimum and to an appropriate rate
- gradually increase output until capture takes place (ideal capture @ 2mA)
(3) Paceport on PA
- insert PAC
- attach pressure transducer to RV port to ensure in RV
- attach adaptor to TV port and insert probe to the reference mark
- attach ECG monitoring and advance until ST elevation indicates contact with epicardium
- secure and connect side port to a saline flush
- commence pacing
OTHER INFORMATION
- dress to ensure wires are not exposed
- suture
- perform CXR
COMPLICATIONS
- arrhythmia
- microshock
- CVL insertion complications
- myocardial perforation
- infection
VIDEO
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
2 Comments
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Should the side port always be connected to KVO fluids?
Hi Susan,
In our institution we don’t normally run any fluids down the sheath side-port… unless we need the access! I would refer to your local policies and procedures though to clarify the same.
Regards,
James