IN this PPT I talk about : what is the pacemaker, types of pacemaker, complication of it, and nursing management for patient with pacemaker.

1. Pacemaker
PREPARED BY:
FATIMA ABU-SABHA

2. Outline:
1. Definition.
2. Pacemaker design.
3. Pacemaker types .
4. Complication of Pacemaker.
5. nursing intervention.

3. What is the pacemaker?
A Pacemaker is an electronic device that provides electrical
stimuli to the heart muscle.
• Pacemaker are usually used :
1- when a patient has a permanent or temporary slower than
normal impulse formation.
2- when A symptomatic AV or ventricular conduction
disturbance.
3- To control some tachydysrhythmias that don’t response to
medication.

4. pacemaker design
Pacemakers consist of tow components:
 electronic pulse generator; contain the circuitry and batteries
that determine the rate (beat per minute) and the strength or
output ( milliamperes) of the electrical stimulus delivered to
the heart .
 pacemaker electrodes ( leads); which carry the impulse
created by the generator to the heart.
1. Endocardial leads.
2. Epicardial wires.

5. Cont. pacemaker design
Most pacemaker have elective replacement indicator (ERI) , A signal
that indicates when the battery is approaching depletion. The
pacemaker continues to function for several months after the
appearance of ERI to ensure that there is adequate time for a
battery replacement.
Battery replacement are usually performed using a local anesthetic,
hospitalization is necessary for implantation or battery replacement.

6. Pacemaker types
Temporary pacemaker
▪ are intended for short-term use during
hospitalization. Are used to support
patents until they improve or reserve a
Permanent pacemakers .
▪ Epicardial wires and the endocardial
may be Temporary.
▪ located outside the body, and may be
taped to the skin or attached to a belt
or to the patient's bed.
▪ The Temporary generator size is about
the size of a small paperback book.
Permanent pacemakers
▪ Permanent pacemakers are
pacemakers that are intended for long-
term use.
▪ Endocardial leads .
▪ The generator implanted in a
subcutaneous pocket.
▪ They last approximately 6 to 12 years.
▪ The permanent generator it weighs less
than 1 oz and is the size of a thick
credit card.

7. Cont. Pacemaker types
Single-Chamber System
▪ The pacing lead is implanted in
the atrium or ventricle,
depending on the chamber to be
paced and sensed
Dual-Chamber Systems
▪ Have Two Leads One lead
implanted in the atrium One lead
implanted in the ventricle

8. Implanted
trancvenous pacing
lead and pacemaker
generator

9. Complication of the pacemaker use
1. Local infection at the entry site of the leads for temporary pacing, or at the
subcutaneous site for permanent generator placement.
2. Pneumothorax and hemothorax .
3. Bleeding and hematoma at the lead entry site for temporary pacing, or at the
subcutaneous site for permanent generator placement.
4. Ventricular ectopy and tachycardia from irritation of the ventricular wall by the
endocardial electrodes.
5. Movement or dislocation of the lead placed transvenously.

10. Cont. Complication of the pacemaker use
1. Phrenic nerve, diaphragmatic, or skeletal muscle stimulation if the lead is
dislocated or if the delivered energy is set high .
2. Cardiac perforation resulting in pericardial effusion and rarely, cardiac
tamponade, which may occur at the time of implantation or months later.
3. Twiddler syndrome may occur when the patient manipulates the generator,
causing lead dislodgment or fracture of the lead
4. Pacemaker syndrome ( hemodynamic instability caused by ventricular pacing
and loss of AV synchrony).

11. Nursing implementation
 ASSESSMENT AND PREVENTION OF PACEMAKER
MALFUNCTION.
 PREVENT AND TREAT THE COMPLICATIONS.
 PATIENT EDUCATION.

12. Assessment and prevention of pacemaker malfunction.
Three primary problems can occur with a pacemaker, these problems
include failure to pace failure to capture, and failure to sense.
 failure to pace occurs when the pacemaker fails to initiate an electrical
stimulus when it should fire, is noted by absence of pacer spikes on the
rhythm strip.
 failure to capture occur when the pacemaker generates an electrical
impulse and no depolarization is noted. On the ECG, A pacer spike is noted,
but is not followed by p wave or a QRS complex .
 Failure to sense occurs when the pacemaker doesn’t sense the patient’s
own cardiac rhythm and initiates an electrical impulse.

13. Assessment and prevention of pacemaker malfunction.
1. When failure to capture occurs, nurse should adjusting the output and
placing the patient on his or her left side to facilities contact of a
transvenous pacing wire with the endocardium and septum ( in
temporary pacemaker) .
2. When Failure to sense occurs, nurse should turning the patient to the
left side and adjusting the sensitivity (temporary pacemaker) .
3. The flowing data should be noted on the patient’s record : model of
pacemaker, type of generator, date and time of insertion, location of
pulse generator, stimulation threshold and pacer setting. This
information is important for identifying normal pacemaker function and
diagnosing pacemaker malfunction.

14. Assessment and prevention of pacemaker malfunction.
1. The battery and security of connections of temporary
pacemakers shall be checked every shift and documented in the
patient’s medical record.
2. The ECG is monitored very carefully to detect pacemaker
malfunction
3. Monitor V/S especially the heart rate; because the patient
experiencing pacemaker malfunction may develop bradycardia.

15. Prevent and treat the complications
1. Prophylactic antibiotics and antibiotic irrigation of the subcutaneous pocket prior
to generator placement has decreased the rate of infection to less than 2%.
2. If bleeding or hematoma occur, use of cold compresses.
3. the sites is carefully inspected for purulent drainage, erythema, and edema, and
the patient is observed for the signs of systemic infection.
4. Frequent ECG monitoring to detect cardiac perforation, because this condition
can be recognized by the change in QRS complex morphology.
5. Assess Symptoms of perforation that include pleuritic chest pain from
pericarditis, diaphragmatic or intercostal muscle stimulation and, in the
presence of pericardial effusion, patients may develop shortness of breath and
hypotension as tamponade develops.

16. Cont. Prevent and treat the complications
1. Assess sign and symptoms of pneumothorax, (hypoxia, shortness of breath,
pleuritic pain, and hypotension).
2. Assess for dysrhythmias and treat as indicated.
3. After implanted the pacemaker, nurses should minimizing patient activity to
prevent dislodgment of the pacing electrode.

17. Patent ducation
1. Object that contain magnets (eg, the earpiece
of a phone, large stereo speaker, jewelry, and
wraps) shouldn’t be near the generator for
longer than a few second.
2. Advice the patient to place digital cellular
phones at least 6 to 12 inches ( or on the side
opposite of) away from the pacemaker
generator and not to carry them in a shirt
pocket.
3. Patient should be cautioned to avoid such
situation or to simply move farther away from
the area if they experience dizziness or a
feeling of rapid or irregular heartbeat.

18. Cont. Patent ducation
▪ Battery replacement. Most pacemaker
batteries last 6 to 12 years. Replacement
requires a outpatient surgery to open the
subcutaneous pocket and replace the battery.
▪ Tell patient that : For the first few weeks after
receiving your pacemaker, don’t raise your
arm (the one closer to the pacemaker site)
above the level of your heart. Keeping your
arm down will help the area heal and keep
the leads from moving.
▪ Don’t shower until the third day after the
procedure. Gently wash the incision site, but
don’t put lotion or powder on it.
▪ Placement of the pacemaker generator and
leads in relation to the heart.

19. Cont. Patent ducation
▪ Tell all your healthcare providers,
including your dentist, that you have a
pacemaker.
▪ Don’t do arm exercises and don’t do tasks
or activities, like sweeping, that require
you to repeatedly move your arm.
▪ For 1 to 2 months, don’t lift, push, or pull
anything that weighs more than 2.3 kg ,
including children.
▪ Signs of pacemaker malfunction to
report,including dizziness,
fainting,fatigue,weakness,chest pain, or
palpitations.
▪ Avoid tight-fitting clothing over the
pacemaker site to reduce irritation and
avoid skin breakdown

20. What is this ???

21. Thank you for listening