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心臟植入性電子儀器(CIED )護理照護指引- Cathroom Troubleshooting_20130907北區
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心臟植入性電子儀器(CIED )護理照護指引- Cathroom Troubleshooting_20130907北區



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  • 1. CIED implant trouble shoot in cath room 台北榮民總醫院 護理師 郭宜蘭
  • 2. Venogram Subclavian vein cephalic vein
  • 3. Acute Venous Stenosis Limiting Access
  • 4. Implantation Techniques - Acute  Pneumothorax  Hemothorax  Pneumo- hemothorax  Brachial plexus injury  Arterial puncture  Chylothorax  Infection  Pocket Hematoma / Seroma
  • 5. Pneumothorax In PASE Trial: 1.97%
  • 6. Management for Pneumothorax  withdraw the needle, wait a moment or two to make certain that a rapid-onset, large, markedly symptomatic pneumothorax is not occurring, and then proceed  If a pneumothorax does develop, it may do so in this setting over a matter of hours and may not even be apparent radiographically at the end of the procedure.  If a lung puncture has occurred, obtaining another upright chest radiograph 6 hours after completion of the procedure is advisable. If a pneumothorax has developed, a chest tube or catheter evacuation procedure may be necessary, although frequently, a small to moderate pneumothorax that is not expanding can be managed conservatively without evacuation.
  • 7. Avoid air embolism (esp. for large-bored sheaths) press proximal end of sheath and instruct patient to hold breath during pacing lead insertion use of introducer sheath with hemostatic valve
  • 8. Myocardial Perforation  When recognized, lead MUST be pulled back  Be prepared for tamponade  May require open procedure to manage but heart usually seals itself.
  • 9. Diaphragmatic Stimulation Lead in Cardiac Vein Lead inadvertently placed into Post.Cardiac V
  • 10. Management of Pocket Hematoma  Observation and close follow- up – Soft – Minimal to no tenderness  Surgical evacuation – Tense pocket threatening suture line – Weeping suture line – Severe pain – Immunocompromised host
  • 11. Causes of Open Circuit Due to Implant Technique  Loose set screw  Improperly seated lead terminal pin  Conductor fracture – Rib Clavicle Crush – Tight ligature  “Dry” pocket - air in pocket with unipolar configuration – Replacement
  • 12. Pulse Generator Pocket Chronic  Pain - pocket neuralgia – Incorrect tissue plan – Incorrect location - too lateral – Smoldering infection  Erosion – Pressure necrosis – Smoldering infection  Migration  Twiddler’s Syndrome
  • 13. Pressure Necrosis Thinning and discoloration at lateral margin Total breakdown and 2° Infection
  • 14. Smoldering Pocket Infection with draining fistula  Presented 2 years post implant  Eschar and draining fistula at edge of incision, surrounding erythema  Waxed and waned on oral antibiotics  Local cultures were negative January 24, 2002
  • 15. Improper Location of Pulse Generator If the pacemaker is placed too lateral, it will cause discomfort every time the patient rotates arm forward
  • 16. Loose Anchoring Sleeve Twiddler’s Syndrome
  • 17. Conductor Fractures  Occurs at stress points – Rib-Clavicle Crush – Tight Anchoring sleeve ligature – Angulation of lead – Traction on lead  If external conductor of bipolar lead, conversion to unipolar will allow for elective management
  • 18. Tight Anchoring Sleeve Damage to Lead
  • 19. Conductor Coil Fracture
  • 20. Insulation Damage
  • 21. Thanks for your listening:) See you next time. It’s time to wake up!!