Your SlideShare is downloading. ×
  • Like
心臟植入性電子儀器(CIED )護理照護指引- Cathroom Troubleshooting_20130907北區
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

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

  • 340 views
Published

 

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
340
On SlideShare
0
From Embeds
0
Number of Embeds
3

Actions

Shares
Downloads
5
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 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!!