A pacemaker is a small electronic device implanted under the skin to help control abnormal heart rhythms. It has a battery and computer chip that monitors the heartbeat and sends electrical pulses to the heart when needed. Pacemakers are either permanent or temporary. Permanent pacemakers have leads placed into the heart through veins to deliver pulses. They are implanted in the upper chest. Temporary pacemakers are external and used short-term. Pacemakers come in different types depending on which heart chambers they stimulate. Nursing care involves monitoring the patient's heart rhythm and pacemaker function, caring for the incision site, and educating patients about activity restrictions and precautions.

1. 
PREPARED BY
DR.SHALI B.S
PROFESSOR
MAMATA COLLEGE OF
NURSING.KHAMMAM

2. INTRODUCTION
 A pacemaker is a match box sized electronic device that is
placed under the left collarbone. This device is powered by
lithium iodide battery and has a tiny computer to monitor
heartbeat. Usually, battery life typically ranges from seven to 15
years depending on the number of wires used. These wires are
those that are inserted in the heart through a vein. This is one
end that’s inserted and the other end is attached to the

4. WHAT IS A PACEMAKER.
A pacemaker is a device that sends
small electrical impulses to the heart
muscle to maintain a suitable heart
rate or to stimulate the lower
chambers of the heart
(ventricles)

5. The normal electrical signal starts
at the top of the heart in an
area called the sinus node located
in the right atrium.
The signal then travels through the
AV node into the lower chambers of
the heart. As the signal reaches the bottom of the
heart,
the heart contracts resulting in a
heartbeat. The normal heartbeat is 60 to 100
beats per minute at rest and varies with activity.

6. • Failure of the SA node to send out adequate
electrical signals resulting in a slow heart rate.
• A block in or below the AV node which prevents
the impulse from reaching the lower chambers
of the heart.
• Abnormal heart rhythms that are not controlled
by medications.
Pacemakers are also used to treat syncope
(unexplained fainting spells), heart failure and
hypertrophic cardiomyopathy.

7. TYPES….
 PERMANENT PACEMAKER
 TEMPORARY PACEMAKER

8. • The permanent pacemaker is usually
implanted in the upper chest and the leads
are threaded through a vein(external jugular
vein) into the heart.
• The generator is attached to the leads and
placed under the skin.
 The leads must touch the heart so the
electrical signals can be carried back and
forth between the heart and the generator.

9. The temporary pacemaker is
used to treat arrhythmias that
arouse for a small period of time.
 A temporary pacemaker is
placed outside of the body and is
removed once the permanent
pacemaker is implanted.

11. OTHER TYPES…

12. DUAL CHAMBER PACEMAKER
 These types of pacemakers use two leads,
one is placed in right atrium and the other
placed in right ventricle.
 The electrodes delivered to the heart are
timed in such a way that it stimulates the
atria to contract just before ventricles.
 An important thing is that the timings are set
in such a manner that atria and ventricles
beat in tune with each other.

13. RATE RESPONSIVE PACEMAKER
This pacemaker is used to
control the heartbeat as per
bodily changes. It uses a
sensor that recognizes the body
changes and adjusts the
heartbeat.

15. NURSING
CONSIDERATIONS..

16. BEFORE PACEMAKER
INSERTION

17. •Take informed written consent.
• Blood investigations.
• An electrocardiogram (ecg) chest x-ray.
• If patient is diabetic adjust the insulin dosage.
•Do not discontinue any of medications without
first talking to health care provider.

18.  Normal meals in the evening before
surgery.
 Nothing per mouth after 12 midnight.
 Remove make-up,nail polish,& jewellery.

19.  Secure iv line to deliver medications and fluids during
the procedure.
 To prevent infection and to keep the pacemaker insertion
site sterile:
 An antibiotic will be given through the iv at the beginning
of the procedure.
 Preparation of the part left or right side of chest.
 Sterile drapes are used to cover from neck to feet.

20. DURING PACEMAKER INSERTION
SURGICAL TEAM INCLUDES…
Cardiologist
Nurse
Technicians.

21. WHERE IS THE
PACEMAKER
IMPLANTED?

23.  The endocardial (transvenous) approach is
the most common method.
 A local anesthetic (pain-relieving medication) is
given to numb the area. An incision is made in
the chest where the leads and pacemaker are
inserted.
 The lead(s) is inserted through the incision and
into a vein, then guided to the heart with the aid
of the fluoroscopy machine.
 The lead tip attaches to the heart muscle, while
the other end of the lead (attached to the pulse
generator) is placed in a pocket created under
the skin in the upper chest

24.  The epicardial approach is a less common
method in adults, but more common in
children.
 During this surgical procedure, general
anesthesia is given.
 The surgeon attaches the lead tip to the
heart muscle, while the other end of the lead
(attached to the pulse generator) is placed in
a pocket created under the skin in the
abdomen.

25. HOW ARE THE LEADS TESTED?
 After the leads are in place, they are tested
to make sure they function properly and can
increase heart rate.
 This lead function test is called “pacing.”
Small amounts of energy are delivered
through the leads into the heart muscle.
 This energy causes the heart to contract.

26. HOW LONG DOES THE PROCEDURE LAST?
The pacemaker implant
procedure may last from 2
to 5 hours.

27. AFTER THE PROCEDURE..
 A special monitor, called a telemetry monitor,
will continually monitor heart rhythm.
 The telemetry monitor consists of a small
box connected by wires to chest with sticky
electrode patches.
 The box displays heart rhythm on several
monitors in the nursing unit. The nurses will
be able to observe heart rate and rhythm.

28.  A chest X-ray will be done after the
pacemaker implant to check lungs as
well as the position of the pacemaker
and leads.
 Feeling of discomfort at the pacemaker
implant site during the first 48 hours
after the procedure.

29. COMPLICATIONS:

30. LOCAL INFECTION AT THE ENTRY
SITE OF THE LEAD

31. SWELLING (FORMATION OF HEMATOMA)

32.  The swelling was
Aspirated under
Aseptic technique.
(White milky fluid)

33.  Bleeding
 Hemothorax from puncture of subclavian
vein or internal mammary artery
 Perforation of the myocardium.
 Dislocation of the lead.
 Ventricular ectopy & tachycardia from
irritation of the ventricular wall by the
endocardial electrode.

34. CARE OF PATIENT WITH A
PACEMAKER

35. ASSESSMENT:
 After temporary or permanent pacemaker is
implanted . the patients heart rate & rhythm
is monitored by ecg.
 Then pacemaker settings are noted &
compared with egg recordings to assess
pacemaker function.
 The incision site is observed for bleeding,
hematoma formation, or infection which may
be evidenced by swelling, tenderness,pain &
unusual drainage.& Report to physician.

36. Observe for potential sources of electrical
hazards.
Exposed wires must be carefully covered with
non conducive material to prevent electrical
accidents.
Patients with permanent pacemaker assesed
for anxiety, level of knowledge, adherence to
the therapeutic regimen.

37.  Preventing infection by changing the
dressing regularly & changes in the wound
appearance are reported.
 Checking the vitals regularly.
 Managing potential complications.
 Promoting effective coping by recognising
patients emotional status & assist the patient
to explore the feelings.

38. Teaching stress reduction techniques like
deep breathing exercises.
Develop interest in other activities like
music, drawing, reading etc.

39. TEACHING PATIENTS SELF- CARE:
 Importance of reporting or pacemaker clinic,
so that pacemaker rate & function is
monitored.
 Demonstrating how to check the pulse &
reporting if any slowing or increasing.
 Wear loose fitting clothes.
 Notify physician if the pacemaker area

40.  Limit use of arm and shoulder where the
pacemaker was placed for the first 1 to 3
months.
 Should not do any heavy pushing, pulling, or
raising arm above shoulder until told otherwise
by cardiologist.
 Do not drive until advised by your cardiologist
At least 1-4 weeks.

41. PACEMAKER
PRECAUTIONS…

42.  Avoid being near areas with high voltage, magnetic force fields, or
radiation because these can cause pacemaker malfunction.
 Symptoms of pacemaker malfunction are dizziness,
lightheadedness or changes in heart rhythm. If symptoms occur,
back up 10 feet and check your pulse.
 When you go to an airport, always carry your pacemaker card with
you. Because the pacemaker contains metal, it may trigger an
airport metal detector.
 Explain to the airport attendant that you have a pacemaker so that
special arrangements can be made for a security check.
 Do not have an MRI (Magnetic Resonance Imaging) test because
it can damage your pacemaker.

43. CALL YOUR CARDIOLOGIST IF YOU HAVE:
 • severe pain at your pacemaker site
 • frequent or constant hiccups
 • twitching of your abdominal muscles
 • shortness of breath
 • dizziness, lightheadedness
 • signs of infection: drainage, redness.
 Hospitalization is necessary periodically to
change battery.

44. CONCLUSION
 The modern pacemakers come with the facility
of recording heartbeat, monitoring blood
temperature, breathing rate and other factors to
adjust heart rate according to the changes in
the activity.
 Pacemakers are used to control a slow or fast
heart rhythm by giving small electrodes
(electrical pulses). It is different from
implantable cardiac defibrillator because it uses
light electrodes to control a heart beat; while,
ICD uses high rate of electrode to cure

45. Thank u
all