External Pacing

 

Clinical Indications:

 

  • Patients with symptomatic bradycardia (less than 60 per minute) with signs and symptoms of inadequate cerebral or cardiac perfusion such as:
  • Chest pain.
  • Hypotension.
  • Pulmonary edema.
  • Altered mental status, confusion, etc.
  • Ventricular ectopy.

 

Procedure:

 

  1. Press ON.
  2. Connect the patient ECG cable, apply ECG electrodes to the ECG cable and patient, and select Lead I, II, or III.
  3. To receive the best monitoring signal, make sure there is adequate space between the ECG electrodes and the therapy electrodes.
  4. Identify the QUIK-COMBO therapy electrode sites on the patient. Use either the anterior-lateral or anterior-posterior position and prepare the patient’s skin.
  5. Apply therapy electrodes to the patient.
  6. Connect the therapy electrodes to the therapy cable.
  7. Press PACER.
  8. Observe the ECG rhythm.
  9. Confirm that a triangle sense marker (▼) appears near the middle of each QRS complex.
  10. If the sense markers do not appear or are displayed in the wrong location (for example, on the T-wave), adjust ECG SIZE, or select another lead.
  11. The sense marker location may vary slightly on each QRS complex.
  12. Press RATE or rotate the SPEED DIAL to select the desired pacing rate. (70 bpm for adult)
  13. Press CURRENT or rotate the SPEED DIAL to increase current until electrical capture occurs.
  14. Electrical capture is indicated by a wide QRS complex and a T-wave following the pace marker.
  15. For each delivered pacing stimulus, a positive pace marker (▲) displays on the ECG waveform.
  16. Note: Dashes (---), not heart rate, are displayed on the Home Screen during noninvasive pacing, and heart rate alarms are disabled.
  17. Palpate patient's pulse or check blood pressure to assess for mechanical capture.
  18. Consider use of sedation or analgesia if patient is uncomfortable.
  19. Note: To change rate or current during pacing, press RATE or CURRENT.
  20. The RATE and CURRENT buttons allow changes in increments of 10; the SPEED DIAL allows changes in increments of 5.
  21. Note: To interrupt pacing and view the patient's intrinsic rhythm, press and hold PAUSE. This causes the pacer to pace at 25% of the set rate. Release PAUSE to resume pacing at the set rate.
  22. To stop pacing, reduce current to zero or press PACER.
  23. Document the dysrhythmia and the response to external pacing with EKG strips in the patient care report (PCR).

 

Demand and Non-Demand Pacing

 

  • The LIFEPAK 15 monitor/defibrillator can be used for either demand or non-demand (asynchronous or "fixed rate") pacing.
  • Demand mode is used for most patients. In demand mode, the LIFEPAK 15 pacemaker inhibits pacing output when it “senses” the patient’s own beats (intrinsic QRSs).
  • In demand mode, if the ECG SIZE is set too low to detect the patient’s beats, or if an ECG lead becomes detached so that the ECG rhythm is not present, the pacemaker generates pacing pulses asynchronously. This means that the pacemaker generates pacing pulses at the selected rate regardless of the patient’s ECG rhythm.
  • Non-demand mode can be selected if noise or artifact interferes with proper sensing of QRS complexes.
  • Press OPTIONS to access non-demand mode.
  • Noninvasive Pacing Procedure
  • ECG monitoring during pacing is performed with the ECG electrodes and patient ECG cable.
  • Therapy electrodes are not capable of monitoring ECG and delivering pacing current at the same time.
  • Be sure to place the QUIK-COMBO therapy electrodes in the proper locations. Improper placement of the electrodes may make a difference in the capture threshold. For example, if the electrode placement is reversed, more pacing current may be needed to achieve capture.
  • WARNING POSSIBLE INABILITY TO PACE
  • Using other manufacturers’ combination therapy electrodes with this device could cause a decrease in pacing efficacy or the inability to pace because of unacceptably high impedance levels and invalidate the safety agency certifications. Use only the therapy electrodes that are specified in these operating instructions.
  • WARNING POSSIBLE INTERRUPTION OF THERAPY
  • Observe the patient continuously while the pacemaker is in use. Patient response to pacing therapy (for example, capture threshold) may change over time.