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).