Why transcutaneous pacing

The most common indication for TCP is symptomatic bradycardia, most commonly resulting from acute MI, sinus node dysfunction, and complete heart block. The AP position is preferred because it minimizes transthoracic electrical impedance by sandwiching the heart between the two pads.

Overdrive pacing is used to stop symptomatic tachydysrhythmias. Indications : Hemodynamically significant hypotension, chest pain, pulmonary edema, altered mental status bradydysrhythmias unresponsive to atropine, asystolic cardiac arrest more likely to be successful when initiated early after a witnessed arrest—unwitnessed arrest seldom responds to transcutaneous pacing , failed intrinsic pacemaker.

When considering institution of transcutaneous pacing, always think about alternate causes for acute dysrhythmia, e. Treat underlying cause. Optimal placement for pads varies by manufacturer, but is generally anterior-posterior or anterior-lateral, with the former being most common. Begin at 10 milliamps and increase by increments of 10 until capture is noted. A medical history is obtained from family members and includes heart failure, stroke, and hypertension.

High degree AV block with wide complex escape rhythm. The transcutaneous pacer is set for 70 PPM at 50 mA. Pacing spikes are visible with what appear to be large, corresponding QRS complexes. The patient begins to move and reaches for the pacing pads. However, she is still non-verbal and does not follow commands. Transcutaneous pacing TCP is a difficult skill that is often performed incorrectly. The problem of false capture also known as echo distortion is under-recognized and under-reported in the medical literature.

There are many reasons why medical professionals often fail to achieve true electrical and mechanical capture. The EKG monitor continued to demonstrate adequate ventricular capture by the pacer. These heart contractions did not correspond with the surrounding thoracic muscle contractions generated by the pacer. The current was gradually increased to mA, and the heart began to contract in unison with the pacer shocks.

The opinions expressed on the website are the opinions of the website and content authors alone and do not represent the policies or opinions of Maine Medical Center, Maine Medical Partners, MaineHealth, or Tufts University School of Medicine. About Us Contact. Transcutaneous Pacing. When do we perform Transcutaneous pacing TCP? Symptomatic clinically significant bradycardias Don't just treat a number. Treat those bradycardias associated with hypotension, pulmonary edema, or evidence of decreased cerebral perfusion that is unresponsive to initial first line measure Initiate TCP while searching for correctable causes and concomitantly administering other therapies i.

What about transvenous pacing TVP? TCP is only a bridge until a transvenous pacemaker can be placed There are a few instances where TCP may be preferable over TVP Patients who have received thrombolytics Patients who may respond to respond to therapy eg.

Five Step Approach to Transcutaneous Pacing. Step 1: Apply the pacing electrodes and consider sedation eg. Step 2: Turn on the monitor and set it to "pacing mode".

Step 3: Select the pacing rate using the rate button generally bpm is adequate. Step 4: Increase current output from minimal until capture is achieved. Below is an ECG with incomplete capture. Step 5: Confirm mechanical capture with pulse or ultrasound [3,4].

Complications Induction of Vfib rare Patient discomfort, burns these are rare due to the large pads and lower outputs of today's TC pacing devices Failure to recognize an underlying treatable ventricular fibrillation due to obscuration of the ECG by pacer spikes This can be troubleshooted by hitting the "cancellation button" on your monitor.