Pacing catheter insertion

Pacing catheter insertion

· prepare and insert PAC introducer as previously described, monitor ECG and arterial blood pressure

· confirm with medical officer method of insertion (insert in B4 using a blind technique or transfer to CCU and insert with aid of fluoroscopy)

· assist medical officer to insert pacing swan

· prepare, check and connect pacing box to patient

· set and document pacing threshold and parameters

Pacing swans are inserted infrequently and therefore the expiry date frequently expires prior to its use. Therefore please borrow pacing swan catheters from the general intensive care unit and fill out the appropriate reimbursement forms.

Removal of pacing catheter

Equipment Gauze swabs, tegaderm occlusive dressing, persist plus swab stick, stitch cutter, bung.

· explain procedure to patient

· position supine (increase CVP, thereby decreasing risk of venous air emboli)

· transfer or disconnect IV solutions if applicable and occlude with bungs

· continuously monitor PA distal lumen while withdrawing the pacing catheter

Clinical applications

Although pre-morbid states and intra-operative events play a primary role in predicting outcomes, patient care in the immediate post operative period is crucial to outcome. Diligent informed and proactive nursing management is required to prevent complications and promote recovery.

The admission of a patient to the cardiothoracic intensive care setting is a systematic process. Please refer to chapter 1. A complete verbal report from the anaesthetist and surgical consultant or registrar in his absence will alert the bedside nurse to any relevant intraoperative events (dysrhythmias, hypotension, difficult intubation, vasoactive medications and so on).

When the admission procedure has been completed (Airway Breathing Circulation) attention is turned to the systematic gathering of data to evaluate the adequacy of performance of the cardiovascular, pulmonary, renal, neurologic, gastrointestinal, haemotoligic and metabolic systems. Thorough patient assessment together with a complete verbal report from the attending anaesthetist and surgical consultant serves as a basis for formulating an individualised nursing plan.