Transcutaneous pacing

Question 1

What are the advantages of TCP?

Answer 1

Non invasive and established quickly
Easy to perform
Requires minimal training
Can be initiated while waiting fro expert help to establish transvenous pacing

Question 2

What are the disadvantages?

Answer 2

Pt discomfort and sedation/analgesia may be required

Question 3

Where are the pads placed during TCP? What factors may affect pad placement?

Answer 3

Anterolateral

• one pad placed right parasternal in 2nd intercostal space
• one pad mid axillarly line over the 6th left intercostal space

Shpuld be placed 8 cm away from implantable devices

Question 4

What are the differences between asynchronous and synchronous pacing?

Answer 4

Asynchronous

• fixed mode
• deleivers pacing irrespective of the pts intrinsic rhtyhm

Synchronous
- defib senses pt’s QRS complexes and delivers pacing stimulus when only needed

Question 5

What are the factors which affect success of TCP?

Answer 5

Electrode to skin contact - ensure skin is dry
Electrode size, should be > 8 cm in diamter
Pad position

Question 6

What are the indications for TCP of bradyarryhtmias?

Answer 6

• Symptomatic bradyarrhythmias failing response to chemical pacing with atropine 500 mcg IV (rpt to 3 mg), aAdrenaline 2-10 mcg/min
• recent asytolic events
  Mobitz TII AV block
  CHB
  Ventricular standsti;l
  HR < 40 bpm
  HF
  Ventricular arrhytmia

Question 7

How do you identify 
- failure to capture
- failure to sense
- failure to pace
What are the common causes of the above?

Answer 7

Failure to capture

• pacing spike NOT followed by QRS complex
• due to poor pad contact
• non-viable myocardium
• inadequate energy output

Failure to sense

• unbale to sense pts intricnsic rhythm or so sensitive that it senses external or internal signals as QRS complexes and fails to deliver electrical impulse.
• due to disconnection or poor contact of ECG electrodes or ECG gain may be too high or low

Failure to pace
- technical problem
COMMENCE CPR