Unit 2: Pacemaker Types

Question 1

External Pacemakers

Answer 1

• Transcutaneous (TCP)
• Transvenous (TVP)
• Transthoracic (TTP)

Question 2

Transcutaneous (TCP)

Answer 2

-defibrillator pads are placed on the patients torso using an anterior/posterior position

> On monitor: pacer spikes prior to QRS complexes

> Nursing Care:

• place pads on patients chest and back
• monitor HR, BP, Rhythm
• stay w/ patient until stable
• maintain continuous cardiac monitoring to ensure detection of rhythm change or pacer failure

Question 3

Transvenous (TVP)

Answer 3

a pacer wire is inserted into the right ventricle (so that it touches the wall) through central venous access; wire is attached to external pacemaker

> On monitor: pacer spike prior to QRS complex

> Nursing:

• monitor BP, HR, and Rhythm
• maintain continuous cardiac monitoring to ensure detection of rhythm change or pacer failure
• monitor central venous access for signs of infection

Question 4

Transthoracic (TTP)

Answer 4

a pacer wire is surgically placed in the atrium or the ventricle and fed out through the skin; externalized wire is attached to an external pacemaker

> On monitor:

• Atria = pacer spike prior to P wave
• Ventricle = pacer spike prior to QRS

> Nursing:

• monitor BP, HR, an Rhythm
• maintain continuous cardiac monitoring to ensure detection of rhythm change or pacer failure
• monitor incision site for signs of infection

Question 5

Internal Pacemakers

Answer 5

-Atrial
-Ventricular
-Biventricular
-Dual Chamber
>pacer wires are placed in the atrium, ventricle, or both, and attached to a small pacemaker generator placed under the skin near the clavicle

> On monitor

• Atria = pacer spike prior to P wave
• Ventricle = pacer spike prior to QRS
• Biventricle = double pacer spikes prior to QRS (d/t having pacer lead in each ventricle)
• Dual Chamber: pacer spike prior to P wave and QRS wave

> Nursing:

• monitor BP, HR, and Rhythm
• maintain continuous cardiac monitoring to ensure detection of rhythm change or pacer failure
• do not place medication patches or defibrillation pads over pacemaker
• monitor incision site for infection