P2portal

Pacemaker Implantation (Temporary)

Insert a guide catheter (usually 5F) into the vein and then put the guidewire (J-wire) through the guide catheter into the vein.
Remove the guide catheter out of the vein, leaving behind the J-wire still inside the vein.
Insert the introducer sheath through the J-wire into the vein – if needed suture it in place. Introducer sheath has a port for administering medicine such as blood-thinners.
Pull out the guide wire (and its dilator) out of the introducer sheath.
Guide the electrode wire into the introducer sheath and into the vein, using real-time fluoroscopic images, all the way to the heart. The electrode wire is usually 30-50 cm depending on the patient.
Attach an electrical port helper to the part of the electrode wire outside the vein. The branch of the helper labelled as ‘distal’ is then connected to the V2 chest lead on the EKG machine.
Descend the electrode wire down the vena cava into the right atrium. EKG will guide the position of the wire:

Secure the introducer sheath to hold the electrode wire in this position.
Remove the distal branch of the electrode (negative) from V2 lead of the EKG and attach to the negative port of the pacing unit, and attach the positive branch to its positive port.
Switch on the pacing unit and bring down the volume of the atrium pacer to zero – when not pacing atrium.
Start with 10 mA on the ventricular output.
Set pacers beats per minute according to the patients indication (example: 80bpm).
Slowly titrate the ventricular pace output down one unit at a time while keeping an eye on the patients monitor until there is loss of capture (heart stops responding) and the cardiac rhythm returns.
Raise the ventricular output to 2 units up to recapture (make the heart respond to the signal again).
Adjust the capture and bpm according to the patients condition.