Transcutaneous Pacing
Transcutaneous pacing is a method of external electrical stimulation of the heart through a set of electrode pads. It isn’t as efficient as transvenous pacing because the electrical stimulus (the pad) isn’t in direct contact with the heart muscle.
In a life-threatening situation, when time is critical, a trans-cutaneous pacemaker is the best choice. (See Indications for transcutaneous pacing.)
The device works by sending an electrical impulse from the pulse generator to the patient’s heart by way of two electrodes, which are placed on the front and back of the patient’s chest. Transcutaneous pacing is quick and effective, but it’s used only until the doctor can institute transvenous pacing.
Transcutaneous pacing is recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care for symptomatic bradycardia when a pulse is present. It isn’t recommended for cardiac arrest because research shows that it’s ineffective in cardiac arrest.1
Equipment
Transcutaneous pacing generator ▪ transcutaneous pacing electrodes ▪ cardiac monitor ▪ electrocardiogram (ECG) electrodes ▪ ECG cables and monitor ▪ washcloth ▪ towel ▪ nonemollient soap ▪ Optional: clippers.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
If applicable, explain the procedure to the patient.
Assist the patient to a supine position and expose his torso.6
If necessary, clip the hair over the areas of electrode placement.6 However, don’t shave the area. If you nick the skin, the current from the pulse generator could cause discomfort and the nicks could become irritated or infected after the electrodes are applied.
Prepare the skin on the patient’s chest and back by washing it with nonemollient soap and water; dry the skin thoroughly to improve electrode adherence.6
Attach monitoring electrodes to the patient in lead I, II, or III position. Do this even if the patient is already on telemetry monitoring because you’ll need to connect the electrodes to the pacemaker. If you select the lead II position, adjust the LL (left leg) electrode placement to accommodate the anterior pacing electrode and the patient’s anatomy.
Plug the patient cable into the ECG input connection on the front of the pacing generator. Set the selector switch to the “monitor on” position.
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