dropping a transvenous pacer

[JkGrocerz]

---

Members do not see this ad.

seen one about a year ago, haven't really done one yet. tried reading up on it in tintinalli but it didnt give me all the info i wanted.

anyone know what to do and how to do it? I'm sure there are some people here who know how to do these . if there's some place on the web or in a book please let me know

thanks

 

[BADMD]

http://www.amazon.com/Clinical-Procedures-Emergency-Medicine-Roberts/dp/0721697607

The bible of ED procedures

 

[WallowaWanderer]

I don't know but if you drop it I would definitely open another kit. Those things are supposed to be sterile and stuff.

 

[kungfufishing]

5 second rule

 

[WilcoWorld]

5 second rule

LOLz

 

[leviathan]

There's a video of placment on EMRAP.tv...too tired/lazy to find it myself right now. Let me know if you have trouble finding it and I will put it up tomorrow.

 

[Egon]

This is a really striaghtforward and quick procedure. The most important part is becoming familiar with the equipment. I've done 7 in the past year....just familiarize yourself with the kit. (Many are expired, look at the date of what you have in stock and you can justify opening it up for teaching purposes.)

Remember Positve if for proximal, keep the wire curvature in your favor to curl into the ventricle. Also, once you inflate the balloon just turn the pacer on and you will see capture when you hit the ventricle about 25-30cm, (forget about hooking the lead up to the EKG, it's too time consuming.) Each hash mark is 10cm on most kits, you shouldn't need to float much ast 30cm if you are doing the RIJ aproach, anything past that you are curling up or are in the IVC.

Roberts and Hedges has a nice section on it. However, you need to become familiar with the pacer box you carry in your depaertment as they vary on how to turn on, adjust, etc... Otherwise, it's almost as easy as doing an IJ.

 

[drpcb]

Pretend you are doing a central line.

Make sure you advance the tip into the RV as it should be meeting the endocardium there.

PEARL: Have an assistant get a nice subxiphoid echocardiographic view for you (it can be a tech, nurse etc. just place the probe and have them hold the view- and you will be able to watch the tip pass into the RV. Sometimes it will coil in the RA and you won't know this without a fluoro or cxr. You will see that you are deep and wonder why you can't capture.

 

[Rendar5]

ahem...
Coolest Procedure Ever!!!!😀

Seen one a year ago, and read a good guide to it in Shah...I think that was the proceure book?

 

[leorl]

as an aside, we recently came up against this problem in our ED. If your ED is using temporary pacing kits produced by ARROW, they have recently mistakenly sent out a lot of two kits with the same lot number. But the kits are different - one comes with a straight dilator assembly, and one comes with a curved dilator assembly (the arm that comes out of the dilator, this is the one you want). The pictures on the front are different but people who stock the ED wouldn't notice cuz the product number is the same.

This causes great confusion when trying to put in the pacer, and has led to hairy situations not only here but other local hospitals. So if you're using that company, check your stock!

 

[8744]

The hardest part is putting in the Cordis. Am I the only one that has gotten so used to using ultrasound for lines that I will only put in femorals without it?

 

[Apollyon]

The hardest part is putting in the Cordis. Am I the only one that has gotten so used to using ultrasound for lines that I will only put in femorals without it?

Yes.

 

[kungfufishing]

U/S IJ 80% of the time over the past year or so. The rest of them have a reason for me to put in something else.

 

[WilcoWorld]

I would agree that venous access is the most challenging part of the procedure from a dexterity standpoint. The rest of it is just familiarizing yourself with the equipment & knowing when you're where you want to be. Even so, I'd prefer this to be done by a Cardiologist when possible.

As for the US question, I use US on >90% of my IJ's, but obviously not on subclavians, and only use it on femoral lines if there's a lot of scarring making it a tough line. Yes, there are sterile covers, but I still think it's harder to stay sterile with an US probe on your field. When I'm in the neck, this is outweighed by the benefit of knowing where I'm going. When I'm in the groin it's more of a wash.