transvenous pacing

[basementbeast]

any one have a good way to remember how to set the pacer (sensitivity, etc) when floating an emergent TVP? rate 80, mA to max.....

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[southerndoc]

mA to max? I start at the lowest setting and increase until I get capture, then add 10% (just as ACLS teaches with transcutaneous pacing). Only during asystole do I go with the maximum amperage, which is of course transcutaneous.

 

[BADMD]

any one have a good way to remember how to set the pacer (sensitivity, etc) when floating an emergent TVP? rate 80, mA to max.....

You basically want to make sure you see the capture beats and not have the pacer fire due to intrinsic beats. So set the sensitivity to asynchronous. Once you have capture, then drop the mA. Once your mA are optimized, then optimize the sensitivity. You would prefer to have the minimum number of asynchronous beats.

 

[basementbeast]

some references start with mA max then decrease until loss of capture then increase for capture.

 

[southerndoc]

some references start with mA max then decrease until loss of capture then increase for capture.

Can you give some references? I am aware of this for asystole, but not for patients with intrinstic but bradycardic rhythms.

 

[basementbeast]

no references off the top of my head....i am too burnt to look it up now....i may be wrong...i am ALWAYS open to correction and learning...that is why i asked ....

 

[BADMD]

Can you give some references? I am aware of this for asystole, but not for patients with intrinstic but bradycardic rhythms.

Here is the Madigan Army Hospital page on floating a transvenous pacer: http://www.mamc.amedd.army.mil/cardiology/book126.pdf . I'm not sure how you would float a transvenous pacer with the mA set to the minimum. You have to achieve capture to see that it is placed properly. If your generator is set at the minimum, you have two variables determining capture, where as if you go to max, there is only one. One you have advanced the wire, achieve capture, and are sitting at the RV apex, then I'd turn it down to the minimum and then increase by 50-100%.