Presentation on theme: "Pacemaker follow up and troubleshooting"— Presentation transcript:
1Pacemaker follow up and troubleshooting This is one in a series of lecturers to complete the subject but to be practical we must start with this, in the past we hade only one (temporary )pulse generator now we have five and some times all of them are in-use.
2When the patient leaves the cath When the patient leaves the cath. lab with a permanent pacemaker what should I do?A picture of Einstein deeply thinking, some one admits the patient, some one implant the temp pacer, some one implant the perminant , then me the patient and the pacemaker are left togather.
3Should I? A- Educate the patient . B- Document. C- Start follow up. D- Non of the above.E- All of the above.
4Educate The patient activity Wound care Concerns Follow up The arm on the same side as the pacemaker should not be lifted above shoulder level for four weeks.He should be careful not to hit or rub the insertion site.Instruct the patient not to "fiddle" or play with the pacemaker under your skin.avoid activities like heavy lifting, running, or contact sports. Do not lift more than 5 kilograms for two weeks. If you have any specific questions regarding activity, ask your doctor.It is best to take it easy for four weeks at home to avoid damaging the pacemaker.Cellular Phones: You may use a cellular phone; however, do not hold the cellular phone on the same side as your pacemaker or place it in your shirt pocket over the pacemaker.Strong Magnets: Avoid strong magnets. Examples are magnets used for an MRI and hand-held security wands.Strong Electrical Fields: Avoid strong electrical fields. Examples are radio transmitting towers, ham radios, and arc welders. Also, avoid leaning over the open hood of a running car because its electrical field can interfere with your pacemaker.Microwave Ovens: You may cook with a microwave oven. Microwave ovens in good working order are safe to use.The pacemaker site should be kept clean and dry.The patient may take a tub bath when you go home after getting a pacemaker, but keep the incision dry for at least two weeks.The dressing should be changed every day using sterile gauze.He must not use ointment on the incision site unless instructed to do so by the doctor.Carefully inspect the incision with each dressing change to note any redness, swelling or discharge.Wound careEmphasize on the importance of follow upGive him the exact place and timeProvide him with a phone numberactivityConcernsFollow up
5Document • Demographic information on patient Pacemaker operative recordManufacturer, model number and serial number of all implanted hardwareRecords of data from each follow-up visit• Patient symptoms or complaintsDemographic information on patient (name, age, telephone number or other means of contract, next of kin or alternative way of contacting a patient)Oprative records (what was changed and whats happened)Records of data from each follow-up visit including programmed setting, telemetry threshold evaluations and rhythm stripsEvaluation of the pacemaker siteDocumentation of hardware advisory or recall, or any surgical complicationsCurrent medications
6What is the aim of the follow up visits? 1- patient and family education.2- Collect and maintain patient records and institutional databases.3- Optimize pacing system function including maximizing power source utilization.4- detect and correct pacemaker system abnormalities.5- Act as a resource centre for cardiac pacing (RESERCH AND TRAINING)
7Frequency Of Pacemaker Follow Up PostimplantationTwo weeks12 weeksSix monthsEnd of life paramiters and elective replacment indicatorsIntensified follow up periodMaintenance period
9Considerations in determining a pacemaker follow-up schedule • Known reliability of the implanted pacing system.• How long the patient has had the pacemaker• Programmed parameters (higher outputs = shorter time from elective replacement time to end of service)• Complexity of pacing system.• Collection duration for diagnostics.• Concurrent use of implantable cardioverter-defibrillator.• Application of cardioversion, electrocautery or defibrillation.• Patient dependency on pacing.• Stability of rhythm and cardiovascular symptoms.• High or unstable thresholds or low and stable thresholds.• Patient’s ability to report symptoms accurately.• Patient distance from follow-up clinic.Considerations in determining a pacemaker follow-up schedulePatient-related considerationsPacer system-related considerations
13Pacemaker syndromePocket and muscle stimulatin(perforatin, insulatin breake,flipping and unipolar)
14Patient related problems Under passing or no pacing What troubles to shoot?Patient related problemsUnder passing or no pacingOversensing can produce underpassingFarfeald sensing, myopotential, interferance, crosstalk
15Electrode tissue interface: 1- lead imaturity.2- electrolytes.3- drugs.4- MI.Over sensing:1-myopotential.2- interference.3-cross-talke.4- fare field sensing.Improper fixation.Generator failure:1- temporary.2- perminant.Lead problems:1- twiddelers syndrome.2- lead fructure.3- insulation breakeBattery depletion
35Patient related problems Under passing or no pacing What troubles to shoot?Patient related problemsUnder passing or no pacingOver passingPsudo-malfunction1- hysteresis.,2- rate smoothing.3- mood swithc.4- fusion and psudo-fusion.