/ Employee Name (printed): ______
Employee Number: ______
Facility/Dept.: ______

Competency: Temporary Pacemaker Management

Objective:To verify the provider’s ability to identify the basic components of a pacemaker, to understand the pacemaker’s indication(s) for use, and to identify the sensing and stimulation thresholds specific to a given patient

Method of Evaluation Key:

O = ObservationRD = Return DemonstrationT = TestV = Verbal

Competency Criteria / Method of Evaluation / Met / Not Met
Knowledge:
Identifies the components of a pacemaker: generator & epicardial pacing wires (unipolar & bipolar)
Explains indications for atrial and ventricular pacing
Describes how to protect, label, and secure the pacer wires:
  1. Identifies appropriate insulating material that can be used to protect the wires from aberrant external microshocks
  2. Uses proper aseptic technique to clean the pacer exit site

Describes the four common modes of pacing: DOO, VVI, AAI, DDD
Locates the Pacing Indicator Light (Green) and the Sensing Indicator Light (Blue)
Locates the battery indicator light; verbalizes where back-up batteries are available and when to change the batteries
Explains the principles behind sensing and capturing
Locates the emergency DOO button
Skills:
Adjusting sensing
  1. Set pacemaker RATE to at least 10ppm below the patient’s intrinsic rate (to ensure non-pacing) UNLESS the patient cannot tolerate this hemodynamically**
**In the event of hemodynamic instability, the nurse may attempt to locate the sensing threshold beginning as step #3, but must be ready to return to initial settings
  1. Adjust the atrial or ventricular output to prevent the risk of competitive pacing as follows:
  • Atrial: Set A OUTPUT to 0.1 mA.
  • Ventricular: Set V OUTPUT to 0.1 mA.

  1. Decrease Sensitivity: Slowly turn the atrial or ventricular sensing dial counterclockwise(to increase mV value) until the SENSE indicator stops flashing. The PACE indicator will flash continuously.

  1. Increasing Sensitivity:Slowly turn the atrial or ventricular sensing dial clockwise (to decrease mV value) until the SENSEindicator flashes continuously, and the PACE indicator stops. This is the sensing threshold.

  1. Set the sensitivity to half the threshold value

  1. Restore RATE and OUTPUT to the previous value

Adjusting output
  1. Set the pacemaker rate to at least 10 ppm above the patient’s intrinsic rateUNLESS the patient cannot tolerate an increased heart rate***
***If the patient cannot tolerate a rate increase, the provider may still attempt to locate the stimulation threshold but must be ready to return to the initial settings
  1. Decrease the output by slowly turning the output dial counterclockwise until ECG shows loss of capture

  1. Increase the output slowly by turning the output dial clockwise until ECG shows consistent capture (The PACE indicator will flash continuously; the SENSE indicator stops) – this is the stimulation threshold

  1. Set the output value to twice the stimulation threshold

  1. Restore rate to previous value

Documentation
Documents vital signs, cardiac rhythm, mode of pacing, pacing rate, A/V output, and A/V sensing per unit policy
Documents a skin assessment at the site of the pacer wires per unit policy
Attitude:
Connects the pacemaker to the patient for a minimum of 24 hours post-operatively and as indicated
Places the pacemaker in a readily visible and accessible for location
Provides the patient and family with pacemaker education

References:

  • Medtronic: Dual Chamber Temporary External Pacemaker (Model 5392) – Operator’s Manual:
  • Nursing Reference Center Plus: Epicardial Pacing Wires: Caring for and Using

Employee’s Signature Employee NumberDate

Validator’s Signature Employee NumberDate

Clinical Excellence & Staff Development/07.2017