It is a device often placed in the chest or abdomen of an individual with abnormal heart rhythms to help control such rhythms and maintain a somewhat normal heartbeat. Once in the patient’s chest or abdomen, a permanent pacemaker will help monitor the individual’s heart rhythms to ensure that the heart does not beat slower than expected.
Setting: permanent pacemaker implantation can take place in various settings which include the operating room, in the electrophysiology (EP) laboratory or the catheterization laboratory. The electrophysiology and catheterization laboratories involve the implantation of the permanent pacemaker by an interventional electrophysiologist, and it is believed to require a shorter hospital stay and decreased medical costs compare to that carried out in the operating room. The procedure, despite where it takes place, it requires various personnel including the implanting physician, a technician, a scrub nurse and a circulating nurse (Yamaguchi et al., 2016). Maintenance is often in the recovery room or the patient’s hospital room under the care of a nurse.
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Purpose: a permanent pacemaker is often recommended when the doctor notices a problem with the normal electrical signals that help the heart in beating or when the heart is beating slower than expected (Yang, Cheng & Zhang, 2016). It includes a pulse generator, leads an electrodes on each lead. The pacemaker identifies when the heart is beating slower and sends an electric impulse through the lead electrodes to help increase the rate of the heartbeat. Further, when the heart beats at a fast than its limit, the pacemaker will not pace in such an instance to keep the pulse regular. Current permanent pacemakers are developed in a way that does not result in competition with the heart and therefore will only work as a compensatory mechanism and when necessary.
Pre-intra- and immediate post-procedure care: The patient is allowed to recover in the recovery room or the hospital room under the supervision and monitor especially of the vital signs by the nurse. The patient is advised to inform the nurse of any chest pains, tightness or any form of being present at the site of the incision. The patient undergoes a chest x-ray two to four hours after the implant is done to identify the pacemaker’s leads (Haghjoo, 2012). The patient also undergoes a check-up from a staff member from the pacemaker clinic. The check-up involves a programmer who also ensures that the pacemaker is functioning as expected. The patient is provided with an identification card that includes the permanent pacemaker’s model, make an serial number which he or she is asked to keep in the wallet.
Ongoing post-procedure care: When performed on an outpatient basis, the patient can be discharged once he or she completes the recovery process. The facility ensures to provide a follow-up appointment before official discharge (Haghjoo, 2012). The patient is required to always consult the doctor in case he or she feels ill after any activity and when he or she has a question concerning engagement in a new activity. He or she is also advised to inform the clinic if there is fever or chills, shortness of breath, palpitations, chest pains or dizziness.
Documentation:
DATE OF VISIT: XX/XX/XXXX
SUBJECTIVE: this patient had an implanted permanent pacemaker and came in with a pacemaker pocket infection.
The patient undergoes an implantation vial the iliac vein as it leaves a small wound size and bleeding is greatly reduced.
OBJECTIVE: A fifty-five centimeter sheath was inserted into the patient’s external iliac vein with a seventy-five centimeter long lead in the right ventricular septum.
ASSESSMENT: The pacemaker pocket infection was treated
PLAN:
1. The patient will come back for follow up assessments for proper heart rate.
References
Haghjoo, M. (2012). Techniques of Permanent Pacemaker Implantation. In Current Issues and Recent Advances in Pacemaker Therapy . InTech.
Yamaguchi, T., Miyamoto, T., Yamauchi, Y., & Obayashi, T. (2016). A case report of successful permanent pacemaker implantation via the iliac vein. Journal of arrhythmia , 32 (2), 151-153.
Yang, B., Cheng, Y., & Zhang, D. E. (2016). The Indications and Notice of Installation Temporary Pacemaker or Permanent Pacemaker. In Medicine and Biopharmaceutical: Proceedings of the 2015 International Conference (pp. 161-168).
