Temporary pacemaker : Programming &Trouble shooting
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1 2015 춘계심장학회 Temporary pacemaker : Programming &Trouble shooting 서울아산병원 한두영
2 Temporary Pacemaker Overview Indication of Temporary Pacemaker Programming ; NBG Code, Pacing/Sensing Device Trouble shooting
3 Temporary pacemaker 란? 일시적으로전기적자극을통하여서맥이 있는환자의심장을인공적으로박동하게 만드는 Electronic device
4 Indication for Temporary pacemaker Symptomatic Heart Block Sick Sinus Syndrome Symptomatic Sinus bradycardia Sinus arrest Pacemaker Replacement Pacemaker dependant patient Support After Heart Surgery Post TAVI (Transcatheter Aortic Valve Implantation) Other Overdrive ventricular pacing (suppress ectopic activity) Overdrive atrial pacing ( break SVT, atrial flutter)
5 Access Sites
6 Access Site 비교 장점 Femoral vein Puncture 가비교적쉬움 RV apex 로자연스럽게위치 Internal jugular vein 환자거동이용이함. 단점 환자다리에 Sheath 와 Cath 가있기때문에거동이불편함 Puncture 가비교적어려움 RV apex 로위치하기가부자연스러울수있음
7 Catheter Placement Strategy
8
9 V Pacing 위치에따른 ECG
10 Epicardial pacing
11 Transcutaneous pacing
12
13 Devices
14
15 Programming
16 NBG Code NASPE / BPEG (NBG) Code NASPE North American Society of Pacing and Electrophysiology BPEG The British Pacing and Electrophysiology Group 15
17 NBG Code Position I II III IV V Category Chamber(s) Paced Chamber(s) Sensed Response to Sensing Rate modulation Multisite Pacing Letters Used O-None A-Atrium O-None A-Atrium O-None T-Triggered O-None R-Rate modulation O-None A-Atrium V-Ventricle V-Ventricle I-Inhibited V-Ventricle D-Dual (A+V) D-Dual (A+V) D-Dual (T+I) D-Dual (A+V) Manufacturer s Designation Only S- Single (A or V) S- Single (A or V) 16
18 V V I pacing response sensing
19 VOO * * = Sense = Pace
20 VVI I * * = Sense = Pace
21 AAI I * * = Sense = Pace
22 DDD * T / I I * * = Sense = Pace
23 Temporary pacemaker setting Base rate Sensitivity Output
24 5 mv 2 mv 1 mv
25 Sensing threshold check Sensitivity : Signal을 보는 정도 (mv) Under Over 적절한 Sensing sensing
26 Undersensing Oversensing
27
28 Sensing Ventricular Undersensing Ventricular Oversensing
29 Capture threshold check Capture threshold : 실제로심박동을할수있는최소한의 Current (ma) 환자의 HR보다 10~20회 / 분빠르게하여 check Capture threshold
30 Capture Loss of Ventricular Capture
31 Emergency Async : Sensing 을하지않고 VOO 로 pacing Emergency Pacing Rate Check Rate Output: Turn to MAX Sensitivity : Turn to ASYNC
32 Trouble shooting 1. Loss of output 2. Capture failure 3. Sensing failure 4. Cable disconnect
33 Case 1. 59y Male #1.HTN #2.ESRD on HD ( , 월수금 ) s/p AVG & thrombi remove #3.hx. of Rt. scapula fx.( ) #4.parathyroid adenoma (2012) #5.HBV #6.Infective Endocarditis(MRSA) #7.multiple scattered embolic infarction #8.Cardiac arrest dt CAVB s/o Temporary pacemaker insert (15.2.4)
34
35
36
37
38 Case2.
39 1.Pacing 이안됨 2.Sensing 이안됨 3. 둘다안됨 4. 아무런문제없음
40 Case3. VVI 75bpm 1. Loss of output 2. Capture failure 3. Sensing failure 4. Cable disconnect
41 Case4. VVI 75bpm 1. Loss of output 2. Capture failure 3. Sensing failure 4. Cable disconnect
42 Ventricular Undersensing non-sensed R-waves
43 Case5. VVI 75bpm 1. Loss of output 2. Capture failure 3. Sensing failure 4. Cable disconnect
44 Ventricular Oversensing Pacing Pacing Pacing Pacing Pacing interval interval interval interval interval
45 스마트폰을생각해라!!
46 1.Battery 를확인해라 2.Output 을높여라 3.Cable 연결을확인하자 그래도안되면서비스센터로 ~
47 경청해주셔서감사합니다.
Temporary pacemaker 삼성서울병원 심장혈관센터심장검사실 박정왜 RN, CCDS
Temporary pacemaker 삼성서울병원 심장혈관센터심장검사실 박정왜 RN, CCDS NBG Codes 1st Letter 2nd Letter 3rd Letter A V D Chamber(s) Paced = atrium = ventricle = dual (both atrium and ventricle) Chamber(s) Sensed A = atrium
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