Pacemaker transcutaneous

Electrical Stimulation Devices. Bioelectrodes that transmit electrical signals into the body are generally known as electrical stimulation devices, examples of which include cardiac pacemakers, transcutaneous electronic nerve stimulators (TENs) for pain suppression, and neural prostheses such as auditory stimulation systems for the deaf and phrenic nerve stimulators for artificial respiratory control. In these, and other similar devices, electrodes transmit current to appropriate areas of the body for direct control of, or indirect influence over, target cells. 

Current introduced to the body is often held to low values by the electrical resistance of dry skin, between 5,000 and 10,000 ohms (Kantrowitz, 1972). Wet skin will have electrical resistance levels as low as one-tenth of this. Where electrical leads are introduced subcutaneously, resistance falls to 10-50 ohms, and this situation is potentially dangerous. Subcutaneous leads are used for heart pacemakers, artificial hearts, transcutaneous electrical neural stimulation (TENS) to block pain, and subdural leads for the control of Parkinson s disease. 

Pacing of the heart may he done transcutaneously, but this is accompanied by pain. The usual method is with two epicardial electrodes and leads out through the chest to an external pacemaker, or with an implanted pacemaker. 

Pacing system inhibition from interference is more important in the pacemaker-dependent patient. If inhibition is observed in a pacemaker-dependent patient, electrocautery application should be limited to 1-2 s with a rest period of approximately 10 s. This will allow the pacemaker to function properly for a greater portion of the time. In some cases back-up temporary transvenous or transcutaneous pacing will be required, or the pacemaker can be programmed to the asynchronous mode of function. 

Chen D, Philip M, Philip PA, Monga TN. Cardiac pacemaker inhibition by transcutaneous electrical nerve stimulation. Arch Phys Med Rehabil 1990 71 27-30. 

Rasmussen MJ, Hayes DL, Vlietstra RE, Thorsteinsson G. Can transcutaneous electrical nerve stimulation be safely used in patients with permanent pacemakers Mayo Clin Proc 1988 63 443. 

In emergency, transcutaneous pacemaker until transvenous pacemaker can be inserted... 

A transcutaneous pacemaker (for serious signs and symptoms) until a permanent pacemaker is plac ... 

Prepare patient for treatments as needed, such as drug administration (atropine, dopamine, epinephrine) transvenous or transcutaneous pacing or permanent pacemaker insertion for a chronic, symptomatic condition. 

Atropine may be used to increase the heart rate, or a transcutaneous, temporary, or permanent pacemaker may be used. 

Monitor the patient continuously, keeping a transcutaneous pacemaker attached to the patient or in the room. 

Temporary pacemakers may be transvenous, epicardial, transcutaneous, or transthoracic. 

If the patient has an arrhythmia, prepare for use of antiarrhyth-mics, transcutaneous pacing patches (or transvenous pacemaker), defibrillation, or epinephrine. 

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