Transvenous pacemaker placement

  1. Place introducer sheath using sterile technique
  2. Prepare wire: uncoil, maintain curvature of tip, connect adapters to leads, test balloon with ~1.5 mL of air from special syringe to ensure proper inflation, note how to turn stopcock to lock it so balloon doesn’t deflate once in patient
  3. Place contamination sleeve (with the rubber tip away from the pt) over the wire
  4. Advance wire through CVC to at least 20 cm to ensure balloon is past catheter, inflate balloon, lock it with stopcock
  5. Hand the end with adapters to a non-sterile person who will connect the adaptors to the pacemaker generator box (+ to + and - to -). Turn box on, set rate to 80 BPM (or 10-20 BPM faster than pt HR) and set output to maximum..
  6. Float balloon to the RV (can use ultrasound) and watch monitor for pacemaker spikes
  7. Once capture is obtained, turn output down to minimum level that maintains capture
  8. Deflate balloon
  9. Secure the CVC by suturing with 2-0 silk
  10. Connect contamination sleeve to sheath introducer hub and stretch the accordion over the wire, holding the CVC/wire securely so as to not dislodge the wire from the RV. Tighten the end of the sleeve over the wire so it will not slip in/out of the sterile sheath
  11. Cover with transparent film dressing or other sterile barrier
  12. Check pulse to ensure mechanical capture.
  13. Get EKG to ensure electrical capture. It should have LBBB morphology.
  14. Get CXR to ensure proper placement and rule out pneumothorax