Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach

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Skill Checklists for Taylor's Clinical Nursing Skills:
A Nursing Process Approach, 3rd edition

Name Date

Unit Position

Instructor/Evaluator: Position

SKILL 16-8

Using an External (Transcutaneous) Pacemaker

Goal:The equipment is applied correctly without adverse effect

to the patient; and the patient regains signs of circulation,

including the capture of at least the minimal set heart rate. Comments

1. Bring necessary equipment to the bedside stand or overbed
   table.


2. Perform hand hygiene and put on PPE, if indicated.


3. Identify the patient.


4. If the patient is responsive, explain the procedure to the
   patient. Explain that it involves some discomfort and that
   you will administer medication to keep him or her comfort-
   able and help him or her to relax. Administer analgesia and
   sedation, as ordered, if not an emergency situation.


5. Close curtains around bed and close the door to the room,
   if possible.


6. If necessary, clip the hair over the areas of electrode place-
   ment.Do not shave the area.


7. Attach cardiac monitoring electrodes to the patient in the
   lead I, II, and III positions. Do this even if the patient is
   already on telemetry monitoring. If you select the lead II
   position, adjust the LL (left leg) electrode placement to
   accommodate the anterior pacing electrode and the
   patient’s anatomy.


8. Attach the patient monitoring electrodes to the ECG cable
   and into the ECG input connection on the front of the
   pacing generator. Set the selector switch to the ‘Monitor
   on’ position.


9. Note the ECG waveform on the monitor. Adjust the
   R-wave beeper volume to a suitable level and activate the
   alarm by pressing the ‘Alarm on’ button. Set the alarm for
   10 to 20 beats lower and 20 to 30 beats higher than the
   intrinsic rate.


10. Press the ‘Start/Stop’ button for a printout of the waveform.


11. Apply the two pacing electrodes. Make sure the patient’s
    skin is clean and dry to ensure good skin contact. Pull the
    protective strip from the posterior electrode (marked
    ‘Back’) and apply the electrode on the left side of the
    thoracic spinal column, just below the scapula.

Copyright © 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Skill Checklists for Taylor's Clinical Nursing Skills:

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