SOUTH GEORGIA MEDICAL CENTER
CRITICAL CARE
POLICY/PROCEDURE
TITLE: PACING: TEMPORARY TRANSCUTANEOUS
WITH THE ZOLL PD 1400 or Zoll MSeries
NUMBER: 170
PREPARED/COORD BY:
EFFECTIVE: 8/90
APPROVED BY:
Critical Care Department
Critical Care Committee
REVIEWED: 7/93, 9/94, 6/97,
12/98, 1/99
REVISED: 2/94, 11/96, 5/01, 5/04,
6/07, 6/10
POLICY STATEMENT & PURPOSE:
This policy serves as a resource for application and utilization of Transcutaneous Pacing with the Zoll
Monitor
PROCEDURE:
Refer to Guidelines for Practice Prior to Treatment and Procedures (XVI-D40)
A.
Continuous Noninvasive Temporary Pacing
1.
Refer to Guidelines for Practice for the procedure.
2.
Assemble the following equipment:
Zoll Defibrillator with Transcutaneous Pacing capability
Zoll Multifunction Electrode Pads (MFE)
Zoll Multifunction cable
Crash cart
3.
Select Monitor ON and set output to O Ma. (MSeries will default to O Ma.).
4.
Apply ECG electrodes and connect to ECG cable.
5.
Select ECG Lead and size to obtain best ECG waveform. The heart shaped R-wave
detector should flash with each R wave when proper detection of R wave is achieved.
6.
Apply back pacer electrodes between scapula and spine at level of heart (see package
diagram).
7.
Apply front pacer electrode to precordium (see package diagram).
8.
Connect pacer electrodes to multifunction cable.
Pacing: Temporary Transcutaneous with the Zoll Monitor
Number 170
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B.
9.
Select PACER ON.
10.
Set pacing rate 10-20 bpm higher than patient's intrinsic rate. If no rate exists use 100
bpm.
11.
Observe for pacing artifact (
the T wave).
12.
Increase output mA until effective capture is achieved. Ensure that a pulse is being
generated by palpating a femoral or right radial/brachial pulse.
)
and verify that it is well positioned in diastole (after
Evaluation of Pacing Threshold
1.
Press and hold the 4:1 button located on the front of the Zoll defibrillator.
This will deliver a pacing stimulus approximately every fourth beat.
2.
C.
D.
Release the 4:1 button to resume normal operation.
Pediatric Pacing
1.
Refer to A: steps 1-12.
2.
For patients weighing less than 15 kg, use Zoll PD NTP 2100 pacing electrodes and
pacing cable.
3.
Inspect underlying skin q 30 minutes for potential alteration in skin integrity.
Continuous pacing of neonates may cause burns.
Documentation in the medical record should include:
1.
2.
3.
4.
Pre-procedure education
Post-procedure response to treatment
Complications
Communication to physician regarding abnormal findings
References:
Zoll MSeries Operators Guide, 8/03
Zoll PD 1400 Pacemaker/Defibrillator Operators Manual, 4/95