Transvenous Pacing, other tips and tricks
Which site? Right IJ or Left subclavian. Prefer Right IJ so that the Left subclavian can later be used for a permanent pacemaker.
Pacer generator setup: the pacer has 2 sterile wires (the generator has 1 nonsterile wire). The proximal (shorter) wire inserts into the positive port (Proximal = Positive). The longer wire (distal) inserts into the negative port
set to demand
turn rate to 30 bpm greater than intrinsic rate - often ~ 80
Sensitivity = 0
set initial current high: 20-25 mA
Insert the Cordis
Insert the pacer wire: Put the swan sheath (the plastic sterile thing) on first.
insert wire to 20cm
inflate balloon with 1.5cc of air
advance (with the balloon up) observing ECG for changes in ECG morphology and capture of pacing rate (direct wire to RV apex)
approximate depth 35-40cm
once pacing captured deflate balloon
then decrease mA to find threshold - then double (usually this is ~ 5mA)
secure. Extend swan sheath (plastic sterile thing) and lock onto cordis hub













