PACEMAKER TEACHING Maira Abrams Kristen D’Alberto Marijo DiMora Kim Wise

What is a cardiac pacemaker? An electronic device used to pace the heart when the normal conduction pathway is damaged, such as in dysrhythmias.

What do I need to know about a pacemaker?

Electronic Devices  You may NOT have MRI procedure because it will interfere with pacemaker function. *unless specially designed pacemaker  Metal detectors and antitheft devices may be set off by pacemaker. *inform airport security about pacemaker  Microwaves and cell phones are safe to use. *keep cell phone out of pockets near pacemaker

Activity  You MAY engage in physical activities/sports unless there is a risk for direct trauma (such as football, rugby) as this can affect pacemaker functioning.  If planning strenuous activities (such as running a marathon) you must consult with primary care provider beforehand.  Avoid lifting arm on pacemaker side above shoulder until approved by primary care provider. (usually 3-6 weeks)  Avoid heavy lifting, pushing, pulling on side of pacemaker after implantation. Your primary care provider will specify restrictions.

Follow-up Care  You must maintain follow-up appointments with primary care provider to check pacemaker function on regular basis.  Follow-up appointments may be outpatient visits to a pacemaker programmer or monitored at home using telephone transmitter devices.

Home Monitoring  Monitor heart rate every day and notify primary care provider if it drops less than predetermined rate.  Keep incision dry 4 days after implantation or as ordered.  Report signs of infection immediately to primary care provider: drainage or bleeding, redness, swelling, warmth, fever >101F  Report symptoms that may be r/t pacemaker complications: dizziness, palpitations, increased or decreased heart rate.

Safety Measures  It is important to carry pacemaker identification card with current list of medications with you at all times.  It is important to obtain and wear a Medic Alert bracelet at all times.

Common Misconceptions  “I will not need to take any heart medications.”  FALSE. A pacemaker will not replace need for heart medications to treat HTN, angina, dysrhythmias, etc.  “My pacemaker will prevent the risk for a heart attack.”  FALSE. Pacemakers do not protect against blood clots in vessels that cause heart attack and does not strengthen the heart.

Evidence-Based Practice Is my activity going to be completely restricted after I get my pacemaker? Setting: A descriptive cross sectional survey was carried out on consecutive patients at the pacemaker clinic at a public hospital in Karachi, Pakistan. A 47-question tool was developed and tested. Patients' perceptions of safety of performing various routine activities, along with socio-demographic data were recorded. Results: The final sample included 93 adult patients. A majority recalled receiving pacemaker teaching from the implanting physician and house staff. ¼ considered many routine activities unsafe including driving automobiles, passing through metal detectors, bending over, and sleeping on the side of the pacemaker. Also considered unsafe were operation of household appliances- TV/computer, irons, and electrical wall switches. Conclusion This study shows that our pacemaker patients perceive many routine activities as unsafe, potentially leading to disabling life style modifications. The investment in pacemaker technology to improve patient performance is not going to pay dividends if patients continue to remain disabled due to incorrect perceptions.

Resources Aqeel, M., Shafquat, A., & Salahuddin, N. (2008, November 14). Pacemaker patients' perception of unsafe activities: a survey. Retrieved from JILEK, C., TZEIS, S., REENTS, T., ESTNER, H., FICHTNER, S., AMMAR, S., &... KOLB, C. (2010). Safety of Implantable Pacemakers and Cardioverter Defibrillators in the Magnetic Field of a Novel Remote Magnetic Navigation System. Journal Of Cardiovascular Electrophysiology, 21(10), doi: /j x Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical-surgical nursing: Assessment and management of clinical problems. (8th ed., pp ). St. Louis, Missouri: Elsevier Mosby.