Page 1694 - Saunders Comprehensive Review For NCLEX-RN

stimulation threshold to ensure
capture.
k. If loss of capture occurs, assess the skin
contact of the electrodes and increase
the current until capture is regained.
l. Evaluate the client for discomfort from
cutaneous and muscle stimulation;
administer analgesics as needed.
2. Invasive transvenous pacing
a. Pacing lead wire is placed through the
antecubital, femoral, jugular, or
subclavian vein into the right atrium or
right ventricle, so that it is in direct
contact with the endocardium.
b. Monitor the pacemaker insertion site.
c. Restrict client movement to prevent
lead wire displacement.
3. Invasive epicardial pacing—applied by using a
transthoracic approach; the lead wires are threaded
loosely on the epicardial surface of the heart after
cardiac surgery.

4. Reducing the risk of microshock

a. Use only inspected and approved
equipment.
b. Insulate the exposed portion of wires
with plastic or rubber material (fingers
of rubber gloves) when wires are not
attached to the pulse generator; cover
with nonconductive tape.
c. Ground all electrical equipment, using a
3-pronged plug.
d. Wear gloves when handling exposed
wires.
e. Keep dressings dry.

Vital signs are monitored and cardiac

monitoring is done continuously for the client with a
temporary pacemaker.
E. Permanent pacemakers
1. Pulse generator is internal and surgically implanted in
a subcutaneous pocket below the clavicle.
2. The leads are passed transvenously via the cephalic or
subclavian vein to the endocardium on the right side
of the heart; postoperatively, limitation of arm
movement on the operative side is required to

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