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/policies/clinical/uwhc-clinical/department-specific/heart-and-vascular-care-clinic/hvc-2.policy

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Policies,Clinical,UWHC Clinical,Department Specific,Heart and Vascular Care Clinic

Pacemaker Clinic, Routine Visits (HVC)

Pacemaker Clinic, Routine Visits (HVC) - Policies, Clinical, UWHC Clinical, Department Specific, Heart and Vascular Care Clinic

HVC

HVC Pacemaker Clinic, Routine Visits  
Category:  UWHC Departmental Policy   
Policy Number:  HVC    
Effective Date:  August 28, 2013   
Version:  Revision    
Manual:  Heart and Vascular Care Clinic    
Section:  Pacemaker Clinic, Routine Visits 
 
 
I. PURPOSE

The policy is to provide guidance to the Device Nurse, who is specially trained in Cardiovascular Implantable
Electronic Devices (CIED) and who is checking the pacemaker. This policy will provide optimal safety and security
for the patient with a pacemaker while maximizing the life and performance of the pacemaker.

II. POLICY

To provide guidance for obtaining precise pacemaker parameter measurements and generator reprogramming
performed as needed.

III. PROCEDURE
A. The Device Nurse completes a verbal assessment with the patient, which allows them to focus
on/document any specific problems, including episodes, symptoms and assess the integrity of the pocket
site.
B. The Device Nurse saves three 6 second ECG strips. Strips are saved either by utilizing Paceart, the
charting system that supports CIED, or by using the device programmer, including the presenting
rhythm, one with magnet applied over the device and underlying, if different from presenting strip. Staff
will:
1. Verify that the ECG strips demonstrate appropriate rate and modes, based on their pacemaker
programming;
2. Assess for proper capture, sensing and magnet response;
3. Verify that the device elective replacement indicators are not being exhibited, as noted by specific
device company/model. If noted, the patient will be scheduled to see the Electrophysiologist (EP)
in clinic to discuss the procedure; and
4. Document findings in patient’s electronic medical record.
C. View initial interrogation information; implant date, programmed parameters, percent paced battery
life/voltage, lead impedances and recorded episodes.
D. Measure and document the following:
1. P and R waves;
2. Lead stimulation thresholds; and
3. Lead impedances.
E. Confirm that all parameters are programmed with appropriate safety margins. Amplitude 2:1 when using
voltage or 3:1 for pulse width, not to go lower than 1.5 V @ 0.4 ms (Right Atrium [RA]), 2.0 V @ 0.4 ms
(Right Ventricle [RV]). Sensitivity should be programmed at least one-half the measured amplitude unless
undersensing or oversensing occurs. Change settings as required.
F. If the rate modulation feature is enabled, assess the patient’s heart rate response to the indicator used
and adjust according to the patient’s needs.
G. Print and read final report from the programmer.
H. Transfer interrogation to Paceart for charting
1. Verify transferred information.

2. Fill in any added information and chart narrative specific to findings, changes and outcome.
I. Print all needed copies of the Paceart report.
1. All copies will go to the EP Physician for reading and signing, before being sent to the
corresponding destination.
2. One each for hospital medical records, entered into electronic medical record and Referring
Physician(s) outside the UW Health systems.
J. Complete Outpatient Encounter in electronic medical record, file charges accordingly.
K. Routine follow up for patients with pacemakers.
1. Two week post implant.
2. Checks are done every 3 months with a combination of home transmissions and clinic checks.
3. When device reports 1 year to elective replacement, home transmissions will be done monthly.
4. More frequent checks if medically needed or battery status indicates.
IV. REFERENCES

Heart and Vascular Care Clinic – Implantable Cardioverter Defibrillator (ICD) Clinic Check, Routine
Heart and Vascular Care Clinic – Remote Transmission of a Pacemaker, Implantable Cardioverter Defibrillator (ICD)
Heart and Vascular Care Clinic – Remote Loop Recorder
Heart and Vascular Care Clinic – Pacemaker Transtelephonic Check
Heart and Vascular Care Clinic – Management of Pacemaker Cardioverter Defibrillator (ICD) Devices in a Procedural
Setting

V. WRITTEN BY

Clinical Program Coordinator, Heart and Vascular Care Clinic

VI. REVIEWED AND APPROVED BY

Ambulatory Policy and Procedure Committee
Clinic Manager, Heart and Vascular Care Clinic
Clinics Administration
Dr. Michael Field, Assistant Professor, Director of Electrophysiology

SIGNED BY

Deborah D. Tinker, MSN RN CENP, Director of Ambulatory Nursing