Pacing wires - removal in PICU
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Pacing wires are usually removed on day 4-5, but on occasion they are removed earlier.
All handling of pacing wires should be done with gloves on.
Before removal ensure the patient has:
- Normal sinus rhythm
- Patent IV access
- Normal coagulation profile
- Normal platelet count
- Current group and hold
- If APTT normal, remove pacing wires without stopping heparin infusion
- If APTT abnormal, stop heparin infusion for 2 hours and re-check APTT
Atrial and ventricular wires are pulled out together at the same time.
If LA/PA catheters are being removed at the same time as the pacing wires, remove the LA/PA catheters first. If there is a bradycardia/arrhythmia post LA/PA removal there remains the capacity to pace the patient.
Post removal the patient:
- Must be continuously cardiovascularly monitored for 4 hours.
- Should not be transferred between areas for 2 hours.
- Do NOT routinely order a cardiac echo BUT any concerns should trigger the request for an echo to exclude a collection. Tachycardia, cooling of the peripheries and/or respiratory distress are all indications for urgent echo and involvement of the PICU consultant
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- Date last published: 26 November 2018
- Document type: Clinical Guideline
- Services responsible: Paediatric Intensive Care Unit
- Author(s): D Buckley
- Editor: John Beca
- Review frequency: 2 years
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