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Pacing wires - removal in PICU

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Pacing wires are often 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

Heparin Infusion

  •  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 cardiac consultants

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Document Control

  • Date last published: 18 May 2015
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Editor: John Beca
  • Review frequency: 2 years