Cardiac Pacemaker Implantation: Clinical Protocol and Best Practices

Pre-Procedure Assessment

Patient Evaluation

• Review complete cardiac history and indications
• Assess coagulation status (INR < 3.0)
• Review current medications
• Verify NPO status (>6 hours)
• Check recent chest X-ray and ECG

Equipment Verification

• Pacemaker device and leads
• Sterile surgical instruments
• Programming equipment
• Fluoroscopy system
• Emergency equipment

Procedural Steps

1. Pre-operative Preparation

• Obtain informed consent
• Mark implantation site (typically left subclavicular)
• Administer prophylactic antibiotics
• Establish IV access
• Apply monitoring equipment

2. Surgical Procedure

Access Creation

1. Create subcutaneous pocket
2. Obtain venous access (subclavian/axillary vein)
3. Perform venography if needed

Lead Placement

1. Advance RV lead under fluoroscopic guidance
2. Position in RV apex or septum
3. Verify lead parameters:
   • R-wave sensing > 5mV
   • Threshold < 1.0V @ 0.5ms
   • Impedance 400-1000Ω

Device Connection

1. Connect leads to pulse generator
2. Place device in pocket
3. Perform final testing

Post-Procedure Protocol

Immediate Care

• Chest X-ray confirmation
• Device programming verification
• Wound care instructions
• Monitor for complications

Follow-up Schedule

1. 24-hour device check
2. 1-week wound inspection
3. 1-month comprehensive evaluation
4. Regular 6-month follow-ups

Complications Management

Early Complications

• Pneumothorax
• Lead dislodgement
• Pocket hematoma
• Infection

Prevention Measures

• Meticulous surgical technique
• Proper antibiotic prophylaxis
• Careful hemostasis
• Patient education