- Transcutaneous Pacing (TCP) is for temporary management of symptomatic bradycardia, including heart blocks (adults/adolescents and children with a heart rate less than 60 beats per minute).
Symptomatic includes poor perfusion related to the bradycardia as demonstrated by:
- Hypotension (adult systolic BP < 90 mm Hg or Peds systolic BP l< 80 mm Hg), or
- Shortness of breath, or
- Acute altered level of consciousness, or
- Chest pain of suspected cardiac origin, or
- Skin signs suggestive of poor perfusion.
TCP should be utilized prior to or simultaneous with medication administration, when indicated, for symptomatic bradycardia.
- Asystole or PEA cardiac arrest
1. Place appropriate size pacing pads in (anterior-posterior) chest and back position preferred. (-) pad in front and (+) pad in the back. This position is also OK to defibrillate if needed.
**3 lead cables must also be in place in order for the Monitor to read the rhythm**
2. Activate the pacing module, initial pacing rate at 70 bpm and current to 0 (zero) mA.
3. Start Pacing - Slowly increase the mA (current) delivered until electrical and mechanical capture is achieved, demonstrated by palpable pulses that correspond to electrical pacing spikes (max 120 mA).
4. Once electrical and mechanic capture is achieved, slowly increase heart rate, if necessary, to relieve patient symptoms related to bradycardia (maximum rate of 100 bpm).
ADULT/ADOLESCENT (SO): Consider sedation for discomfort and BP > 90
Versed 5 mg IV titrate to attain sedation, once.
Versed 5 mg IN; if needed, may repeat once after approximately 3 minutes.
Versed 0.1 mg/kg IN once (for greater than 13 months through 15 years)
If electrical or mechanical capture does not occur, manage the patient with epinephrine per appropriate standing order SO-C-20 or SO-P-45.
**NOTE: If a lead is removed while pacing the monitor will switch to “Fixed” mode. Once the lead is reattached press the “Menu” button and switch back to “Demand” mode.
DOCUMENTATION: - Time TCP placed, capture time, rate and energy level, response, vitals post capture