Transcutaneous pacing is a medical procedure involving electrical impulses to regulate the heart rate in patients experiencing cardiac dysrhythmias. It is an emergency treatment for patients with symptoms and it is frequently performed by emergency nurses. Transcutaneous pacing is carried out in order to restore normal heart function and prevent future complications, as it has proven to be an effective and life-saving intervention in critical situations. According to the statistics, abnormal heartbeat is one of the most reoccurring reasons for ED admission for patients over 65 (Adams & Adams, 2021). Thus, emergency nurses must thoroughly understand this procedure to ensure timely and appropriate patient care. The Transcutaneous pacing: An emergency nurse’s guide (Adams & Adams, 2021) is intended to provide the necessary TCP information to nurses. The purpose of this review is to evaluate this guide.
The article provides information on the cases in which TCP needs to be used. It focuses on bradycardia as the major reason for transcutaneous pacing application. Bradycardia is characterized by an abnormally slow heart rate, thus, when a patient shows signs of bradycardia, it is essential to apply necessary medical procedures in order to increase and stabilize the heartbeat. Transcutaneous pacing has been demonstrated to be an effective way to treat bradycardia in case of emergencies, thus, it is logical that the focus of the article is on this condition. The article also mentions that TCP is used when the patient’s state does not become stabilized with pharmacologic treatment or if the organs’ perfusion is at risk. It gives a particular example of the necessity to use TCP in case there is no response to atropine sulfate (Adams & Adams). The article, however, does not provide sufficient information on using TCP in case of tachycardia, a condition characterized by an abnormally fast heartbeat. It can also lead to serious complications such as heart failure and stroke. Thus, it would be logical to highlight the cases of tachycardia as well.
Transcutaneous pacing: An emergency nurse’s guide gives a thorough understanding of the nurse’s role in TCP. It provides information on each of the steps of preparing the patient for transcutaneous pacing, which are explaining the procedure, obtaining informed consent, and ensuring that all necessary equipment is available. The nurse’s role in informing the patient and their relatives about what the procedure consists of and why it is necessary if pointed out. It is also stressed that during the procedure, the nurse monitors the patient’s vital signs and checks how pain affects the patient to provide analgesia or sedation if it is necessary to alleviate pain and discomfort (Adams & Adams, 2021).
One of the strongest points of the article is explaining in detail the steps of utilizing the medical equipment needed to perform TCP. It explains that the nurse needs to check all the necessary equipment before the procedure and names the equipment, which is the ECG monitor, ECG and pacing electrodes, cables, and defibrillator (Adams & Adams, 2021). Nurses need to know in advance the kind of equipment available at that particular facility. Further, the nurse is responsible for preparing the patient’s chest for TCP, which includes skin disinfection and hair removal, which the article also mentions.
The main focus of the article is on the equipment application, which can help the nurses to improve their practical skills. It points out that it is crucial for the nurses to follow the rules of how the electrodes need to be placed strictly. Pacing electrodes positioning depends on their compatibility with the equipment, and it can vary in each facility, thus, a nurse needs to know these details in advance (Adams & Adams, 2021). It is also important for nurses to look after the integrity of the pacing pads, especially when it is necessary to transfer the patient. Overall, all the details of how the equipment needs to be utilized, are highlighted.
Transcutaneous pacing: An emergency nurse’s guide also explains which modes need to be chosen in which case: there is a synchronous and asynchronous mode, with the former being the preferential one (Adams & Adams, 2021). The beginning current level should be zero, and it should be increased gradually to decrease the risk of any possible discomfort. It is mentioned that it is possible to decrease the current quickly in situations of emergency when the patient’s state requires more urgent actions. The technical part is highlighted sufficiently for the nurses to understand the procedure and what exactly they need to do.
The article also addresses the contingencies that can arise during the procedure and the possible actions to deal with them, which is also highly important for nurses to know. One of these issues is failure to capture, which takes place when the current is not increased to the necessary level. One of the steps suggested by the article is to change the position of the electrodes to be able to raise the current to the appropriate level. The article, however, could have discussed in more detail the cases when TCP cannot be applied due to the patient’s underlying medical condition.
Overall, the article gives a comprehensive guide for nurses on the steps and tasks that the nurse is responsible for. It provides the background for the situations in which transcutaneous pacing needs to be used, paying special attention to bradycardia as the main reason for TCP application. It lacks, however, sufficient information on severe tachycardia cases. It also explains the nurse’s role in detail and gives thorough understanding of the technical use of the equipment. Potential contingencies and how they can be addressed are mentioned as well, but more information on the cases of when TCP cannot be applied could be added.
Reference
Adams, A., Adams, C. (2021). Transcutaneous pacing: An emergency nurse’s guide. Clinical Nurses Forum, 47(2), 326-330. Web.