Always Turn on a Pacing Pulmonary Artery Catheter Prior to Floating The Device
Bradford D. Winters MD, PhD
There are several temporary transvenous pacing devices available for use in the intensive care unit (ICU). They include pacing wires, pacing catheters, paceport pulmonary artery catheters (PACs), and pacing PACs. Pacing wires are devices that use essentially bare wires, which are placed through an introducer sheath into the central circulation and advanced into the heart until pacing is captured. Pacing catheters usually have an inflatable balloon at their tip much like a PAC that allows blood flow to help guide the catheter forward as it is advanced through the introducer sheath. Since it depends on blood flow for effective placement, it is not useful in emergent episodes of asystole and may be difficult to place in the case of extreme bradycardia. Paceport and pacing PACs have similar potential problems since they are flow directed for their placement. Ideally, pharmacological treatment with atropine, epinephrine, or isoproteronol and/or transcutaneous pacing with Zoll pads will create a situation that provides time and adequate cardiac output such that a transvenous system can be placed when asystole or extreme bradycardia occurs.
Paceport and pacing PACs differ in that the paceport PAC, in addition to the normal lumens for measuring cardiac output, pulmonary artery pressures, and so on, has a special lumen through which a special wire matched to the catheter can be introduced. The wire exits through an orifice so as to come in contact with the right ventricular wall and effect capture. The pacing PAC does not have this port nor a special wire but rather has electrodes built into the wall of the catheter such that when it is in normal position for doing cardiac output measurements, the electrodes are positioned for affecting pacing capture. They are in a fixed position on the device, which can make capture difficult if the catheter is not oriented in optimal position. While the orifice on the paceport catheter is also in a fixed position, the wire exits to move somewhat independently so as to contact the ventricular wall.