53401 EPG In-service Guide April 2017

53401 TRAINING LEARNING OBJECTIVES § Identify the control knobs and be able to explain how to use them to program device. OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

§ Distinguish oversensing, undersensing, and loss of capture. § Identify the basic components of the 53401 Temporary External Pacemaker. § Identify the basic steps of Rapid Atrial Pacing. § Locate resources for the 53401 EPG (e.g., Cable Compatibility Guide, other training materials). § Describe the key steps in changing the batteries. § Identify do’s and don’ts for cleaning the device. § Identify compatible cables. § Describe when the device should be returned to Medtronic for cleaning or maintenance.

53401 TRAINING RESOURCES

OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Education materials: medtronic academy.com

Videos: medtronic academy.com youtube.com

Manuals: manuals. medtronic.com/ manuals/main/ region

53401 TEMPORARY PACEMAKER Intended Use

OVERVIEW

§ Used with a cardiac pacing lead system for temporary single chamber pacing in a clinical environment by trained personnel

BASIC OPERATION

§ Used where short-term demand (synchronous) or asynchronous pacing is indicated for therapeutic, prophylactic, or diagnostic purposes

TROUBLESHOOTING PROCESS

§ Must be used in an environment where the patient is monitored continuously to ensure that it is operating properly and delivering appropriate therapy to the patient

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

53401 TEMPORARY PACEMAKER Contraindications

OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

There are no known contraindications for the use of temporary pacing as a means to control heart rate. However, the patient’s age and medical condition may dictate the type of temporary pacemaker and lead system that the physician uses. Note: Temporary pacing is contraindicated in the presence of another pacing system.

SYSTEM SCOPE SINGLE CHAMBER EPG SYSTEM 1

2

3

OBJECTIVES OVERVIEW

BASIC OPERATION Patient Cable (Model 5433)

TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP)

Heart Wires/ Temporary Pacing Leads

4

COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Model 53401 Single Chamber EPG

Heart

BASIC OPERATION BUTTONS, DIALS, AND INDICATORS

Buttons:

OVERVIEW

6

On/Off

2

Lock/Unlock

Parameter Dials:

BASIC OPERATION 3

TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP)

4

COMPONENTS: DEVICE, BATTERY, AND CABLE

3

Rate

4

Output

5

Sensitivity

6

Rapid Atrial Pacing Controls

Indicators: 5 7

MAINTENANCE AND CLEANING 1

SUMMARY

1

8

2

7

Battery Indicator

8

Lock Indicator

BASIC OPERATION POWER BUTTON

§ Power button turns device On and Off. § To turn Off, press and hold the Power button for 2 seconds.*

OVERVIEW BASIC OPERATION

§ If not held for 2 seconds, the temporary pacemaker will remain On.

TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Power button *Device needs to be unlocked to turn Off.

BASIC FUNCTION LOCK BUTTON § Press the lock button to hold settings. OVERVIEW

§ Lock indicator shows if controls are locked.

BASIC OPERATION

§ Device needs to be Unlocked to reprogram and turn device Off.

TROUBLESHOOTING PROCESS

§ Device automatically locks 60 seconds after the last parameter adjustment.

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE

Lock indicator

MAINTENANCE AND CLEANING Lock button

SUMMARY

BASIC FUNCTION PACING RATE CONTROL § Select the desired pacing rate by turning the rate button, top knob. OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

§ Turn clockwise for higher rates (counter clockwise for lower rates). § The range is 30-200 paces per minute (ppm).

BASIC FUNCTION VENTRICULAR OR ATRIAL PACING Pacing Rate Interval*

Pacing Rate Interval

Ventricular: VVI pacing Paces only the ventricles. OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP)

Pacing Rate Interval

Pacing Rate Interval

COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

*The pacing rate interval may time from a paced or an intrinsic beat.

Atrium: AAI pacing § Paces only the atrium. § The stimulation conducts through the AV node to the ventricles. § Not for use in patients with high degree heart block.

BASIC FUNCTION SENSING AND PACING Sensing Patient’s intrinsic rhythm: No Pacing

OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP)

Pacing and Sensing

COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

P

P

P = Paced beat S = Sensed (intrinsic beat)

S

P

P

S

P

BASIC FUNCTION SENSING AND PACING Synchronous and Asynchronous Pacing Inhibits pacing for intrinsic beats OVERVIEW BASIC OPERATION Pacing rate set from intrinsic beat.

TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Paced beat unchanged from intrinsic beat.

Asynchronous Pacing Pacemaker will emit an output at a fixed rate regardless of intrinsic activity. Note: Asynchronous pacing is contraindicated in the presence of intrinsic cardiac rhythms. Caution: Because it may compete with the intrinsic activity of the heart, asynchronous pacing may result in tachyarrhythmia.

BASIC FUNCTION OUTPUT § Energy used to produce a heartbeat OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

§ Constant current device § Range: 0.1-25 milliamps (mA)

BASIC FUNCTION STIMULATION CAPTURE

OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Pacing Pulse

Capture Depolarization of cardiac tissue after a pacing pulse. ECG shows a P wave or QRS after the pacing pulse.

Loss of Capture ECG shows no heart response as a result of the pacing pulse.

BASIC PACING CAPTURE THRESHOLD Loss of Capture

Capture 3 mA

2 mA

1 mA

ventricular pacing with loss of capture at 1 mA

OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

The minimum electrical stimulus needed to consistently capture the heart outside of the heart’s own refractory period

BASIC PACING FUNCTIONAL NON-CAPTURE If the pacemaker paces too close to an intrinsic beat there may be expected non-capture because the cardiac tissue is in refractory from the intrinsic beat.

OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS Capture

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Functional (or expected) loss of capture

BASIC FUNCTION SENSITIVITY CONTROL § Used by the pacemaker to detect (or “see”) the patient’s intrinsic beats OVERVIEW

§ Needed for synchronous pacing

BASIC OPERATION

§ Range: 0.4-20.0 mV

TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Sensitivity Setting § Higher number = less sensitive § Lower number = more sensitive

BASIC PACING FUNCTION SENSITIVITY OVERVIEW Less Sensitive

OVERVIEW BASIC OPERATION

Amplitude (mV)

5.0

2.5

More Sensitive

Sensing is what the pacemaker “sees.” Like a fence, with a higher number less is sensed, with a lower number, more is sensed.

1.25

TROUBLESHOOTING PROCESS

RAPID ATRIAL PACING (RAP)

This R wave would not be sensed because the sensitivity is set at too high of a number.

Time

Pacing and Sensing

COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

P

P

P = Paced beat S = Sensed (intrinsic beat)

S

P

P

S

P

BASIC PACING FUNCTION SENSITIVITY OVERVIEW Less Sensitive

OVERVIEW BASIC OPERATION TROUBLESHOOTING PROCESS

Amplitude (mV)

5.0

2.5 More Sensitive

1.25

Time

This R wave is sensed however so is the T wave as the sensitivity is set at too low of a number. This will cause oversensing.

RAPID ATRIAL PACING (RAP) COMPONENTS: DEVICE, BATTERY, AND CABLE MAINTENANCE AND CLEANING SUMMARY

Settings: Mode: VVI Rate: 60 bpm

Oversensing: May occur if sensitivity set too sensitive. This results in under pacing. Note: On this ECG the paced beat did not occur at the expected time causing the rate to drop below the programmed rate.