Bedside temporary pacemaker placement
The primary access site was
through the right internal jugular vein (16 cases, 73%), followed by
subclavian vein (4 cases, 18%)
when surgery involved the right neck. The femoral vein approach was used
(2 cases, 9%) after difficulty was experienced in advancing TVCP
catheter through the subclavian vein or right internal jugular vein
site. Except for subclavian vein access, all central venous access was
under ultrasound guidance.
Pacing catheterization guided by bipolar (both proximal electrode and
distal electrode connect to separate V lead) intracavity
electrocardiography (IC-ECG).14, 15The bipolar IC-ECG monitoring plus
direction control skill of the catheter tip made bedside TVCP catheter
placement feasible and
‘visible’.14Target proximal electrode IC-ECG
was slightly ST-segment elevation <2 mV which constitute a
proper position against the ventricular wall and adequate pacing
site,16 but it is impossible to maintain it if patient
change positions (Fig 1). All placement was further confirmed by
following standard 6-lead pacing ECG that II, III, and aVF QRS waves
downward.
Figure 1. Unstable pacing lead.