Clinical and mechanical factors associated with the removal of temporary epicardial pacemaker wires after cardiac surgery

Abstract

BackgroundTemporary pacemaker wires are placed in the majority of patients after cardiac surgery. There is no information on mechanical factors related to wire removal.MethodsClinical information related to temporary wire use and removal was prospectively collected from a large cardiac surgical unit over one year. Measurements of maximal tension that nurses and doctors would apply to remove temporary wires was determined using a hand-held portable scale. In a prospective trial, patients (n = 41) had their wires extracted in series to the portable scale to determine the maximal tension required for safe removal.ResultsVentricular wires were placed in 86.5 % of patients during the observed year. Pacing facilitated weaning from CPB in over 15 % of patients and pacer dependence was seen in 2.1 %. No patients suffered major complications after wire removal. There was no difference in the tension that physicians or nurses would apply to comfortably extract temporary wires. In the prospective trial, there was no difference in the tension required for removal of atrial or ventricular wires (atrial 18.3 ± 17.9 oz versus 14.5 ± 14.2 oz, p = 0.430). There were no patient factors that correlated with the degree of resistance and there was no significant difference between the tension required to remove wires with (21.0 ± 22.5 oz) or without (14.1 ± 5.1 oz) an atrial button.ConclusionsTemporary epicardial wire removal is innocuous and was not associated with any complications. In some patients tension required for safe removal exceeded 20 ounces. Strategies to standardize wire removal may prevent complications and may minimize unnecessary wire retention.

Clinical analysis of temporary pacemaker implantation in 13 children

“…There were no related complications such as myocardial perforation, cardiac tamponade, pacemaker-related arrhythmia, catheter rupture, thromboembolism, or puncture site infection in all 9 children with temporary endocardial pacing. Among the complications associated with temporary epicardial pacing, the most concerning issue related to hemorrhage and late tamponade due to removal of the temporary pacemaker wires which may call for re-exploration and be lifethreatening (28,29). None of the children with temporary epicardial pacing had related complications such as difficulty in wire removal or hemopericardium.…”

Complications of Epicardial Pacing Wire Removal Following Adult Cardiac Surgery: A Systematic Review

“…The study emphasized the significance of meticulous TEPW removal to reduce the risk of problems, as well as the need for additional research in this area to improve patient safety and outcomes. Due to the resistance of wire removal, in the study by Elmistekawy et al, 104 patients had wire retention as a complication [ 6 ].…”

Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP)

“…Se recomienda controlar al paciente durante unas horas tras la retirada de los cables de marcapasos 411 . Por ello, se sugiere no retirarlos el mismo día del alta hospitalaria.…”