Transvenous pacing—troubleshooting

Sometimes transvenous pacing (TVP) just won't work and there are three main reasons why—failure to capture, failure to sense, and failure to pace. In this video, from our Emergency Procedures Masterclass, you'll find out how to diagnose and fix common TVP complications so that you can increase your rate of successful pacing.

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[00:00:00] Sometimes transvenous pacing just won't work, and there are three categories of reasons the transvenous pacer may not function. In this lesson, we're going to review failure to capture, failure to sense, and failure to pace. Let's look first, at failure to capture. The blue arrows on the strip, show pacer spikes that are not being captured,

[00:00:30] meaning they're not followed by a wide QRS. This may be because the wire is not making contact with the ventricle wall or the output is too low or the patient has significant electrolyte abnormalities like hyperkalemia. The solution is to reposition the wire, usually by slightly moving it forward or increasing the output or

[00:01:00] fixing the electrolytes. The second reason transvenous pacer may not work, is failure to sense. In this strip, you can see that the pacer spikes are occurring at regular intervals, even when there are native QRS complexes. This is a case of the device not sensing the native QRS complexes. The solution is to increase the sensitivity, by decreasing the number of millivolts

[00:01:30] needed, to sense electrical activity. Lastly, failure to pace may be the reason for transvenous pacing failure. In this strip here, we see that there's this long period of asystole after the first two captures and this is failure to pace and there are no pacer spikes during this period of asystole. This may be because the machine is oversensing, meaning

[00:02:00] the device is too sensitive and it's picking up a little noise and not putting out pacer spikes or it could be that the battery is low and you need to replace the battery or maybe that the lead is displaced or there's a loose connection. Now that you're aware of the common problems with transvenous pacing, you will be able to avoid them and increase your rate of successful pacing.