In a 2006 publication, analysts discussed events reported to the Pennsylvania Patient Safety Authority about complications from the placement of temporary epicardial pacing wires (TEPW) during open heart surgery.
- One report was of bleeding from the insertion site, leading to pericardial tamponade post-operatively. The tamponade was treated with pericardiocentesis, and the patient was returned to the operating room for correction of the underlying leak.
- The other report was of a fatal, exsanguinating hemorrhage into the chest upon post-operative removal of an atrial pacing wire, because the removal of the wire tore the child’s atrium.
These two reports represent the Scylla and Charybdis of temporary epicardial pacing wire placement: leaking and binding. The 2006 publication included expert commentary, which provided considerations for placement of TEPW:
- Keep electrodes at least 1.5 – 2.0 cm apart on the epicardium to maximize efficacy.
- Carefully select locations.
- If repair suture for bleeding required, use smallest suture possible (e.g. 4-0, 5-0, or even 6-0).
- Avoid long, redundant loops of wire; prevent conduit ensnaring or lassoing which could occur at removal.
- Keep epigastric exit sites near the midline on each side with intra-institutional standardization for ventricular wires to the left of midline and atrial to the right. This avoids confusion for critical care/nursing staffs.
- Keep electrode ends of TEPW electrically isolated in some fashion.
Figure. Potential Failure Modes— Incorrect Placement of Pacing Wires
Excerpted from: McClurken JB. Minimizing complications from temporary epicardial pacing wires after cardiac surgery. PA PSRS Patient Saf Advis 2004 Sep. http://patientsafety.pa.gov/ADVISORIES/Pages/200603_08.aspx.