Performs cardiac pacing (transvenous or transthoracic)


Knowledge

Principles and techniques of cardiac pacing
Patient selection - indications, contraindications and potential complications of the procedure / intervention
Principles of ECG monitoring (heart rate, rhythm, conduction, ST segment change & QT interval) - indications, limitations and techniques. Advantages and disadvantages of different lead configurations
Basic and complex cardiac arrhythmias - recognition and management (pharmacological and electrical)
Surface anatomy: structures in the antecubital fossa; large veins and anterior triangle of the neck; large veins of the leg and femoral triangle
Methods for securing vascular access rapidly
Principles, routes and techniques of peripheral and central venous cannulation
Principles of emergency airway management (see 5.3)
Principles of aseptic technique and aseptic handling of invasive medical devices
Universal precautions and preventative infection control techniques (hand washing, gloves, protective clothing, sharps disposal etc.)
Detection of potential physiological alterations during the procedure
Complications of the technique, how to prevent/recognise them and initiate appropriate treatment
Detection and acute management of cardiac tamponade
Detection and management of haemo/pneumothorax (simple and tension)
Insertion and management of chest drains and air exclusion devices
Principles of defibrillation and cardioversion (see 5.14)
Management and use of the device once in situ necessary to minimise the risks of complications
Indications and technique for removal

Skills & Behaviours

Prepare equipment, patient and staff prior to undertaking the procedure
Choose an appropriate route / method of insertion and position the patient accordingly
Perform the procedure in a manner which minimises the risks of complications
Use protective clothing (gloves / mask / gown / drapes) as indicated
Undertake appropriate investigation to confirm correct placement of device or exclude complications
Recognise and manage emergencies; seek assistance appropriately
Insert a temporary pacing wire
Establish & review pacing box settings
Demonstrate emergency percutaneous pericardial aspiration
Demonstrate emergency relief of tension pneumothorax

Attitudes

Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)
Considers patient comfort during procedures / investigations
Desire to minimise patient distress
Accepts personal responsibility for the prevention of cross infection and self infection
Supports other staff in the correct use of devices
Promotes respect for patient privacy, dignity and confidentiality