Utilizing a Systematic Approach for Evaluating Cardiac Devices
In the ever-evolving healthcare field, cardiac implantable electronic devices (CIEDs) play a critical role in regulating heart rhythms, offering life-saving support, and enhancing the quality of life for millions worldwide. Ensuring optimal functionality of these devices requires detailed care and attention, which can be achieved through regular checks using a standardized method.
A standardized method of checking cardiac devices is crucial for several reasons, including consistency, efficiency, and accuracy, which is vital for ensuring patient safety. By quickly identifying any issues or malfunctions, healthcare providers can take immediate action to address them, thereby reducing the risk of adverse events and improving patient outcomes.
Did you know CHART has CIED content? #DevicEPeeps
One method employed in these check-ups is PBL-STOP, a systematic approach to cardiac device evaluation. PBL-STOP stands for Presenting Rhythm, Battery Status, Lead Impedance, Sensing, Threshold, Observations, and Program & Print. Let's dive deeper into this approach.
Presenting Rhythm: Presenting Rhythm can be viewed upon interrogation of the cardiac device, shown on EGMs. It’s important to note the rate, pacing mode, sensing and pacing percentages, and if the patient is experiencing an arrhythmia.
Battery Voltage: Battery voltage is crucial to ensure that the device remains operational. A low battery voltage could lead to an increased risk of device malfunction, which could lead to ineffective therapy delivery or failure to provide necessary pacing or defibrillation.
Lead Impedance: Impedance measures the resistance to the flow of electrical current through the leads. Monitoring impedance helps detect any abnormalities in lead function, such as breaks or fractures. Any damage or malfunction in these leads can disrupt the transmission of electrical signals, such as inappropriate sensing.
Sensing: Sensing refers to the device’s ability to detect the heart's natural electrical activity. Proper sensing ensures that the device responds appropriately to changes in the heart's rhythm, optimizing its performance. This step also assesses the patient's underlying rhythm.
Threshold: Threshold testing evaluates the minimum amount of electrical energy required to consistently stimulate the heart muscle. Evaluating this value ensures the delivery of effective pacing while optimizing battery life.
Observations: Observation window findings, arrhythmia episodes, and histograms aid in identifying arrhythmias, correlating symptoms with diagnostic data, and determining optimal therapy adjustments based on the information gathered. Analyzing programmed parameters and data collected since the last interrogation offers valuable insights for patient care and treatment planning.
Program & Print: In this final step, make any necessary changes. Then review the patient's current programming and check that all parameters are set correctly. Finally, it is essential to print or save the final report to the patient's record for documentation and future reference.
"PBL-STOP serves as the roadmap guiding us through the complex world of device management, ensuring every key aspect is thoroughly assessed for optimal performance and patient safety."
Using the PBL-STOP method is important in device follow-up because it ensures consistency and accuracy when checking cardiac devices. This checklist serves as a valuable tool for identifying potential issues early, optimizing device settings, and ensuring excellent patient care.
Eager to #LevelUp your device knowledge? CHART offers two Pacing & Programming courses, Nuts & Bolts and Guru. The Nuts & Bolts course explores cycles, modes, NBG codes, and single and dual-chamber pacing. The Guru course explores conduction system pacing, cardiac resynchronization, ICDs, and device technology. Which path will you choose?
Mary Smith
MS, CCDS, RCES, RCIS
Chart Certified Coach and IBHRE Ambassador
Mary works as a Senior Clinical Specialist for Medtronic in CRM. She also facilitates courses at CHART about cardiac devices. Mary has a passion for teaching and mentoring and finds joy in empowering individuals to excel. As a CHART coach, Mary combines her expertise in the medical field with a dedication to nurturing the next generation of talent, ensuring a brighter future in healthcare.
Connect with Mary on LinkedIn to expand your professional network and unlock opportunities for collaboration, growth, and mutual support.
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