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Date of Graduation
12-18-2020
Document Type
Dissertation
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
Advisor(s)
Linda J. Hulton
Megan Rashid
Abstract
The placement of temporary epicardial pacing wires (TEPW) is considered standard practice post cardiac surgery and is dependent on the patient’s cardiac function intra-operatively and their electrophysiologic profile after weaning from cardiopulmonary bypass (Reade, 2007; Elmistekawy et al, 2016). Complications associated with TEPW removal include myocardial damage, infection, perforation, tamponade, disruption of anastomoses, ventricular arrythmias, and death (Bojar, 2009; Carroll et al, 1998;Timothy & Rodeman, 2004). Currently there is no standard practice on the removal of TEPW and there is wide variation in removal practices involving patients who are routinely on medications such as dual antiplatelet therapies and systemic anticoagulation. The utilization of a standardized algorithm would ensure timely review of patient specific lab data, anticoagulation regimen, and use of pacing wires are addressed prior to wire removal in turn mitigating unnecessary risk. Patients were identified using pilot study inclusion criteria and participation in the study was denoted with the placement of a sign over the head of the patient’s bed. Adherence data was measured through collection of nursing checklists and the presence of a post-procedure wire removal note completed by the provider removing the wires. Of the pilot study patients (n=10), 7 nursing checklists were appropriately completed and collected, showing 70% adherence. Ten of 10 patients had a post-procedure wire removal note completed in the electronic medical record, equating to 100% adherence. None of the study patients in the pilot study required re-operation or had bleeding complications post-wire removal. Adherence to the use of a standardized algorithm may reduce risk of bleeding or re-operation associated with temporary pacing wire removal (Kiely, O’Brien, & Mooney, 2020).
Recommended Citation
Norman, Jessica, "Pulling heart strings: Quality improvement algorithm for temporary epicardial pacing wire removal post cardiac surgery" (2020). Doctors of Nursing Practice (DNP) Final Projects, 2020-current. 5.
https://commons.lib.jmu.edu/dnp202029/5
