Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation

12-18-2020

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

School of Nursing

Advisor(s)

Linda 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).

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