TVP Modes & Settings
This commonly used pacing mode means the ventricle is paced, sensed, and pacing is inhibited if intrinsic activity is detected.
What is VVI?
Scenario: Patient with complete heart block and no atrial activity.
Paces and senses the ventricle. Inhibits pacing if intrinsic ventricular activity is detected.
This issue is identified by pacing spikes without QRS complexes.
What is failure to capture?
Example: Pacing spikes without QRS complexes.
You check the ventricular output and it's set to 5 mA. You increase it to 10 mA, and capture is restored.
This must be done before making any changes to pacemaker settings.
What is consult the MRP?
TVP is indicated for this type of arrhythmia that causes unstable bradycardia.
What are heart blocks?
This device delivers electrical impulses to the heart.
What is the pulse generator?
In the DDD mode, this letter indicates dual chamber pacing and sensing.
What is D?
Scenario: Post-op cardiac surgery patient with intermittent AV block.
Dual chamber pacing and sensing. Responds to sensed activity by triggering or inhibiting pacing.
This occurs when the pacemaker fires despite intrinsic activity.
What is failure to sense?
sensitivity setting set too high (e.g., 5.0 mV). You lower it to 2.0 mV, allowing the pacemaker to detect intrinsic activity and inhibit pacing appropriately.
This should be infused at a minimum of 10 mL/hr through the side arm.
What is normal saline?
This complication involves fluid accumulation in the pericardial sac.
What is cardiac tamponade?
This wire is inserted through a sheath and sits in the right ventricle.
What is the transvenous pacing wire?
This pacing mode does not respond to sensed activity and fires at a fixed rate.
What is DOO?
Asynchronous pacing of both chambers. No sensing; fires regardless of intrinsic activity.
A pacemaker that doesn’t fire at all may be experiencing this.
What is failure to pace?
Check generator, replace battery
This bedside item should be taped to the generator for emergencies.
What are spare batteries?
TVP may be used as a bridge to this permanent intervention.
What is permanent pacemaker insertion?
This part of the setup connects the pacing wire to the generator.
What is the bridging cable?
This setting determines how much voltage is needed for the pacemaker to detect intrinsic activity.
What is sensitivity (measured in mV)?
Increasing this setting may help correct failure to capture.
What is output (mA)?
This dressing allows visibility of the insertion site.
What is a transparent dressing (e.g., Tegaderm)?
This complication can occur if the pacing wire perforates the ventricle.
What is ventricular perforation?
This test is ordered after pacemaker insertion to confirm wire placement.
What is a chest X-ray?
Example: Ensures proper wire positioning.
This pacing mode is only appropriate when the patient has intact AV conduction. It paces and senses the atrium, inhibiting pacing when intrinsic atrial activity is detected. It should not be used in patients with AV block due to the risk of ventricular asystole.
What is AAI (Atrial Demand Pacing)?
This term describes when the pacemaker misinterprets noise as intrinsic activity.
What is oversensing?
Interpreting muscle tremors as intrinsic activity. Sensitivity set to 0.5, increase to 2.0 reducing oversensing
This safety check is performed at every shift change.
What is RN-to-RN safety check?
This condition may result from air entering the bloodstream during insertion.
What is air embolism?
This measurement is taken from the black line to the hub of the Cordis.
What is the internal wire length?