Cardiac Devices: Pacemakers, ICDs, and Nursing Responsibilities

A permanent or temporary pacemaker delivers low-energy electrical impulses when the heart's intrinsic rate or conduction is inadequate. An implantable cardioverter-defibrillator (ICD) monitors for selected ventricular tachyarrhythmias and may respond with antitachycardia pacing or a shock; many ICDs also provide bradycardia pacing. Neither device replaces assessment of the person, a palpable pulse, or a resuscitation response when circulation is absent. The RN's central questions are: Is the patient perfusing now? Is the monitor showing electrical capture and is there corresponding mechanical capture? Is the device sensing intrinsic activity appropriately? What changed from the prescribed device plan or the patient's baseline? Device programming and interrogation findings inform care, but symptoms, pulse, blood pressure, level of consciousness and other perfusion cues determine urgency. This lesson separates bedside recognition and emergency action from device-specialist functions. The RN assesses, initiates authorized emergency measures, protects the device system, communicates precise findings, and obtains the device team or most responsible provider. Programming, changing output or sensitivity, applying a magnet, and managing tachytherapy require device-specific knowledge, legal authority, competence, an order or directive where applicable, and organizational...