I read the article, “Mastering Temporary Invasive Cardiac Pacing” in the June issue of Critical Care Nurse (June 2004:25–32). It was very informative and well-written.
I was concerned by the following recommendation: The usual starting point is 10 mA in nonurgent situations. Output then is slowly increased until capture is obtained and the “pacing threshold” is defined. In emergent circumstances, starting with a high output (15–20 mA) is recommended. What happens if capture is obtained with 10 mA? How is the pacing threshold determined?
This appears to be a high level of energy. Generally, smaller levels of energy are required when directly pacing the endocardium or epicardium. Most temporary pacemaker generators (ie, Medtronic) have a maximum output of 20 to 25 mA.
To determine the pacing threshold once capture has occurred, the mA should be decreased until capture is lost. Then, the mA is increased until capture is obtained. This...