A survey of temporary pacing procedures in the Wessex Region
Betts TR., Stewart MD., Amaro VM., Roberts PR.
The insertion of transvenous temporary pacing wires (TPWs) is a common procedure performed in most hospitals in the UK. Despite this, little is known about procedural complications and how technique and operator experience affect outcome. Method: Over a 12-month period data on TPW procedures were prospectively collected at 6 hospitals in the Wessex Region. Questionnaires were completed at the time of TPW insertion and accompanied the patient until TPW removal. Operator experience, supervision, route of insertion, sterile techniques, TPW position and threshold, outcome, complications and treatment were recorded. Results: Questionnaires on 145 procedures (109 urgent, 36 elective) performed on 123 patients were completed and returned. 69 (47.6%) were performed by registrars of whom 12% were supervised. 71 (49%) were performed by SHOs, of whom 80% were supervised. Internal jugular and subclavian vein approaches were performed in equal amount. The femoral vein route accounted for 17% of procedures. Mean procedure time was 36.3+7-27.1 (range 1-150) mins. TPWs were in-situ for 3.5+/-3.4 days (range 40 mins-20 days). One or more complications occurred in 42 (30%) of procedures, the most common being TPW displacement or infection. Complications were more likely to occur following internal jugular vein insertion (p<0.001) and after longer procedures (p<0.05) but were not related to operator grade, experience, specialty (cardiologist vs non-cardiologist) and duration that the TPW was in-situ, or whether it was an urgent or elective procedure. 7 patients died with a TPW in-situ or during the procedure, none directly as a result of TPW complications. 70% went on to have permanent pacemaker insertion, 23% of which were delayed due to TPW complications. Conclusions: TPW insertion has a high complication rate despite operator experience and supervision. Internal jugular vein insertion led I to a higher incidence of TPW displacement and infection. Complications often result in delay to permanent pacemaker implant and prolonged hospital stay.