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Family protection of complications of long-term pacemaker

Forty-three patients with permanent pacemakers were investigated, and 65% and 77% of them listed pacemaker complications and family protection as requirements respectively. 74% of the patients listed the questions about the above knowledge as the most concerned and worried questions. In view of the above investigation results, the complications after pacemaker operation are discussed and analyzed, and the corresponding family protection countermeasures are listed, which will ensure the quality of life of patients after operation and improve the quality of nursing. Pacemaker complications; Family protection; Permanent pacemaker is the main method to treat irreversible cardiac pacing and conduction dysfunction caused by various reasons. Some complications and pacing failure may occur after implantation. This is the part that patients are most worried about and lack knowledge. How to let patients know and protect these complications at home, minimize the harm, and at the same time correctly understand pacemakers and reduce unnecessary concerns. It is the health care knowledge that nurses must master and preach to patients. 1 general information 43 questionnaires about the needs of patients with permanent pacemakers were distributed in this group, and 43 respondents, 28 of whom listed "understanding the complications of pacemakers" as the demand, accounting for 65% of the total. Among them, 9 people were listed as the most in need, accounting for 2 1%. There are 33 people who need "home protection for pacemaker complications", accounting for 77% of the total number, of which 14 people need it most, accounting for 33%. Among the "What are you most concerned about and worried about at present" questions filled in by patients, 32 people mentioned the first aid and maintenance methods of pacemaker complications, accounting for 74% of the total. 2 Common complications after pacemaker implantation 2. 1 Arrhythmia can occur at any stage of pacemaker implantation, especially in the early stage. Due to electrode displacement, endocardial infection, pacemaker failure and different performance. Among them, when the pacemaker is disturbed by the external electromagnetic field in daily life, it will also cause atrial or ventricular triggered pacemakers to be mistakenly triggered by external signals and cause tachycardia. 2.2 Electrode displacement and lead breakage mostly occurred within one week after operation, especially within 24 hours. It can be caused by excessive right ventricle, excessive electrode tension in cardiac cavity or sudden movement, and body position change. Pacing failure may occur after replacement. In addition, because the upper limb often swings regularly (such as some kind of movement), it can often break the lead, destroy the insulation layer under the clavicle and the first rib, and cause local muscles to twitch due to electric leakage, or even completely fail to pace. If the tension of the catheter electrode increases and the electrode clings to the diaphragm wall, it can stimulate the diaphragm to contract synchronously with the heart, and there will be local convulsions in the chest and abdomen consistent with the pacing pulse frequency, which will make the patient's muscles jump and restless. 2.3 After the pacemaker is placed, the pacing threshold can be increased by 2-3 times, and it can be stabilized at 2 times of the initial threshold after one month, which is called physiological threshold increase. This is caused by inflammation and edema at the endocardial contact point of the electrode. If the threshold is still high after this period, the abnormal threshold will increase, which is mostly the result of poor electrode position and poor endocardial contact. 2.4 Infection and skin necrosis are common complications. Local infection can be caused by hematocele, inflammatory infection or abscess. The elderly and frail patients can be infected by the skin worn by pacemakers because of their thin subcutaneous tissue. Systemic infection is rare, but it may lead to severe infective endocarditis, because the electrodes in the heart cavity are easily affected by endocardium. Skin necrosis mostly occurs in the early postoperative period, especially in emaciated patients. If the pacemaker system is buried too shallow, the tension of the skin capsule increases, causing local skin ischemia and necrosis, or trauma causing local skin inflammation and invasion, which can lead to skin necrosis, rupture or infection. 2.5 Pacing system failure Bad pacing circuit, insufficient battery, connection failure, insulation damage, electrode displacement, low signal and high patient's own heart threshold can all cause pacing failure or arrhythmia. Common system failures include: pulse transmission failure refers to irregular pulse or pulse capture disorder without pulse refers to cardiac sensory dysfunction with pulse. Pacemakers can't perceive their own heart rhythm, and competitive heart rhythm appears, which is called poor perception. Pacing frequency is not limited. Due to electronic component failure or battery exhaustion, the circuit is unstable, which makes the pulse frequency suddenly increase and causes tachycardia acceleration. If ventricular fibrillation is caused, the patient may die. 2.6 Decline of cardiac function If the patient originally suffered from ischemic heart disease, cardiomyopathy and cardiac dysfunction, these diseases will not disappear with the installation of pacemakers, but may be further aggravated. Although the pacemaker solves the heart conduction problem of patients, it is different from the normal physiological state of heart excitement and contraction, which will lead to cardiac dysfunction. 2.7 Pacemaker syndrome is seen in patients with ventricular pacing. Due to the asynchronization of atrioventricular contraction, the ventricular filling volume, cardiac stroke volume, blood pressure and pulse can be reduced. The patient has symptoms such as palpitation, blood vessel pulsation, head swelling and dizziness. 2.8 After operation, patients are not used to pacemakers, or the incision is painful, which leads to limb dysfunction, and patients excessively restrict limb activities. In the long run, they will cause useless atrophy of limb muscles and adhesion of joint ligaments, which will affect normal limb function. 3. Family protection measures for pacemaker complications 3. 1 Stay in bed absolutely within 24 hours after operation and do not turn over. The affected limb should be braked within one week after operation, and observation should be strengthened to find out the abnormal changes of the patient's heart rhythm in time. The recovery period after operation should follow the principle of gradual physical exercise to avoid severe and repeated cutting movements of the affected limb, the burden of the affected shoulder and jumping from a height. If the shoulder muscles twitch, it is necessary to pay attention to it, and it is suspected that the wire has fallen off. You should come to the hospital immediately at this time, and you should not delay the opportunity. Early postoperative local dressing should be kept clean and dry, and it should be replaced in time if it gets wet or falls off. At the same time, instruct patients to eat foods rich in protein, keep local skin clean after stitches are removed, and do not wear tight underwear. If there is local redness and pain or even skin ulceration after operation, the patient should not be treated at home and should go to the hospital. If accompanied by fever and other systemic symptoms, we should consider the possibility of infection and deal with it in time to avoid causing more serious infection. 3.2 It is a simple and effective method to teach patients to feel their own pulse after operation. Postoperative pulse monitoring should ensure that you are in the same physical condition every day. If you wake up every morning or sit still for 15 minutes, you should keep monitoring your pulse, especially in the early stage of storage and near the battery life. The pacing situation can be known by detecting the pulse in the early stage, and the remaining energy of the battery can be found as soon as possible by detecting the pulse in the later stage. Generally speaking, the pulse is detected correctly every day for more than a week, and the pulse is slower than before for more than 7 times every day. You should go to the hospital in time. The time to go to the hospital for examination is usually once every two weeks in January and once every three months. This is because the threshold of early pacemakers is unstable and needs to be adjusted in time. There are many factors that cause the increase of pacing threshold, except electrode position, lack of sleep, full meal, antiarrhythmic drugs, hypertension and other factors can all cause it. Therefore, postoperative patients should maintain a good mood, ensure a regular life and work and rest system, and avoid the influence of adverse factors. 3.3 Generally speaking, the patient's original symptoms such as dizziness and fatigue will be improved after implantation of pacemaker. However, if the above symptoms persist after operation, especially in patients with ventricular pacing, they should go to the hospital to check whether there is artificial pacemaker syndrome. This diagnosis must be cautious and differentiated from autonomic nervous dysfunction and menopausal syndrome. Once the symptoms are obvious, atrial synchronous or atrioventricular sequential pacemakers need to be replaced. Whether to continue taking medicine after pacemaker implantation depends on the development of the patient's original disease. Pacemakers only solve the problem of heart conduction. If the original heart function is poor or accompanied by other heart diseases, the medicine should still be taken according to the condition, which can effectively maintain the heart function and reduce the influence of the pacemaker itself on the heart function. 3.4 Early postoperative limb functional exercise is beneficial to local blood circulation and wound healing. Patients should be persuaded to eliminate their concerns, and the exercise program can be started after the stitches are removed. There may be slight incision pain at the beginning. When this situation is normal, you should stick to it after you leave the hospital and go home. Exercise should follow the principle of gradual progress, and should not be rushed. It is the guarantee to improve the quality of life of patients after operation to gradually increase the range of arm lifting, chest expanding or "climbing the wall" until the arm can reach the opposite earlobe on the top of the head and restore normal limb function as soon as possible. 3.5 Generally speaking, the work of pacemakers tends to be stable after patients are discharged from hospital, and few complications will suddenly endanger the life safety of patients. Many patients often worry that the pacemaker will suddenly break down or stop working, so the necessary explanation is the key to relieve their psychological pressure. It needs to be explained to the patient that the energy of the pacemaker is delivered by the battery, and the electricity in the battery cannot be used up at once, but will only be consumed slowly. Therefore, even if the power is insufficient, the pacemaker will only slowly stop working, and the patient's heart rate will gradually slow down and will not suddenly stop. However, sometimes something unexpected happens. When the patient accidentally approaches the high-voltage electromagnetic field or accidentally exceeds the safe distance between the mobile phone and the pacemaker, the patient may feel strange all over. In severe cases, it may cause arrhythmia. At this time, the patient should be instructed not to panic, and should immediately take off his mobile phone and leave the place. Under normal circumstances, pacemakers will soon return to normal. In some unexpected situations, when the pacemaker is severely hit or the affected limb is overloaded, the pacemaker may work abnormally or even the lead may be broken. At this time, patients may have different degrees of discomfort. Patients with severe pacemaker dependence may have symptoms such as blackness and dizziness again. Self-pulse test found that the heart rate slowed down to below normal. At this time, you should immediately stop moving, brake the affected limb, and carry a pacemaker card (which records important information such as the time and type of pacemaker implantation) so as to get to the hospital as soon as possible and be examined by a doctor. Conclusion Various complications will inevitably occur after permanent pacemaker implantation. Some complications can be avoided by strengthening self-protection, and patients have a strong demand for this knowledge. Therefore, nurses have the responsibility to educate patients about this knowledge. Once patients have mastered this knowledge, on the one hand, they can eliminate some unnecessary worries and face their future life with a positive and correct attitude, on the other hand, they can also let patients know some preventive measures and actively prevent accidents. Even if there is an abnormal situation, the patient can basically identify it, thus striving for treatment time. However, it should be noted that education should vary from person to person, and the professional knowledge of pacemaker complications should not be publicized too much. The emphasis should be changed to prevention and health care measures, and the language should be encouraged and comforted so as not to cause patients to be overly nervous and affect their mood. In a word, popularizing family protection measures for pacemaker complications is one of the important contents to improve the quality of life of patients after operation. Nurses master the sense of proportion, educate in time and meet the needs of patients in this respect, which not only enables patients to acquire knowledge, but also improves the quality of medical care.