1) Surgeon wants the pacing wires to be removed. RN informed.
2) Introduce yourself and explain the procedure to the patient.
3) Wash your hands.
4) Auscultate chest – breath sounds and heart sounds.
5) Check rhythm on the cardiac monitor.
6) Check Hemoglobin, platelets, aPTT, PT, INR.
a) PT, normal levels 11 – 15 sec.
b) aPTT, normal levels 20 – 35 sec.
c) INR, normal levels 0.08 – 1.3
d) Platelets must be more than 150K.
7) If steps 4, 5, and 6a,b,c,d are WNL, proceed to remove PCWs.
8) Check most recent time that pain medication was given. If time exceeded over 4 hours and patient complaints of pain. Give pain medication. Revaluate pain scale, 30 minutes later.
9) Get materials:
a) 4 x 4 sterile gauze
b) Tape
c) Suture removal kit
10) Wash or sanitize your hands with alcohol gel/foam. Glove
11) Set up for the procedure
a) Have patient lay in bed. Raise bed to your comfortable working height.
b) Have dressing and tape ready.
12) Remove dressings.
13) Remove sutures securing the atrial PCWs.
14) Apply gentle and gradual traction on one wire. You may feel the heart “tugging” at the wire. Maintain gradual traction till wire “gives” and until completely out of the chest wall.
a) If wire is difficult to remove. STOP and contact Surgeon.
15) Repeat step 14 for second atrial wire.
16) Check cardiac monitor for heart rhythm.
17) Repeat steps 13 – 15 for ventricular pacing wire.
18) Apply dressing and tape.
19) Clean up area, and patient.
20) Reassess heart sounds and heart rhythm on monitor.
21) Wash hand after procedure.
22) Make sure patient is comfortable. Lower bed to the lowest height.
23) Order, STAT, cardiac tamponade precautions, RN to monitor. Document procedure in chart. If CT are in, mark on pleuravac date, and time when wires were removed.
24) Revaluate patient, check dressing, and pleuravac for drainage since removal of wires.