Epicardial Pacing Wire Removal
PREREQUISITE NURSING KNOWLEDGE
• Knowledge of the cardiovascular anatomy and physiology is necessary.
• Knowledge of principles of aseptic technique is needed.1,4,6,7
• Knowledge of placement and function of epicardial pacing wires is necessary.
• Advanced cardiac life support knowledge and skills are needed.
• Principles of general electrical safety need to be applied with use of temporary epicardial pacemaker wires.
• Gloves always should be worn when handling epicardial pacemaker electrodes to prevent microshock because even small amounts of electrical current can cause serious dysrhythmias if they are transmitted to the heart.
• Knowledge of cardiac dysrhythmias and treatment of life-threatening dysrhythmias is necessary.
• Relative contraindications to epicardial pacing wire removal include bleeding, abnormal coagulation study results, presence of dysrhythmias that necessitate pacing assistance, and compromised hemodynamic status.
• Knowledge of signs and symptoms of cardiac tamponade is needed (e.g., hemodynamic instability, dyspnea, muffled heart sounds, diaphoresis, equalizing pulmonary artery pressures, jugular venous distention, pulsus paradoxus, altered level of consciousness).
EQUIPMENT
• Gown, goggles or face shield with mask, nonsterile gloves
• Antiseptic solution (e.g., 2% chlorhexidine-based solution)
Additional equipment that may be needed includes the following:
PATIENT AND FAMILY EDUCATION
• Assess patient and family readiness to learn, and identify factors that affect learning. 
Rationale: This assessment allows the nurse to individualize teaching.
• Provide information about the epicardial pacing wires, the reason for their removal, and an explanation of the procedure. 
Rationale: This information helps the patient and family to understand the procedure and why it is needed and may decrease anxiety.
• Explain the patient’s expected participation during and after the procedure. 
Rationale: Encourages patient participation in the treatment plan and may decrease anxiety.
