Your doctor has recommended that you receive a permanent pacemaker implanted in your body.
But what does that actually mean?
The heart is located in the center of the chest, enclosed by the breast bone and rib
cage.
By contracting in a rhythmic way, it causes the blood in your body to circulate.
A normally functioning heart beats at a rate of between 60 and 100 contractions per minute.
These contractions are triggered by a small piece of heart tissue called the SA node.
The SA node generates a small electrical signal that is transmitted by nerves to the surrounding
muscle.
These electrical impulses are what cause the heart muscle to contract.
In some people, the SA node fails to cause the heart to contract with its normal rhythm,
causing an abnormal heartbeat or arrhythmia.
The most common form of arrhythmia, for which pacemaker surgery is often recommended, is
bradyarrythymia - or slow heart rate.
There are a number of reasons why you may have developed an arrhythmia, but in most
cases the problem is caused by a disruption in the SA node or in the system of nerves
that conducts electrical signals to the heart muscle.
A pacemaker is a device that is designed to provide an electrical signal to the heart
muscle and to help it maintain a proper rhythm.
There are several types of pacemakers and the particular model selected for you will
be based on your specific condition.
But all pacemakers share a common design.
Your pacemaker will consist of two major pieces . . . a small metal box that contains a battery
and other electronic components and an insulated wire, called a lead, which will carry the
electrical impulses from the pacemaker to the heart.
Your pacemaker will be permanently implanted in your chest and, depending on your condition,
either one or two leads will be attached to the heart muscle.
On the day of your operation, you will be asked to put on a surgical gown.
You may receive a sedative by mouth and an intravenous line may be put in.
You will then be transferred to the operating table.
To begin, skin is swabbed with an antiseptic solution and a sterile drape will be placed
around the operative site.
Then the surgeon will make a small skin incision in the upper chest, just below the collarbone.
A pocket is then created between the skin and the tissue that covers the chest muscle.
Next, the team will use instruments called retractors to hold back the skin and underlying
tissue.
They'll locate a large blood vessel called the subclavian vein.
Using a special needle and syringe, your doctor will puncture the wall of the vein.
A thin guide wire is then inserted through the needle and into the vein.
Your doctor gently pushes the wire until it reaches the heart.
Using an instrument called a fluoroscope the surgical team is able to see the wire's progress
through the vein and into the beating heart.
Once the wire is in place, the needle is removed and a catheter - or hollow tube - is passed
over the guide wire and into the heart.
One or two leads are then passed through the catheter.
When the lead or leads are in their proper position, the catheter is removed.
Finally, the lead is connected to the pacemaker, the pacemaker is inserted into the pocket
below the collar bone and the incision is closed.
Germs are present always on your hands and they can be transferred to:
* other parts of your own body, * to the family member for whom you are caring
* your patient * and to any clean object that you touch.
By washing your hands correctly:
* you remove germs from your hands.
* Handwashing is the single most important way you can prevent infection from occurring
and * prevent the spread of infection.
You must carefully wash and dry your hands:
* Before and after each time you care for your family member or your patient.
* Before and after you handle your patient's and your own food and drink.
* Before and after you manipulate any contact lenses.
* Before you apply and after you remove gloves * After you use the toilet.
* After you cough, sneeze or blow your nose.
* After contact with anything that could be soiled or have germs on it.
* After you pick up any object from the floor *
Handwashing takes a minimum of 10-15 seconds, * longer if your hands are soiled.
* The longer you wash, the more germs are removed.
* The friction generated by rubbing your hands together removes the germs from your skin
and * running water can then wash them away
* Every time you wash your hands, take your time and don't rush.
* Do the handwashing carefully and thoroughly.
Use liquid soap from a dispenser.
Bar soap holds germs on its surface.
Make sure you have paper towels and a waste receptacle nearby.
Remove all jewelry from your hand except a wedding band and push your watch and sleeves
up, away from your hands.
Turn on warm water.
Point your fingers down to prevent water running onto your arms and wet your hands.
Apply soap from the dispenser.
Point your fingers down and rub your hands vigorously together in a circular motion.
Star counting seconds at this point.
Intertwine your fingers to clean all surfaces of the fingers.
Rub your fingernails against the palm of the other hand to get soap under the tips of the
nails.
If your nails are soiled, clean under them with an orange stick or brush.
Keep your hands down and continue to rub them together in a circular motion until the end
of your count for 15 seconds.
Keep your hands down and rinse them from the wrist to fingertips.
Pick up a clean paper towel and turn off the water, still keeping your hands pointing down.
Discard the paper towel into a waste receptacle Pick up another clean paper towel and carefully
and completely dry your hands.
Discard the paper towel into a waste receptacle.
The key points to remember are:
* that friction is critical for removing germs * and the friction should be applied for at
least 15 seconds.
* Always keep your fingers pointed down * and turn off the water with a paper towel.
The equipment you will need to assemble includes:
* 2 pairs of clean disposable gloves * cleansing solution;
* small gauze pads for cleaning * large gauze pads for dressing the wound
* adhesive tape * a large sealable plastic bag.
Carefully, wash and dry your hands.
Put on your gloves.
The first step is to remove the old dressing Loosen the edges of the tapes and peel the
tapes off the skin by pulling them towards the wound,
keeping the skin taut with the other hand Lift the tapes and the dressing off together.
Note any odor and the color of any drainage on the dressing.
Discard the dressing and tapes into the plastic bag
If the dressing sticks to the wound, pour a little cleansing solution onto the dressing
and let it sit for a minute.
Gently pull the dressing off, keeping the skin taut above the wound
Look carefully at the wound.
Any of the following should be reported immediately to your doctor or nurse:
* redness of the wound or surrounding skin * drainage from the wound, particularly if
it's yellow and smells * any bleeding
* swelling of the skin around the wound * separation of the edges of a sutured wound
* or maceration, a waterlogged appearance of the edges of the wound.
Pour some cleansing solution onto a small gauze pad, squeeze out the surplus solution
and, with one stroke, clean the wound from top to bottom.
Discard the gauze pad into the plastic bag.
Using a fresh gauze pad with cleansing solution for each stroke, work away from the wound
to clean the skin for about three inches from the wound on either side.
Stroke from top to bottom and discard each gauze pad into the plastic bag.
Remove your gloves and discard them into the plastic bag.
Wash and dry your hands.
Open the package with the large gauze dressing.
Put on clean gloves.
Pick up the gauze dressing, holding it only at two diagonally opposite corners
Center the gauze pad over the wound and place it on the wound.
Tape the dressing securely in place.
Remove your gloves and discard them into the plastic bag.
Seal the bag securely and discard it into the trash
Wash and dry your hands.
If your skin is sensitive to the adhesive on the tape,
* hypoallergenic tape can be bought at your surgical supply store
* or bandages or binders can be used to hold the dressing in place.
Consult with your doctor or nurse.