TROUBLE SHOOTING & TIPS

How to determine where you are without fluoro:

-Turn on pacer and look at what captures:

• If you see pacing spikes that does NOT change the QRS, and the overal rate increases, you are probably in the atrium (you are atrial pacing)

• If you see pacing spikes followed immediately by wide QRS complexes, you are in the ventricle (you are pacing and capturing the V)

• If you see pacing spikes, but the QRS does not change, and you are not capturing the atrium, and you are past 40 cm, you could be in the IVC

You can start with a straight shaped balloon tip.  If you advance past > 40-50 cm and you are not capturing the atrium nor the ventricle, you are likely in the IVC and you might need a little bit of a curve to avoid going straight down into the IVC.  A gentle curve might help guide you into through the tricuspid valve into the right ventricle like below (try to shape the balloon tip with your hands until it looks like something below)

NOTA BENE:  You might have to adjust the above lengths and distances based on height potentially.  If you have a very tall patient (for instance, if they are 6 foot 5) - you might to go past  the 40-50 cm mark to reach the ventricle.  This also applies if you have a shorter patient, in it may take less distance than the standard 40cm mark to reach the ventricle.