Asian Cardiovasc Thorac Ann 2004;12:270-271
© 2004 Asia Publishing EXchange Ltd
Sutureless Fixation of Temporary Pacing Wire
Manoj Purohit, MD,
Markku Kaarne, MD
Cardiac Unit, Royal Liverpool Children s Hospital, Liverpool, UK
For reprint information contact: Manoj Purohit, MD Tel: 44 151 525 5345 Fax: 44 151 252 5643 Email: drpurohitm{at}yahoo.com Pediatric Cardiac Surgery, Royal Liverpool Children’s Hospital, Eaton Road, Liverpool L12 2AP, UK.
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ABSTRACT
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A simple sutureless technique of fixing ordinary straight insulated temporary pacing wire is described by creating a floret of the insulation of the wire. It can be easily accomplished and reproduced.
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INTRODUCTION
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Temporary pacing wires are routinely placed after most open heart procedures. The diagnostic and therapeutic utility of temporary pacing wires put in during surgery is well-established.1,2 The following describes a technique of sutureless fixation, using the ordinary straight insulated temporary pacing wire.
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TECHNIQUE
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Ordinary insulated temporary pacing wire is taken and the insulation is stripped off, two to three cm proximal to the end of insulation. This can be accomplished using a knife with movement of the blade from the chest needle towards the myocardial needle. This results in exposure of pacing wire and formation of a floret of insulation towards the distal end of the exposed wire (Figure 1
). This is used as a fixation device. Any commercially available ordinary straight insulated temporary pacing wire can be used. We have used the temporary pacing wire from Ethicon®, as shown in Figure 1.
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Figure 1. Right, myocardial end of ordinary insulated temporary pacing wire by Ethicon®. Left, after creation of floret of insulation.
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To fix the wire, draw the pacing wire with the help of the myocardial needle through an epicardial/myocardial tunnel in the direction of the solid arrow (Figure 2, left) until the whole exposed wire and rosette are out of the distal hole. Pull back the pacing wire from the chest needle end in the direction of the hollow arrow (Figure 2, left), so that the exposed wire gets buried inside the tunnel and the rosette is opened up at the distal end of the tunnel, fixing the wire in place (Figure 2, right). Now the redundant wire beyond the tunnel is snapped off across the insulated part, thus leaving no naked wire exposed. When the temporary pacing wire has to be removed it can be pulled as usual. If the length of epicardial/myocardial tunnel is kept a little longer than the exposed wire the insulation will tamponade both openings of the tunnel and will be quite hemostatic. The depth of the tunnel has to be varied according to site and condition of application. As in redo surgeries the tunnel has to be myocardial for good contact.
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Figure 2. Left, technique to fix the wire as described in the text. Right, final result of sutureless fixation with the floret of insulation.
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COMMENTS
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Any fixation technique for temporary pacing wire is for securing the wire in place for the best possible contact, not to prevent its forceful dislodgment. A number of custom made temporary pacing leads are available.3 The sutureless technique we have described fulfils the goal using inexpensive, commonly available straight temporary pacing wire and no additional material. We are using the technique routinely and have never encountered any problems with the fixation and removal of the temporary pacing wire. The incidence of retention of insulation is very low and has not produced any complications in the senior author’s experience with this technique in the last seven to eight years. A review of the temporary pacing after cardiac surgery has noted a 0.04% incidence of major complications.4 Complications have been reported when the wires are cut at the skin and allowed to retract, if resistance is met during attempts to remove the wire.5 How these findings can be applied to our technique where there is the potential of retention of a very small piece of insulation in comparison to the whole length of the retained wire remains to be seen. We have found less incidence of retention of the whole wire with the sutureless technique.
The disadvantage of the technique is that it is not suitable for fixing the temporary pacing wire to thin walled atrium and is unipolar. However, the described sutureless technique of temporary pacing wire fixation is simple, easy to learn, perform, and reproduce.
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REFERENCES
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- Waldo AL, Henthorn RW, Plumb V. Temporary epicardial wire electrodes in the diagnosis and treatment of arrhythmias after open heart surgery. Am J Surg
1984;148:275–83.[Medline]
- Ferguson TB Jr, Cox JL. Temporary external DDD pacing after cardiac operations. Ann Thorac Surg
1991;51:723–32.[Abstract]
- Robicsek F, Robicsek SA, Ferrari HA. A new temporary pacing electrode. Ann Thorac Surg
1980;30:493–4.[Abstract]
- Del Nido P, Goldman BS. Temporary epicardial pacing after open heart surgery: complications and prevention. J Card Surg
1989;4:99–103.[Medline]
- Gentry WH, Hassan AA. Complications of retained epicardial pacing wires: an unusual bronchial foreign body. Ann Thorac Surg
1993;56:1391–3.[Abstract]
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ABSTRACT
INTRODUCTION
