[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Critical care](https://durgical.com/en/nursing/areas/critical-care/) › Temporary pacing (transcutaneous and transvenous): set-up, capture, sensing and safety # Temporary pacing (transcutaneous and transvenous): set-up, capture, sensing and safety - Procedure Temporary pacing keeps the heart rate up until the cause is treated; the nurse checks capture on the monitor and at the pulse, comfort, skin and settings. Updated Nov 13, 2026 ## Key points - Electrical capture: a pacing spike followed by a wide QRS and a T wave; do not take the spike's afterpotential for capture. - Mechanical capture: a pulse that matches the paced rate; check it at the right femoral or carotid artery so muscle twitching does not fool you. - Transcutaneous pacing hurts: sedation and analgesia as ordered, and reassess comfort often. - Demand (synchronous) mode is the usual mode; fixed-rate (asynchronous) pacing risks an R-on-T arrhythmia. - Undersensing can trigger ventricular tachycardia or fibrillation; keep a defibrillator ready. ## What it is Temporary pacing gives electrical impulses to the heart when its own rate is too slow or unreliable. Transcutaneous pacing uses pads on the chest and back; it is quick to start but painful and only a bridge. Transvenous pacing uses a wire passed through a central vein into the right ventricle; epicardial pacing uses wires placed on the heart during surgery. The nurse prepares the equipment, places the pads correctly, confirms electrical capture on the ECG and mechanical capture at a pulse, treats pain and anxiety as ordered, checks the skin, connections and settings, and knows what to do when the pacemaker fails to capture or to sense. ## Indications - Symptomatic or unstable slow heart rhythms that do not respond to drugs, such as high-grade heart block, as the medical team decides. - A bridge to transvenous or permanent pacing. - After heart surgery, through epicardial wires, to treat slow rhythms or keep AV timing. ## Contraindications and precautions - Transcutaneous pacing is relatively contraindicated in hypothermia, and is not useful in prolonged asystolic arrest. - It is a temporary bridge only: thresholds rise with time, and in some patients tolerable capture cannot be achieved. - Higher pacing thresholds are expected after chest surgery, with emphysema, pericardial effusion or positive pressure ventilation. - Clean, dry, hair-trimmed skin under the pads; no alcohol or flammable liquids. ## Equipment - Monitor-defibrillator with pacing function and pacing pads (transcutaneous). - Pacing box with fresh battery and connecting cables (transvenous or epicardial). - Central venous access set and sterile barrier for transvenous insertion, as the protocol lists. - ECG monitoring, emergency drugs and the crash cart nearby. ## Step by step (and why) - Explain the procedure and its discomfort, and give sedation and analgesia as ordered — pain and anxiety make pacing hard to tolerate. - Trim hair, wash with soap and water and dry the skin — poor contact causes failure to capture, pain and burns. - Place the front pad over the apex or at V3 and the back pad left of the spine behind it — no bone between the pads and the heart. - Set the rate and mode as ordered, usually demand mode — fixed-rate pacing can fire on the T wave. - Raise the output until each spike is followed by a wide QRS and a T wave, then set it above that threshold as ordered — this keeps capture reliable. - Check a pulse that matches the paced rate at the right femoral or carotid artery — this proves the heart is pumping, not just firing. - Transvenous or epicardial: check connections, battery, settings and which wire is which — loose connections are a common cause of failure. - Check the skin under the pads often and reposition as needed — prolonged pacing can burn the skin. - Record mode, rate, output, sensitivity, threshold and the patient's response — the next nurse needs the same baseline. ## Complications - Failure to capture: wire or pad movement, poor contact, loose connections, a low battery, effusion, ischaemia or acidosis. - Oversensing (for example from shivering) can stop the pacemaker from firing; undersensing can fire on the T wave. - Hiccups or coughing from diaphragm stimulation, and pain from muscle contraction. - Skin burns under pads, especially with long pacing. - Transvenous wire complications: misplacement, pneumothorax, pericardial effusion or tamponade. ## Next step: when to call for help - Call at once if capture is lost, the pulse does not match the paced rate, or the patient becomes hypotensive or loses consciousness. - Call for a new arrhythmia, especially ventricular tachycardia or fibrillation, and be ready to defibrillate. - Report rising thresholds, pain that does not settle with the ordered treatment, or skin damage under the pads. - After transvenous insertion, report breathlessness, chest pain or falling pressure: pneumothorax or tamponade must be ruled out. ## Test yourself Think of the answer, then tap the question to see it. ## How is electrical capture confirmed during transcutaneous pacing? Each pacing spike is followed by a wide QRS with a distinct ST segment and T wave; the afterpotential after the spike is not capture. ## Where is the pulse checked to confirm mechanical capture, and why? At the right femoral or carotid artery, so that muscle twitching from the pacing current is not mistaken for a pulse. ## Why is demand mode preferred to fixed-rate pacing? Fixed-rate pacing ignores the heart's own beats and can fire on the T wave, which may trigger ventricular tachycardia or fibrillation. ## Which skin care reduces pain and failure of transcutaneous pacing? Trimming (not shaving) hair, washing with soap and water, drying the skin well and avoiding alcohol under the pads. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/temporary-pacing-set-up-capture-sensing-and-safety/) ## Connections ## Related 3 - [Cardiac monitoring at the bedside: leads, alarms and rhythm changes to report](https://durgical.com/en/nursing/cardiac-monitoring-at-the-bedside-leads-alarms-and-rhythm-changes-to-report/) - [The crash cart: checks and organisation](https://durgical.com/en/nursing/the-crash-cart-checks-and-organisation/) - [After heart surgery in the ICU: bleeding, tamponade, rewarming, pacing wires and chest drains](https://durgical.com/en/nursing/after-heart-surgery-in-the-icu-bleeding-tamponade-rewarming-pacing-wires-and-che/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Using transcutaneous cardiac pacing to best advantage: How to ensure successful capture and avoid complications (Doukky R et al., J Crit Illn 2003;18(5):219-225)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6376978/) (Journal of Critical Illness, open access in PubMed Central, 2003); [Temporary epicardial pacing after cardiac surgery (Gillham MJ, Barr TM, BJA Education 2023;23(9):337-349)](https://pmc.ncbi.nlm.nih.gov/articles/PMC10433321/) (BJA Education, open access in PubMed Central, 2023); [Troubleshooting Transvenous Pacemakers with Point of Care Ultrasound (POCUS) (Gohde E et al., POCUS J 2025;10(1):53-60)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12057482/) (POCUS Journal, open access in PubMed Central, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/temporary-pacing-set-up-capture-sensing-and-safety/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/temporary-pacing-set-up-capture-sensing-and-safety/