Troubleshooting Transvenous Pacemakers with Point of Care Ultrasound (POCUS)

Emergent transvenous pacing can be performed for patients with an unstable bradyarrhythmia in the emergency department. While emergent transvenous pacemaker (TVP) placement is performed relatively rarely, its importance in the management of these patients requires emergency physicians to be familiar with the procedure. Point of care ultrasound (POCUS) is traditionally used for the initial vascular access associated with TVP placement but can also be indispensable in the subsequent placement and advancement of the TVP wire itself. This article discusses two cases and then outlines a general protocol that incorporates POCUS into a standard emergent TVP procedure. Further, we outline some common POCUS troubleshooting tactics to improve success and ways in which POCUS can rapidly identify complications.