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Cardiac pacemaker dysfunction in children after thoracic drainage catheter manipulation
K W Lobdell1, H L Walters, C Hudson
1Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit 48201, USA.
Insights
Subcutaneous emphysema near pulse generators in two children with pacemakers was managed non-invasively. Manual compression and monitoring resolved the issue, ensuring proper pacemaker function without further procedures.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Complete heart block necessitates pacemaker implantation in pediatric patients.
- Permanent epicardial-lead, dual-chamber, unipolar pacemaker systems are utilized for pediatric cardiac pacing.
Observation:
- Postoperative subcutaneous emphysema occurred in the pulse generator area of two children.
- Emphysema was temporally related to thoracic catheter manipulation during pacemaker placement.
Findings:
- Manual compression of the pulse generator effectively managed acute emphysema.
- Non-invasive management, including pressure dressings and monitoring, ensured satisfactory pacemaker function.
Implications:
- This approach offers a conservative, non-invasive strategy for managing postoperative emphysema in pediatric pacemaker patients.
- Caregiver education is crucial for vigilant observation and maintaining pacemaker integrity.
Abstract:
Two children underwent placement of permanent, epicardial-lead, dual-chamber, unipolar pacemaker systems for complete heart block. Postoperatively, both patients demonstrated subcutaneous emphysema-in the area of their pulse generators-temporally related to thoracic catheter manipulation. Acutely, each situation was managed with manual compression of the pulse generator, ascertaining appropriate pacemaker sensing and pacing. Maintenance of compression with pressure dressings, vigilant observation/monitoring, and education of the care givers resulted in satisfactory pacemaker function without invasive intervention.