Make Sure any Cordis in Place is the Correct Size when Emergently Floating a Transvenous Pacing Wire
Christina L. Cafeo RN MSN
David G. Hunt RN, BSN
Peter J. Pronovost MD, PhD
One of the most difficult and frustrating situations to occur when caring for a critically ill patient is not having all of the required supplies available, especially during a crisis situation. This situation particularly seems to occur when certain emergency procedures arise only sporadically. As a result, staff may be unsure of both the supplies and the equipment required to treat such emergencies in a timely and efficient manner.
What not to Do
Many clinicians have faced the misadventures associated with placing a transvenous pacing wire. Temporary transvenous cardiac pacing is a potentially lifesaving intervention used primarily to correct profound bradycardia. A transvenous pacing wire is typically placed through a 6 French Cordis catheter. If the patient does not have a Cordis catheter in place, the temptation is to break open the closest kit that contains a Cordis and proceed to gain central access. However, this is usually a mistake; usually, the closest kit that contains a Cordis is one for inserting pulmonary artery catheters. Invariably these have Cordis catheters that are 7.5F—that is, catheters that are too big to insert a transvenous pacing wire through. Similarly, if the patient already has a Cordis in place, it is almost always a 7.5F catheter.
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