Note Template – Transvenous Pacemaker Insertion

(You can directly edit this note to suit your specific condition by directly clicking on parts that you wish to edit. Copy and paste note after you are done editing)

Procedure: Transvenous Pacemaker Placement

Performed by: ***

Supervised by: ***

Indication: ***

Universal Protocol: Time-out was performed and the correct patient and site were verified

Consent: Obtained

Procedure: Using the previously placed [LEFT/RIGHT]*** internal jugular catheter, a bipolar pacing catheter was advanced into the Cordis. The catheter was advanced to approximately 15 centimeters whereupon the balloon was inflated. It was further advanced into the right atrium and then the right ventricle to a depth of [ DEPTH in CM ]*** cm at which point pacing was achieved. The balloon was deflated and the catheter was retracted [ ] cm. The pacer wire was then advanced an additional [ ] cm and capture achieved again at [ ] mAmp. The patient tolerated the procedure well.

Post Procedure Diagnosis: Same as indication

Complications: None

Estimated Blood Loss:  10 cc

Specimens Removed: None

Prosthetic devices/implants: No

Assistant(s): None

Follow-up chest X-ray ordered.