What should the nurse do first if a pacemaker fails to capture?

What should the nurse do first if a pacemaker fails to capture?

• A. Apply transcutaneous pacing pads
• B. Restart the IV
• C. Administer atropine
• D. Call the physician only

Answer: (A)

When a pacemaker fails to capture, the first priority is to provide external pacing to keep the heart beating and maintain perfusion. Immediately apply transcutaneous pacing pads and start external pacing at a rate that supports the patient’s perfusion, then monitor for capture and hemodynamic improvement. While external pacing is established, assess the device and leads—confirm they’re connected properly, ensure the generator isn’t in a magnet mode, and be prepared to transition to transvenous pacing if needed. Don’t delay pacing to troubleshoot the device; notify the physician and arrange definitive device evaluation and possible lead or battery interventions. Atropine or IV fluids may be considered as additional measures, but they do not replace the need for immediate pacing support when capture is lost.

When a pacemaker fails to capture, the first priority is to provide external pacing to keep the heart beating and maintain perfusion. Immediately apply transcutaneous pacing pads and start external pacing at a rate that supports the patient’s perfusion, then monitor for capture and hemodynamic improvement. While external pacing is established, assess the device and leads—confirm they’re connected properly, ensure the generator isn’t in a magnet mode, and be prepared to transition to transvenous pacing if needed. Don’t delay pacing to troubleshoot the device; notify the physician and arrange definitive device evaluation and possible lead or battery interventions. Atropine or IV fluids may be considered as additional measures, but they do not replace the need for immediate pacing support when capture is lost.