Pacemaker Protocol

1. Contact the cardiologist.

• Introduce yourself and explain that you are treating his/her patient for dysphagia and would like to use NMES
• Explain placement in submental region and frequency of 50 Hz and a phase duration of 130 uSec to 400 uSec
• Indicate that you plan to set up appointment with pacemaker rep for interrogation to check interference
• If physician indicates that this is unnecessary, ask for documentation, such as script that indicates “Ok to proceed with NMES

2.  Contact Pacemaker Company

• Call number on back of patient’s pacemaker card
• Request interrogation and interference testing
• Give requested information, such as reason, location, etc.

3. Discussion with Pacemaker Rep

• Explain that you want to use NMES with the patient
• Indicate that you have spoken with cardiologist
• Schedule time with rep to allow both of you to be present with the patient
• Interrogation and test for interference is a free service

4. Appointment

• Rep will set the patient up and interrogate the pacemaker
• Place the electrodes and be ready to go
• The rep will place a magnet over the pacer to prevent a shock from occurring, but still allows it to function
• Explain to the patient that you need to increase as high as you can to ensure there will not be a problem during later treatments
• Set the device with standard parameters indicated for treating that particular patient
• Turn on and progress mA to max; the rep will have a digital display to tell if there is interference; if so discontinue and do not proceed with use; if not, you can proceed with use in treatment

5. Documentation

• Ask rep for a printout of the graph
• Sign it, along with signature from the rep
• Write the date and the parameters used and document in the chart as well
  • Example: “Guidant rep Mary Smith provided pacemaker interrogation and interference testing for NMES in
    the submental region for potential treatment of dysphagia. Equipment tested at frequency of 50 Hz, phase duration of 180 uSec, placement in submental region. No interference noted.”
• Send a copy of findings to cardiologist