Pacemaker or ICD (defibrillator) implantation Information for patients South Yorkshire Regional Cardiac Rhythm Management Service
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On return to the ward, my wound will be covered with a dressing - how long should this be left on? Providing the dressing is relatively clean, and there is no increasing swelling at the site, the dressing will remain in place for 5 days. As the dressing is completely waterproof, you may shower as soon as you feel able. Without disturbing the dressing, it is advisable to check your device area 3 to 4 times a day by looking in the mirror. By doing this, you will become aware of any changes such as excessive swelling, redness or discharge which could indicate infection. During this time, if you have any concerns about your wound or the dressing, please contact your GP, the arrhythmia nurses or the ECG department during office hours. For any concerns during the weekend or evening, please contact any of the cardiology wards on the numbers at the back of this booklet. How and when should I remove the dressing? Your dressing should be removed on day 5 after your discharge. If you are removing the dressing yourself, ensure you first wash your hands and whilst looking in the mirror, carefully peel the dressing off by loosening the outer edges. Discard the dressing into a domestic waste bin and wash your hands again. You may have some 'steristrips' (paper stitches) over the surface of the wound. Please try to leave these undisturbed and allow them to come off in their own time. This may potentially take up to 3 weeks but be patient as trying to remove them yourself could lead to infection or the wound being pulled open. page 3 of 12
Will I need to keep a dressing over my wound? Providing the wound looks clean and dry there is no need to cover it over. You will need to take care with shoulder straps such as bra's and braces as they can rub against the wound. Most patients choose not to wear these until the wound is completely healed. Please do not apply any medicated creams or powders on or near your wound until you have been for your first device check at 6 weeks. Will my wound have stitches that need removing? Occasionally, your wound may have stitches that need to be removed around 8 days after your procedure. If this is the case, the ward nurse will inform you and will organise for either a district nurse or your GP's nurse to remove them on the appropriate day. You should still remove your dressing on day 5 after your procedure and leave uncovered providing the wound is clean and dry. What should I do if I have any concerns about my wound? If you have been discharged from hospital then it is advisable to ask your GP or practice nurse to check your wound. If this is not possible you should contact your arrhythmia nurse or ECG department during office hours, or any of the cardiology wards in the evening or at weekends. How long after my procedure can I bathe or shower? Providing you have your waterproof dressing in place, you may shower or bathe as soon as you feel able. Once your dressing is removed at 5 days after procedure, you may continue to bathe or shower. However, you should only allow clean water near your wound until it is completely page 4 of 12
healed and do not rub the wound directly with a sponge or flannel. It is advisable to wipe around your wound whilst looking in the mirror. Also, do not use any perfumed products until your wound has completely healed. I was told not to use my arm - what does this mean? Your device will have 1, 2 or 3 leads, which are attached to parts of the heart. Whilst the lead or leads are reasonably secure following your procedure, they remain quite delicate for a few weeks after they have been implanted. Any strenuous lifting, pushing, pulling or pressing involving the arm on the side of your device may cause the lead or leads to move or be pulled out of place. Should this happen, it would mean another operation to re-implant the lead or leads back into the appropriate place. Where possible you should try not to over use the affected arm at least until you have visited the ECG department for your first device check at 6 weeks. If before this time, you have any concerns or worries about this, please contact your arrhythmia nurse or the ECG department during office hours. Does this mean I cannot use my arm at all? No. Not using your arm at all may be more harmful as it can lead to a frozen shoulder or at worse, a clot developing in your arm from lack of blood circulation. Providing you do not excessively lift your arm above your head or use any strong movements your lead or leads should remain in place. The main movements to try and avoid as much as possible are; 1. Stretching the affected arm up above your head - you may find it easier to put this arm into the sleeve first when getting dressed. page 5 of 12
2. Reaching backwards with the affected arm - this is particularly important as this can potentially pull the lead or leads out of place. 3. Pushing yourself up the bed or from a chair with the affected arm - this is a very strong movement, which is best avoided wherever possible. 4. Lifting heavy objects with the affected arm creates a large amount of pressure around the shoulder and pectoral area, which in turn can be harmful to your wound. 5. Prior to discharge you will be seen by the physiotherapist and given exercise information to keep your shoulder joint mobile. How will I know if my pacemaker or defibrillator is working? Your device will be checked by a highly skilled technician in the ECG department before your discharge from hospital following your implantation. This procedure is similar to having an ECG and although it is painless, there are aspects which may cause strange feelings or flutterings in your chest and for a very short time your heart rate will be increased. This is part of the device checking process and there is no need for alarm. Throughout the device check, which only takes around 5 minutes, the technicians will inform you of what they are doing and will reassure you and answer any questions you may have. How often will my device be checked? The timing of device checks varies from individual to individual. Following your discharge from hospital you will receive an appointment in the post within a few days. This will be for your first follow up device check and will be approximately 6 weeks after your implant. This will always be carried out in the ECG department on B floor of the page 6 of 12
Chesterman building (unless there is an option for you to attend a clinic nearer to your home). If this is the case, your technician will inform you and the hospital concerned who will in turn contact you with future appointments. After each device check, the technician will tell you when you need to attend again and you are usually offered a time of day preference. It is really important that you attend for your device check, however, it is not wise to attend if you are not well with a heavy cold, flu or stomach upset. In this case, please inform the ECG department on the number on your appointment card as soon as possible to reschedule your device check and to allow your cancelled appointment to be used for other patients. The ECG department will provide you with your device identification card. This will be sent out in the post with your first appointment. If you do not recieve this please contact the ECG department direct; their contact number is at the back of this booklet. I understand my device relies on a battery - how long will this last and how can I be sure it won't run out? Device batteries last an average of 7 years. However, some defibrillator devices may hold a shorter life if shocks need to be delivered. Part of your device check will be to test and checkthe battery life. When yor technician feels yor device battery requires change, they will inform you during your check and will at that time add your name to our outpatient waiting list for this simple procedure to be done. Please do not worry that your battery will run out; you are usually listed with a year still left on the battery. page 7 of 12
How will my battery be changed? This will be carried out in hospital, but you will only need to stay for a few hours. The procedure is performed in the cardiac catheter suite in Chesterman using a local anaesthetic. It involves opening up the same 'pocket' that your device is sitting in, carefully lifting out the device and replacing the battery, which is attached. Your lead or leads will not be disturbed during this procedure but you will need to adhere to the same wound care advice as when your device was first implanted. There are no restrictions with the arm movements following a battery change, providing the leads have not been replaced. Will I be exempt from wearing a seat belt until my wound heals? No. You are not exempt from wearing a seat belt following a device implant. However, you are advised to adhere to the following for your own comfort; 1. Try to sit in the car where the seat belt comes over the opposite shoulder to your device. This is very important whilst your wound is still healing as it could cause unnecessary friction leading to potential skin breakage and infection. 2. If for any reason you are required to sit with the seat belt over the affected shoulder, then please place a soft towel or pad underneath the belt over the device to prevent any irritation. page 8 of 12
Will I be allowed to drive after my procedure? The Driver and Vehicle Licensing Agency (DVLA), has very clear rules about driving and exclusions for people having pacemakers or defibrillators implanted. These guidelines can be accessed by anyone looking on their website. You must remember that every device implant is performed for a different reason and it is usually the circumstances that lead to the implant which dictate how soon you can drive. Ideally, you should be informed before your discharge of how long you must cease driving, however, if you have any concerns or are unsure, please contact your arrhythmia nurse or the ECG department on the number at the back of this booklet. How soon will I be allowed to travel? This decision will be up to your individual consultant and will depend on the circumstances which led to you requiring a device. Travelling abroad is a viable option with a heart device and the ECG department can help with providing information about local hospitals which could help if you are unfortunate to develop a problem whilst away. It is vital that you carry your device information with you at all times in case the company of manufacture need to be contacted with a problem. Do I need to take any precautions when travelling abroad? When making the booking, you must inform your holiday company and insurance provider that you have a heart device. They may ask for other details about your condition. If they require information from the hospital, they will need to contact the secretary of page 9 of 12
your consultant who can be accessed through the hospital switchboard: 0114 243 4343. As well as ensuring you carry your device information with you, you will need to inform the check in desk and security points at all the airports you visit. They will be familiar with the safety requirements for pacemakers and defibrillators and they will ensure no harm will be caused to your device. For information on de-activation of your ICD please contact your arrhythmia nurse or the ECG department for a copy of the relevant booklet. page 10 of 12
Useful contact numbers for pacemaker or defibrillator advice Arrhythmia Nurses 0114 226 9064 ECG Department 0114 271 4315 Chesterman Two 0114 271 4346 (closes at 10pm and weekends) Chesterman One 0114 226 6305 Firth Seven 0114 226 6215 Northern General Hospital 0114 243 4343 Useful website addresses Arrhythmia Alliance British Heart Foundation DVLA www.heartrhythmcharity.co.uk www.bhf.org.uk www.direct.gov.uk page 11 of 12
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