Stanford Cardiac Arrhythmia Service

Following BPID implantation

What Happens After I Leave the Hospital?

Followup of Patients after Implantation of Biventricular Implantable Cardioverter Defibrillator (BiVICD)

Activity

Patients are instructed not to lift the elbow that is on the side of the defibrillator above the ear for 4 weeks after implantation. Movement of the large shoulder muscle could cause the lead inside of the heart to move out of position.  Patients are instructed not to participate in any activities that require forceful large arm movements, such as basketball, swimming, and golf, for 4 weeks following surgery. If you have additional questions about exercise, please discuss them with your Arrhythmia Team.  Driving should be discussed on an individual basis with the patient’s doctor. Patients are instructed to avoid sitting in the sun without covering the generator site because it may become excessively warm beneath the skin.
Patients are reassured that the defibrillator will not harm others even if it should fire while the patient is  touching someone else.

Wound Care

The patient is instructed to remove the dressing daily from the patient’s incision and look at it carefully by standing in front of a mirror. If the patient has the small adhesive strips called Steri-strips still in place, the patient is instructed not to remove them. Patients should check the wound for the following: The wound should look the same or appear less red and tender than the previous day.  There may be minimal drainage from the incision site. The drainage should be clear or only blood tinged and should not have an odor.  The patient should replace the dressing with a clean dressing every day.

The patient should notify the doctor who implanted the defibrillator immediately if the incision has become more red, more tender, or has a cloudy drainage that may indicate an infection. The patient should notify the doctor if the defibrillator area has been swollen or enlarged and feels tense. This could indicate that there is bleeding in the area.

The patient should take the patient’s temperature if the patient is feeling excessively warm or have chills. If the patient has a temperature greater than 100, the patient should contact the patient’s doctor that day.

The patient should sponge bath only for the first 5 days following the defibrillator implantation. After the fifth day, the patient may shower unless otherwise instructed by the patient’s doctor. The patient should pat dry the site but not to rub the site. The Steri-strips will be removed at the one-week incision check-up unless it is felt that it would be beneficial to keep them on longer.

Magnetic Interference

Microwave ovens, computers, VCRs, small electrical tools, and garage door openers are all safe to use. Patients are instructed to avoid large magnetic fields such as: leaning over a car engine while it is running, running motorcycle engines, chainsaws, power plants, etc. Cellular phones should not be used directly above the defibrillator. They should be held 6 inches away from the defibrillator (hold phone to the ear opposite of the defibrillator). Patients should not keep the phone in the "on" position in a pocket on top of the ICD.

When traveling in the airport, patients are instructed to inform Security Personnel that the patient has a defibrillator and they will hand search the patient instead of walking through the metal detector. The metal detector will not harm the defibrillator, but the patient may set off the alarm.

The patient cannot have an MRI done because of the possible magnetic interference.

Identification

The patient is instructed to carry a defibrillator identification card in the patient’s wallet at all times. The patient will be given a temporary card upon discharge and a permanent card will be mailed to the patient from the defibrillator manufacturer in 6-8 weeks. The patient may wear a Medic Alert Emblem which may be ordered.

The patient should notify the defibrillator manufacturer if the patient gets a new address or telephone number. Their toll-free phone number is on the temporary and permanent identification card.

What you should do if the patient feels a fast heart rhythm

The patient should lie down immediately if the patient feels a fast heart rhythm. The patient is instructed to have family members or a friend nearby, or call 911.

What the patient should do after the ICD fires

If the patient receives 1-2 shocks and feel that your heart rhythm is back to normal, the patient should call the Arrhythmia Service doctor at (650) 723-7111 to let them know. This is not an emergency if the patient feels okay.

If the patient receives 3 or more shocks in rapid succession, the patient should call 911 and then call the Arrhythmia Service doctor. This service is available 24 hours a day, 7 days a week at the above number.

If the patient receive a shock but becomes or remains unconscious, bystanders should call 911 and immediately start CPR.

Follow-Up

At discharge the patient will be given a clinic appointment at Stanford for 7-10 days after implant to get the wound checked. If this is not arranged prior to discharge, the patient should call the Arrhythmia Service at (650) 723-7111 so that we can coordinate the follow-up.

It is very important that the patient have the patient’s defibrillator checked regularly (1 month after implant and every 3 to 4 months remotely or in the clinic thereafter). The patient should contact the Arrhythmia Service at (650) 723-7111 if that has not been arranged for the patient.

If patient is to undergo dental procedures or any type of surgery involving electrocautery, the patient’s dentist/physician should be asked to contact either the device manufacturer or the Arrhythmia Service (Normal teeth cleaning is safe and requires no special instructions).
It is advisable that family members be certified in CPR. Classes are available at local chapters of the American Heart Association or the Red Cross.

 

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