Implantable cardiac defibrillator insertion discharge instructions (patient information)


 * Associate Editor-In-Chief: Mohammed A. Sbeih, M.D.[mailto:msbeih@perfuse.org]

Overview
A surgeon made a small incision (cut) in your chest wall and implanted an implantable cardioverter-defibrillator (ICD) under your skin and muscle. The ICD is the size of a large cookie. Leads, or electrodes, were placed in your heart and were connected to your ICD. The ICD can quickly detect life-threatening arrhythmias (abnormal heartbeats). It is designed to convert any abnormal heart rhythm back to normal by sending an electrical shock to your heart. This action is called defibrillation. This device can also work as a pacemaker.

When could I drive after the procedure?
You should not drive after the procedure without asking your doctor when you could do that. This is different for everyone.

What medications should I take after the procedure?
Ask your doctor whether you should go back to taking the medications you were on before the procedure. Be sure your doctor knows about everything you are taking.

Should I take any OTC pain medications?
You may take acetaminophen (Tylenol) every six hours as needed for pain in the area where the catheter was placed. Please be sure you are not taking more than one product containing acetaminophen, and do not take more Tylenol than what is recommended on the label.

Wound care
You should be able to do most of your normal activities within 3 - 4 days after surgery. But you will have some limits for up to 6 weeks. Do not do these things for 2 - 3 weeks: Keep your incision completely dry for 4 - 5 days. After that, you may take a shower and pat it dry. Always wash your hands before touching the wound. For 6 weeks, do not lift your arm higher than your shoulder on the side of your body where your ICD was placed.
 * Lift anything heavier than 10 - 15 pounds
 * Push, pull, or twist too much
 * Wear clothes that rub on the wound

What precautions should I take?
Most devices will not interfere with your defibrillator, but some with strong magnetic fields might. Ask your doctor or nurse if you have questions about any specific device. Most appliances in your home are safe to be around. This includes your refrigerator, washer, dryer, toaster, blender, personal computer and fax machine, hair dryer, stove, CD player, remote controls, and microwave. There are several devices you should keep at least 12 inches away from the site where your ICD is placed under your skin. These include: Tell all health care providers that you have an ICD. Some medical equipment may harm your ICD. Because MRI machines have powerful magnets, talk to your doctor before having an MRI. Stay away from large motors, generators, and equipment. Do not lean over the open hood of a running car. Also stay away from: If you have a cell phone: Be careful around metal detectors and security wands.
 * Battery-powered cordless tools (such as screwdrivers and drills)
 * Plug-in power tools (such as drills and table saws)
 * Electric lawn mowers and leaf blowers
 * Slot machines
 * Stereo speakers
 * Radio transmitters and high-voltage power lines
 * Products that use magnetic therapy, such as some mattresses, pillows, and massagers
 * Electrical or gasoline powered appliances
 * Do not put it in a pocket on the same side of your body as your ICD.
 * When using your cell phone, hold it to your ear on the opposite side of your body.
 * Handheld security wands may interfere with your ICD. Show your wallet card and ask to be hand searched.
 * Most security gates at airports and stores are okay. But do not stand near these devices for long periods. Your ICD may set off alarms.

When may I resume my regular activities?
Do not use your arm on the side where your pacemaker is inserted to lift, push or pull anything weighing more than five pounds, at least for the first 6 weeks. You may do the daily activities like face washing, hair combing, and tooth brushing. You should avoid swimming, playing golf or playing tennis after the procedure.

When can I go back to work?
It depends on the type of your work. You can ask your doctor when you can go back to work.

Follow-up care
You will be informed about your follow-up appointments before leaving the hospital. You will need to see your doctor regularly for monitoring. Your doctor will make sure your ICD is working correctly and will check to see how many shocks it has sent and how much power is left in the battery. Your first follow-up visit will probably be about 1 month after your ICD is placed. ICD batteries are designed to last 4 - 8 years. Regular checks of the battery are needed to check how much power it has left. You will need minor surgery to replace your ICD when the battery begins to run down.

When to seek urgent medical care?
You should tell your doctor about every shock you feel from your ICD. The settings of your ICD may need to be adjusted, or your medicines may need to be changed. Also call your doctor if:
 * Your wound looks infected. Signs of infection are redness, increased drainage, swelling, and pain.
 * You are having the symptoms you had before your ICD was implanted.
 * You are dizzy, have chest pain, or are short of breath.
 * You have hiccups that do not go away.
 * You were unconscious for a moment.
 * Your ICD has sent a shock and you still do not feel well or you pass out. Talk to your doctor about when to call the doctor's office.