Implantable Cardioverter Defibrillators

Implantable Cardioverter Defibrillators (ICD) is a small battery-powered device placed in the

chest to stop and detect irregular heartbeats (arrythmias). Delivers electric shock to restore
a regular heart rhythm.
Types:
 Traditional ICD
Is implanted in the chest, and wires (leads) attach to the heart. The implant
procedure requires invasive surgery.
 Subcutaneous ICD
Implantation is at the side of the chest below the axillary which is attched to an
electrose that runs along the breastbone.

PROCEDURE:
BEFORE
 Your doctor will explain the procedure to you and ask if you have any questions.
 You will be ask to sign a consent form that gives your permission to do the test. Read the
form carefully and ask questions if something is not clear.
 Tell your doctor if you are sensitive to or are allergic to any medicines, latex, tape, or
anesthetic agents (local and general).
 You will need to fast for a certain period before the procedure. Your doctor will tell you how
long to fast, usually overnight.
 If you are pregnant or think that you could be, tell your doctor.
 Tell your doctor of all medicines (prescription and over-the-counter) and herbal or other
supplements that you are taking.
 Tell your doctor if you have heart valve disease, as you may need to take an antibiotic
before the procedure.
 Tell your doctor if you have a history of bleeding disorders or if you are taking any
blood-thinning medicines (anticoagulants), aspirin, or other medicine that affect blood
clotting. You may be told to stop some of these medicines before the procedure.
 Your doctor may request a blood test before the procedure to see how long it takes your
blood to clot. Other blood tests and chest X-ray may be done as well.
 You may get a sedative before the procedure to help you relax.
 Based on your medical condition, your doctor may request other specific preparation.
DURING
 Having an ICD implanted may be done on an outpatient basis or as part of your stay in a
hospital. Procedures may vary depending on your condition and your doctor’s practices.
 Generally, an ICD insertion follows this process:
 You will be asked to remove any jewelry or other objects that may interfere with the
procedure.
 You will be asked to remove your clothing and will be given a gown to wear.
 You will be asked to empty your bladder before the procedure.
 An intravenous (IV) line will be started in your hand or arm for injection of medicine and
fluids, if needed.
 You will be placed on your back on the procedure table.

 You will be connected to an electrocardiogram (ECG) monitor that records the electrical
activity of the heart during the procedure using. Your vital signs (heart rate, blood pressure,
breathing rate, and oxygenation level) will be monitored during the procedure.
 The surgical site is cleaned. In some cases, hair may be shaved or clipped.
 Large electrode pads will be placed on the front and back of the chest.
 You will receive a sedative in your IV before the procedure to help you relax. However, you
will likely remain awake during the procedure.
 The ICD insertion site will be cleansed with antiseptic soap.
 Sterile towels and a sheet will be placed around this area.
 A local anesthetic will be injected into the skin at the insertion site.
 Once the anesthetic has taken effect, the doctor will make a small incision at the insertion
site
 A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The
sheath is a plastic tube through which the ICD lead wire will be inserted into the blood
vessel and advanced into the heart.
 It will be very important for you to remain still during the procedure so that the catheter
does not move out of place and to prevent damage to the insertion site.
 The lead wire will be inserted through the introducer into the blood vessel. The doctor will
advance the lead wire through the blood vessel into the heart.
 Once the lead wire is inside the heart, it will be tested to verify proper location and that it
works. There may be 1, 2, or 3 lead wires inserted, depending on the type of device your
doctor has chosen for your condition. Fluoroscopy, (a special type of X-ray that will be
displayed on a TV monitor), will be used to position the lead.
 For subcutaneous ICDs, one or two small incisions are made near the top and bottom of the
sternum or breast bone. The lead wire is then tunneled underneath the skin next to the
sternum and from the sternum to the incision on the left side of the chest.
 The ICD generator will be slipped under the skin through the incision (just below the
collarbone for traditional ICDs and on the left side of the chest for S-ICDs) after the lead
wire is attached to the generator. Generally, if you are right-handed, the device will be
placed in your upper left chest. S-ICDs are implanted on the left side of the chest near the
heart. If you are left-handed, or have a contraindication to a left-sided device a traditional
ICD can be placed in your upper right chest.
 The ECG will be observed to monitor ICD function. Certain tests may then be done to assess
the device function.
 The skin incision will be closed with sutures, adhesive strips, or special glue.
 A sterile bandage or dressing will be applied.
AFTER
 communicate with your ICD wirelessly. Information about ICD function can then be related
to your doctor over the internet.
 Tell your doctor right away if you have any of the following:
 Fever or chills
 Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
 Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness or fainting
 Palpitations
 ICD shock
 If your device generator feels loose or like it is wiggling in the pocket under the skin
 Your doctor may give you other instructions after the procedure, depending on your
particular situation.

INTRA AORTIC BALLOON PUMP

DEFINITION WITH RATIONALE:
-An intra-aortic balloon pump (IABP) is a type of therapeutic device. It helps
your heart pump more blood. You may need it if your heart is unable to pump
enough blood for your body.

- The IABP consists of a thin, flexible tube called a catheter. Attached to the
tip of the catheter is a long balloon. This is called an intra-aortic balloon, or IAB.
The other end of the catheter attaches to a computer console. This console has
a mechanism for inflating and deflating the balloon at the proper time when
your heart beats.

Why Is Management Of The Patient With An Intra-Aortic Balloon Pump Important?

-Because IABP therapy is a highly invasive strategy associated with severe
and potentially life-threatening complications (e.g., hemorrhage), intensive
management of patients with an IABP is important to ensure optimal
counterpulsation and patient outcomes and to prevent complications.

PURPOSE:
- To outline the nursing management of patients requiring an Intra-Aortic
Balloon Pump (IABP). The following guidelines have been prepared to establish a
quick reference guide for the safe and effective use of IABP therapy. This
guideline will cover assessment, monitoring, and management of patients with
the Datascope IABP.

PROCEDURE:
 Perform hand hygiene and don PPE as appropriate
 Identify the patient using two unique identifiers, according to facility
protocol
 Establish privacy by closing the door to the patient’s room and/or
drawing the curtain surrounding the patient’s bed
 Introduce yourself to the patient and family member(s), if present;
explain your clinical role; assess the coping ability of the patient and
family and for knowledge deficits and anxiety regarding IABP therapy
 Determine if the patient/family requires special considerations
 regarding communication (e.g., due to illiteracy, language barriers,
hearing impairment); make arrangements to meet these needs if
they are present
- Use professional certified medical interpreters, either in person or
via phone, when language barriers exist
 Reinforce the purpose of IABP therapy and the need to keep the
affected extremity immobile; answer any questions and provide
emotional support as needed
 Verify that the patient is supine with the head of the bead ≤ 30° and
with the affected limb immobilized
 Perform a thorough assessment of the patient’s cardiovascular system
and hemodynamic status to determine response to IABP therapy as
currently timed
 Assess vital signs and level of pain using a facility-approved pain
assessment tool. Administer analgesics and sedatives, as ordered (6)
 Zero the transducer, according to manufacturer’s instructions, to
ensure accuracy of the readings
 TO BE CONTINUED.....

What To Expect After Management Of a Patient With An Intra-Aortic Balloon Pump

 The patient’s cardiac workload will be reduced and myocardial
perfusion will be increased
 The patient’s cardiac function will improve
 The patient will not experience adverse effects from the IABP therapy

PATIENT CARE:
 Keep the patient in supine position with HOB elevated no more than 30 degrees.
Reverse trendelenberg should be used.
 Do not flex the leg with IABP catheter. If needed, apply a knee brace.
 Log roll patient from side to side.
 After IABP catheter is removed, ensure that direct pressure is held over the site,
either manually or using C Clamp, until hemostasis is achieved.
 Patient should be flat in bed for 1 hour after IABP is removed, and should remain
on bed rest for 4 hours...
 Assess the site for hematoma or bleeding and monitor distal pulses of lower
extremity Q15mins x 4, Q30mins x 2, and then Q1 hour x 2 after removal.

NOTIFY DOCTOR IF:

 Blood in tubing.
 Any vascular changes (diminished pulses, lost signals).
 Augmentation pressure less than 5mmHg above systolic BP.
 Bleeding or hematoma at insertion site or signs of retroperitoneal bleed.
 Drop in hematocrit unexplained by other bleeding sites.
 Abrupt stop in urinary output.
  Any signs of dissecting aorta (sudden or recurrent chest pain, back pain,
discrepancy of upper extremity blood pressure).

NURSING CONSIDERATIONS:
PRIOR:
DURING:
POST:

CARDIAC STRESS TEST