Download Pacemaker Implantation

Pacemaker Implantation
Why do I need a pacemaker?
Your heart is a muscular pump about the size of a clenched fist.
Depending on how active you are it may beat more than 100,000 times a day and
pump about 300 litres (75 gallons) of blood per hour. It is made up of four chambers,
two small ones (atria) that collect the blood and two larger ones (ventricles) with
more muscle that pump the blood around the body. Electrical signals control the
heart to ensure it beats at the right time at the right rate.
The natural pacemaker of the heart, which decides how fast your heart beats, is
called the sino-atrial node and is found in the upper right chamber.
These electrical signals travel through the atria to a ‘junction box’ in the middle of
the heart (the atrio-ventricular node). From here the impulses are passed through
the lower chambers of the heart (ventricles). The electricity causes the heart muscle
to contract, that is to beat and pump the blood around the body. In between each
beat the heart relaxes again and blood flows from the atria to fill the ventricles.
While the electrical impulses travel freely and regularly through the heart it will beat
at a steady pace to meet your body’s needs.
The electrical system- what goes wrong?
Sometimes the natural pacemaker fails to work properly causing the rate of the
impulses to become too slow. There could also be problems at the atrio-ventricular
node. The impulses sent by the natural pacemaker may become delayed here or
even fail to reach the ventricles altogether. This is called ‘heart block’, which can
also cause the heart rate to become too slow. This may make you feel tired,
breathless, dizzy or even experience fainting episodes.
Your new pacemaker
Your new permanent pacemaker will ensure your heart rate meets the needs of your
body. It does this by producing electrical impulses similar to the heart’s own.
Depending on your individual needs, your pacemaker will be programmed to do the
following, both of which will ensure the heart always beats at an adequate rate:
•
replace impulses from the natural pacemaker
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ensure the impulses from the natural pacemaker are transmitted correctly
from the atria to the ventricles.
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Your pacemaker consists of two basic parts:
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a box called the pulse generator that houses the battery and electronic
circuitry
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insulated wires or leads that carry the impulses to the heart. These are very
flexible and allow for normal body movements. The electrode at the tip of the
lead conducts the electrical impulse into your heart. The electrode will also
detect your natural heartbeats so that the pacemaker can withhold its
electrical impulse if necessary.
Depending on your particular problem you will have either a single or dual chamber
pacemaker. A single chamber pacemaker has one lead positioned either in the right
atrium or right ventricle. Dual chamber pacemakers have two leads, one in each
chamber. Some people require an additional lead, which can help the heart pump (a
biventricular pacemaker. Others require a larger pacemaker that can treat
dangerously fast heart rhythms (an implantable defibrillator).
What are the likely benefits?
The pacemaker will prevent your heart from going too slowly and the symptoms
caused. It may also allow us to increase your medicines to improve other heart
problems.
Consent
We must, by law, obtain your written consent before any operation and some other
procedures. Staff will explain all the risks benefits and alternatives before they ask
you to sign a consent form. If you are unsure about any aspect of the proposed
treatment, please do not hesitate to ask a member of staff.
Are there any risks?
This procedure cannot be performed without some element of risk. The majority of
patients have no major problems (about 95 out of 100 people). Although rare,
serious problems can occur so it is important you understand that these are
potential complications of the procedure before you sign the consent form. It is
important to remember that in most cases it is usually far more risky not to have a
pacemaker.
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Pneumothorax (air leak around the lung)
Sometimes we use a vein underneath the collarbone to get the wires to your
heart. This lies very close to the lung and it possible to nick the lung and
produce an air leak. This may go away on its own or may require a drain.
This may mean that you have to stay in hospital longer than expected,
usually an extra day or two.
Pericardial Effusion (blood leak around the heart)
Sometimes, while the leads are being positioned in your heart, a small hole is
produced which allows blood to leak around the heart. This usually requires a
drain and will mean you have to stay in hospital a few days longer than
expected.
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Infection
This can happen soon after the procedure or at any time for many months
afterwards. It can be a serious complication. In general, we do not implant
pacemakers into people who have a serious infection.
We also give you antibiotics before the operation to reduce the risk. If the
wound worries you in any way at any time, please let us know.
Haematoma (bruising)
It is common to have some bruising. Rarely, it can become very large and will
require a drain. Blood-thinning drugs make this more likely. Only very rarely
do we do a second procedure to drain a large blood clot.
Lead displacement
Occasionally a lead becomes dislodged and does not work properly. This
usually happens in the first few hours after the procedure. If this happens a
repeat procedure is necessary to put the lead back into position. After a few
weeks, the wires become bonded to the heart by scar tissue and it is
extremely rare for a wire to become dislodged.
Vein Thrombosis (blood clots)
Sometimes, the veins used to carry the lead to the heart narrow or clot off.
This happens in many people but very rarely causes a problem. It may cause
some swelling in the arm on the affected side and usually settles in a few
days. Sometimes, blood thinning tablets are required.
Death
This is a potential but very rare complication. It is important that you and your
relatives understand this. Other, even rarer, complications can occur,
particularly on certain clinical situations which your doctor can discuss with
you.
Are there any alternatives?
There are no drugs available that work as effectively as a pacemaker. Sometimes
the pacemaker helps treat your condition but is not actually essential. In this
situation not having the pacemaker would make it more difficult to control your
symptoms.
If you are unsure about the procedure, speak to a doctor or nurse to discuss the
potential problems of not having a pacemaker.
What happens before the procedure?
Pre-assessment Clinic
Before attending for you pacemaker implantation you will either be invited to attend
a clinic to see a nurse or be telephoned by a nurse.
At the pre-assessment a nurse will take a brief medical history, a list of current
medications you are on. You will be given detailed information about your procedure
including the risks involved.
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Prior to your pacemaker implantation you will need to have a recent set of blood
tests and an MRSA screen, this either be done at your pre-assessment clinic
appointment or forms will have been sent to you for you to get these investigations
done at your GP.
If you have any question or special requirements please discuss with the nurse at
your pre-assessment.
Do I keep taking my usual medication?
If you are taking antibiotics prior to your procedure, you will need to make the nurse
aware.
If you are taking Warfarin, Clopidogrel and/or Aspirin you need to stop this
medication up to seven days before your procedure. However, there are occasions
where it is not safe to stop it, please discuss this with the nurse at pre-assessment
or telephone for advice.
If you usually take a diuretic do not take on the day of your procedure. If you are
taking any Diabetic medication this will be discussed with you at your preassessment, as you may need to slightly alter your doses for the day.
Please bring in all your medication on the day of your procedure.
Could my appointment be cancelled?
Unfortunately it is possible that your booking may be cancelled or delayed. Should
this happen we will contact you as soon as possible to let you know the situation
and to re-book your procedure.
What should I do if I cannot attend my appointment?
Please contact the co-ordinator on 01206 742385 as soon as possible.
On the day of your procedure
You must have nothing to eat or drink four to six hours prior to your appointment
time, this will be discussed at your pre-assessment.
You should arrive at your appointment time stated in your letter to the Elmstead Day
Unit reception.
What to bring
On admission we advise you to bring a small bag with essentials such as glasses,
slippers and a dressing gown. You will be provided with a hospital gown during your
stay. It is unlikely that you will be kept in hospital overnight, but it is worthwhile
bringing some toiletries just in case.
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Please do not bring any valuables, jewellery or large sums of money. Colchester
General Hospital cannot accept responsibility for any loss or damage to property
belonging to patients
You might like to bring a book or a magazine with you, as you could be on the bed
for long periods of time.
Preparation
You will be collected from the Elmstead Day Unit reception by a nurse and taken to
the Cardiac Angio Suite where you will be prepared for your procedure and be seen
by the doctor.
What happens during the procedure?
You will be awake while your pacemaker is fitted. The procedure takes between 1-2
hours and will be carried out in the cardiac catheter laboratory.
To prevent infection your shoulder area where your pacemaker generator will be
inserted will be cleaned with cold antiseptic and we will cover you in a sterile sheet.
Staff will all wear masks and hats and the doctor and nurse will also wear a sterile
gown and gloves to prevent infection.
The doctor will use some local anaesthetic to numb the area which stings but will
numb after a minute or so. You will be able to feel a certain amount of pulling which
should not be too uncomfortable.
We do not use a general anaesthetic for this procedure, as it is unnecessary and
may increase the risks involved, but you may ask for a sedative at any time before
or during the procedure to relax you.
The doctor will then make a horizontal cut about two inches long and form a pocket
into which the pacemaker can be placed.
The doctor will thread the leads of the pacemaker down into the heart through a
vein. An x-ray camera will be used to make sure they are in the right place. A
cardiac physiologist will then perform a series of tests. You may be asked to help
here by taking deep breaths, coughing, sniffing and panting.
Once the doctor and cardiac physiologist are satisfied with the position of the wires,
the pacemaker will be connected and implanted in the pocket. The site is then
stitched closed, usually with dissolvable stitches.
What happens after the procedure?
Once you are back in recovery a nurse will regularly check your pulse, blood
pressure, ECG and the insertion site. You should rest in bed for the first couple of
hours and keep the arm on the affected side (usually the left) fairly still and only
move gently while things are settling down. We may give you a further dose of
antibiotic after the procedure.
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You may also have a chest x-ray to check that the pacemaker is correctly
positioned.
The cardiac physiologist will provide you with a pacemaker identification card
(always have this with you at all times) and a pacing appointment card.
The cardiac physiologist will perform a pacemaker check and re-programme it to
suit your needs. He or she will also let you know of any precautions or special
instructions that you need to follow in the first few weeks after the implant.
A nurse will discuss with you wound care, pain relief and any queries you have
about you pacemaker, you will be provided with a pacemaker implantation
discharge advise leaflet.
What happens after I go home?
It is important that you rest for the remainder of the day on either a bed or sofa and
limit your activities to essential ones such as going to the toilet.
It is essential that you be accompanied for the first 24 hours after your operation.
Driving
You can drive one week after your pacemaker has been put in but you must inform
the DVLA. It is usually recommended that you wait until after your first check-up.
If driving is part of your occupation, you will need to take special advice about when
you can return to work as a driver. You should discuss this with your doctor. You will
need to ring the DVLA for advice and speak to your employers.
You need check the terms and conditions of your insurance policy before driving as
the insurance company may have its own rules. You should also inform your
insurance company about the pacemaker in order to avoid problems with any claims
you may make in the future. If you have any problems with them, contact the British
Heart Foundation for a list of insurance companies who do not penalise people with
pacemakers.
General activity
For the first six weeks avoid heavy lifting (including carrying shopping bags),
vigorous exercise and activities such as vacuuming, ironing and gardening that
involve using the arm on the pacemaker side. During this time try not to lift the arm
on the side of the pacemaker above shoulder height – this includes hanging
washing on the line and putting things on high shelves.
Signs to look out for
You need to be aware of signs that your pacemaker may not be working as well as it
should be such as:
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breathlessness
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dizziness
fainting
prolonged weakness
swollen ankles
swollen arm on the side of the pacemaker
chest pains
prolonged hiccups.
If you suffer any of these, contact the pacing clinic or your GP as soon as possible,
you should tell all health professionals that you see (doctors, nurses,
physiotherapists, and dentists), that you have a pacemaker before you have any
treatment or surgery.
Remember to keep your pacemaker card with you at all times.
Who can I contact with queries and concerns?
Pacing Clinic/Appointments
01206 742612
Monday to Friday 9am-4pm
Cardiac Angio Suite
01206 745978
Mon, Tue, Thur, Fri (8am – 8pm)
British Heart Foundation
www.bhf.org.uk
08450 70 80 70
Patient Advice and Liaison Service (PALS)
01206 742683
NHS direct
0845 46 47
Your GP
DVLA
www.dvla.gov.uk
0870 850 0007
Your NHS number
When you attend hospital you will be asked for your NHS number and other
information such as your address. Please be patient with this procedure. It is to
ensure our records are kept up to date and to protect your safety. However, if you
do not know your NHS number, please do not worry – you will still receive care!
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Concerns or complaints
If you have any concerns or worries about your care please contact the department
responsible. However, if you are unable to resolve your concerns or wish to make a
formal complaint, please contact the Integrated PALS (Patient Advice and Liaison
Service), Complaints and Litigation Service on 01206 745926 or ask any member of
staff for a leaflet, which will describe how you may make a complaint.
Your views
If you or a family member has recently been in either Colchester General Hospital or
Essex County Hospital for any reason, you can tell us about your experience by
visiting the www.nhs.uk website and then click on the "Comments" section, or you
can write to the address on the front of this leaflet or email your comments to
[email protected]
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