Patient education: Implantable cardioverter-defibrillator insertion – Discharge instructions (The Basics)

What are discharge instructions? — Discharge instructions are information about how to take care of yourself after getting medical care for a health problem.

What is implantable cardioverter-defibrillator insertion? — This is surgery to put an implantable cardioverter-defibrillator, or "ICD," in the body.

An ICD is a device that goes under the skin near the heart (figure 1). It can sense and treat certain abnormal heartbeats.

Most ICDs also have a built-in pacemaker. A pacemaker sends electrical signals to the heart. These signals cause the heart to beat at a normal rate. Pacemakers are used to treat a heart rate that is too slow.

An ICD has 2 parts:

●Battery (picture 1) – This sits under the skin. Depending on the type of ICD, it goes either in the upper chest or on the side, near the armpit. When the ICD senses an abnormal heartbeat, the battery creates an electrical shock or shocks that travel through wires to the heart.

●Wires – These are also called "leads" or "electrodes." Your ICD can have 1, 2, or 3 leads.

There are different types of ICDs. In most ICDs, the wires go from the battery through a vein and into the heart. There is also a "subcutaneous ICD" ("S-ICD") that has wires that go under the skin. These wires sit near the heart but not actually inside of the heart.

To insert an ICD, the doctor makes a cut, or "incision," in the skin of your upper chest to place the battery. They put the leads in the correct place and connect them to the battery.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

For the first 24 hours after surgery:

●Do not drive or operate heavy or dangerous machinery.

●Do not make any important decisions or sign any important papers.

●Do not drink alcohol of any kind.

You should also:

●Take all of your medicines as instructed.

●Take care of your incision – You might have stitches, skin staples, surgical glue, or a special skin tape on your incision.

•Keep your incision dry and covered with a bandage for the first 1 to 2 days after surgery. Your doctor or nurse will tell you exactly how long to keep your incision dry.

•Once you no longer need to keep your incision dry, gently wash it with soap and water whenever you take a shower. Do not put your incision underwater, such as in a bath, pool, or lake. This can slow healing and raise your chance of getting an infection.

•After you wash your incision, pat it dry. Your doctor or nurse will tell you if you need to put an antibiotic ointment on the incision. They will also tell you if you need to cover your incision with a bandage or gauze.

•Always wash your hands before and after you touch your incision or bandage.

●Limit your activity or arm movement for several weeks after surgery, if your doctor tells you to. For example, you can use your arms to wash or comb your hair. But the doctor might want you to keep your elbow lower than your shoulder on the side where your device is. Your doctor or nurse will tell you what movements and activities are safe for you.

●Take a stool softener to help with constipation, if needed. Opioid pain medicines can cause constipation.

●Take non-prescription medicines to relieve pain instead of opioids, if you choose. Examples include acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve).

What follow-up care do I need? — The doctor will want to see you again after surgery to check on your progress. Go to these appointments.

If you have stitches or staples, you will need to have them taken out. Your doctor will usually want to do this in 1 to 2 weeks. Some stitches absorb on their own and do not need to be removed. If the doctor used skin glue or skin tape, it will fall off on its own. Do not pick at it or try to remove it yourself.

What else should I know? — There are things you will need to do as you get used to living with an ICD:

●Check your ICD regularly to make sure that it works – Many people can check their ICD from their home, using either their phone or computer. Be sure that you know what to do if your device sends a shock.

●Talk to your doctor about driving – Many states do not allow people to drive for some time after they have an ICD put in or after they get a shock from their ICD. Your doctor will tell you how long you need to wait before you drive again.

●Avoid certain electric or magnetic sources – People who have an ICD need to avoid certain electric or magnetic sources or equipment. Your doctor will tell you which ones are safe for you to be near, and which ones you should avoid. For example, some people with an ICD should not walk through a metal detector at the airport. People who cannot walk through a metal detector can have a security search by hand instead.

●Be aware of cell phones and other devices – Some cell phones or other devices, like "smart watches," might have a strong magnet that could affect your ICD. If you are not sure if your device has a magnet, check with the company that made it, or ask your doctor. To be safe, it's a good idea to carry your cell phone in a pocket or bag below your waist so it is not right next to your ICD. Do not sleep with these devices on your bed.

●Let all of your doctors and nurses know that you have an ICD – Some procedures and tests are safe for people with an ICD, but others are not. For example, most people with an ICD should not have a type of imaging test called an MRI scan, but some new ICDs are safe in the MRI machine. Most doctors recommend that people wear a medical bracelet letting others know that they have an ICD.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if:

You have symptoms of a heart attack (figure 2), such as:

●Severe chest pain, pressure, or discomfort with:

•Breathing trouble, sweating, upset stomach, or cold and clammy skin

•Pain in your arms, back, or jaw

•Worse pain with activity like walking up stairs

●Fast or irregular heartbeat

●Feeling dizzy, faint, or weak

Call for advice if:

●Your device sends a shock.

●You have a fever of 100.4°F (38°C) or higher, or chills.

●You have redness, pain, or swelling around the incisions from your surgery.

●You have nausea or vomiting for more than 2 days after going home.

More on this topic

Patient education: Implantable cardioverter-defibrillator insertion (The Basics)
Patient education: Implantable cardioverter-defibrillators (The Basics)
Patient education: Pacemakers (The Basics)
Patient education: Catheter ablation for the heart (The Basics)

Patient education: Implantable cardioverter-defibrillators (Beyond the Basics)
Patient education: Pacemakers (Beyond the Basics)
Patient education: Catheter ablation for abnormal heartbeats (Beyond the Basics)