Combo Device Implant

The entire process will be explained by the doctor and consent will be taken to perform the procedure. Ensure to ask every minute concern clearly before the test.

• Inform the doctor in case any medication is being taken, in case one is sensitive to or allergic to any medication and if any disorder was faced by the patient in the past. Also, if the patient has a heart valve disease, the same should be informed to the doctor as an antibiotic would be required in this case before the procedure. Further, alert the doctor in case of pregnancy, suspicion of pregnancy or if one is in the phase of breastfeeding.
• Fasting will be required before the procedure, usually overnight.
• Blood tests might be required before the procedure.
• A sedative will be used prior to the procedure to help the patient relax.

However, based on the specific medical condition of the patient, he/she will be requested to follow a set of pre-procedure instruction by the doctor.

The procedure might defer as per the specific medical condition of the patient. However, in general cases, a combo device implant involves the following process:

• The patient will be asked to remove all sorts of jewellery, wear an operation gown and empty the bladder.
• The position on the operation table will be such that the patient will have his or her back area on the table.
• To inject medication and administer fluids, an intravenous (IV) line will be inserted into the patient’s arm.
• The patient will be contented the electrocardiogram monitor.
• The areas are cleaned where the ECG electrodes are placed, and in few cases, hair may also be removed.
• The area on the back and front of the chest will be used to place large electrode pads.
• A sedative will be used to help the patient relax during the procedure. However, the patient is likely to remain awake when the procedure is done.
• The area of ICD insertion will be cleaned using an antiseptic soap.
• A sheet and sterile towels shall be kept around the ICD insertion area.
• A local anaesthetic will be provided in the area of insertion.
• Post the anaesthesia comes to effect; the surgeon makes a small incision in the area of insertion.
• Now, insertion of a sheath into a blood vessel is done, generally under the collarbone. This helps to guide the ICD lead wire into the blood vessel and further proceed into the heart.
• After the lead wire is inside the heart, doctors begin the testing process to verify proper location and that the device is working properly. The number of wires to be inserted depends on the type of device being installed.
• The ICD generator shall be slipped beneath the skin through the incision post the lead wire is connected to the generator. The generator is placed on the non-dominant side of the patient, i.e., if one is a right-handed person, the device shall be installed on the upper left chest and vice-versa.
• Observation of the ECG will be done to inspect the ICD function. Few tests may also be performed to monitor the device functioning.
• The incision area will be then closed.
• In the end, sterile dressing will be done in the operated area.

• Post procedure, the patient will be kept under observation to monitor vital signs in the recovery room or the hospital room.
• It is suggested that the patient should immediately inform the doctor/nurse in case he/she feels chest pain or tightness, or any other type of discomfort in the area of incision.
• After the duration of bed rest is completed, the patient is assisted by the nurse to get up, and a BP check is performed. The patient should ensure to move slowly after the course of bed rest to avoid light-headedness.
• Once the patient is perfectly conscious again, he/she will be in a condition to eat or drink.
• The pain medication will be provided as the patient might experience soreness or pain in the area of insertion.
• As soon as the patient is alert and the blood pressure, breathing rate and pulse are stable, he/she is prepared for the discharge.
• Ideally, in every case, the patient is required to stay at least one night in the hospital for observation after the procedure in completed.
• The patient should have someone to drive back or assist to reach back home after the discharge.

Common risks of this procedure include the following:

• Bleeding due to the incision or at the site where the catheter is inserted
• Vessel damage at the area where the catheter is inserted
• Infection in the area of incision
• Breathing problems or in some extreme cases, lung collapse.
• Patients who are allergic to or sensitive to medications or latex should notify their doctor.
• Ensure to discuss every concern with the doctor as complications completely depend on specific medical condition of the patient.