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CIED implant trouble shoot in cath room
台北榮民總醫院
護理師 郭宜蘭
Venogram
Subclavian vein
cephalic vein
Acute Venous Stenosis Limiting Access
Implantation Techniques - Acute
Pneumothorax
Hemothorax
Pneumo- hemothorax
Brachial plexus injury
Arterial puncture
Chylothorax
Infection
Pocket Hematoma / Seroma
Pneumothorax
In PASE Trial: 1.97%
Management for Pneumothorax
withdraw the needle, wait a moment or two to make certain that a rapid-onset, large, markedly symptomatic pneumothorax is not occurring, and then proceed
If a pneumothorax does develop, it may do so in this setting over a matter of hours and may not even be apparent radiographically at the end of the procedure.
If a lung puncture has occurred, obtaining another upright chest radiograph 6 hours after completion of the procedure is advisable. If a pneumothorax has developed, a chest tube or catheter evacuation procedure may be necessary, although frequently, a small to moderate pneumothorax that is not expanding can be managed conservatively without evacuation.
Avoid air embolism (esp. for large-bored sheaths)
press proximal end of sheath and instruct patient to hold breath during pacing lead insertion
use of introducer sheath with hemostatic valve
Myocardial Perforation
When recognized, lead MUST be pulled back
Be prepared for tamponade
May require open procedure to manage but heart usually seals itself.
Diaphragmatic Stimulation Lead in Cardiac Vein
Lead inadvertently placed into Post.Cardiac V
Management of Pocket Hematoma
Observation and close follow-up – Soft
– Minimal to no tenderness
Surgical evacuation – Tense pocket threatening suture
line
– Weeping suture line
– Severe pain
– Immunocompromised host
Causes of Open Circuit Due to Implant Technique
Loose set screw
Improperly seated lead terminal pin
Conductor fracture – Rib Clavicle Crush
– Tight ligature
“Dry” pocket - air in pocket with unipolar configuration – Replacement
Pulse Generator Pocket Chronic
Pain - pocket neuralgia
– Incorrect tissue plan – Incorrect location - too lateral – Smoldering infection
Erosion
– Pressure necrosis – Smoldering infection
Migration Twiddler’s Syndrome
Pressure Necrosis
Thinning and discoloration at lateral margin
Total breakdown and 2° Infection
Smoldering Pocket Infection with draining fistula
Presented 2 years post implant
Eschar and draining fistula at edge of incision, surrounding erythema
Waxed and waned on oral antibiotics
Local cultures were negative
January 24, 2002
Improper Location of Pulse Generator
If the pacemaker is placed too lateral, it will cause discomfort every time the patient rotates arm forward
Loose Anchoring Sleeve Twiddler’s Syndrome
Conductor Fractures
Occurs at stress points – Rib-Clavicle Crush – Tight Anchoring sleeve
ligature – Angulation of lead – Traction on lead
If external conductor of bipolar lead, conversion to unipolar will allow for elective management
Tight Anchoring Sleeve Damage to Lead
Conductor Coil Fracture
Insulation Damage
Thanks for your listening:)
See you next time.
It’s time to wake up!!
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