Implantable Cardioverter Defibrillator

WHAT YOU SHOULD KNOW:

• An implantable cardioverter (CAR-d-o-ver-ter) defibrillator (d-FIB-ri-la-ter) is also called an ICD. It is a device that monitors your heart rate and rhythm. The ICD gives your heart a shock if you start having arrhythmias (uh-RITH-me-uhs). Arrhythmias are when your heart does not beat normally. Some arrhythmias can cause the heart to stop beating. The ICD will shock your heart so that it starts beating normally again. An ICD can make your heart beat faster if it is not beating fast enough. It can also slow your heart down if it is beating too fast.
  
  
• An ICD is made up of a generator, a programmer, and leads. The generator and the leads will be placed inside you during surgery. The generator has a metal shell with a battery and a small computer inside. The computer monitors your heart rate and rhythm. Leads are wires that have one end that attach to the inside of your heart and the other end is connected to the generator. The generator transmits information about your heart to the programmer. Surgery is needed to get an ICD. The surgery may be done when you are already a patient in the hospital or you may come into the hospital the morning of your surgery. It is possible that you may go home after the surgery.
  
  
• The leads are usually placed inside the heart. There are some instances that the leads may be placed on the outside of the heart. The generator is usually placed in a pocket under the skin in the shoulder area. It may also be placed in a pocket under the skin in the abdomen (belly).

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery. You may bleed more than usual, get blood clots, or an infection. The leads could poke a hole in your heart, lung, or vein. Putting in the leads can cause arrhythmias. Blood may also form in the pocket where the generator is placed. This can cause pain and infection. Sometimes, the leads may disconnect and a second surgery may be needed. The leads may break. A second surgery may be needed to fix them. You could die from this surgery. Your caregivers will closely watch you for any of these problems.
  
  
• If you do not get an ICD, your heart problems could get worse and you could die. Ask your caregiver if you have any questions about your care.

WHILE YOU ARE HERE:

Before Your ICD Surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Bathroom: Go to the bathroom before your ICD surgery. Otherwise, you may have to wait until after surgery.
  
  
• Transport: You will be taken on a stretcher (cart) to the operating room. A caregiver will help you onto the operating room table and will help make you comfortable. A belt will be put over your legs for safety. Your arms will be tucked at your sides. The room will be very bright and noisy, and there will be lots of people walking around.
  
  
• Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.
  
  
• Local or monitored anesthesia: Anesthesia is medicine that keeps you from feeling pain during surgery or a procedure. Local anesthesia is a shot of numbing medicine put into the skin where you will have surgery. You will be fully awake during the surgery or procedure. You may feel pressure or pushing, but you will not feel pain. Monitored anesthesia means you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the surgery or procedure.

During Your ICD Surgery:

• Your caregiver will clean your neck and chest with a special soap. This soap may make your skin yellow, but it will be cleaned off later. Sheets will be put over you to keep the surgery area clean.
  
  
• A lead is put into a vein near your collarbone or neck. With the help of a special x-ray machine, the lead is then placed or guided into your heart. The leads will be sewn to the inside of your heart, but may be sewn to the outside of your heart instead. The other end of the lead is connected to the generator. The generator is then placed in a pocket under your skin. This pocket is usually in the shoulder area, but may also be in the abdominal (belly) area. The ICD is set so that it will monitor your heart all the time. The incision is then closed with stitches or staples.
  
  
• The surgery may last two to three hours.

After Your ICD Surgery:

You will be taken to a recovery room where you will wake up. There will be lots of noise and activity. This is normal. Caregivers will be checking on you often. You will have a bandage covering your stitches or staples. If you are spending the night in the hospital, you will be taken to your room when you are awake and your pain is controlled. If you are going home, you will be allowed to leave as soon as you are awake and your pain is controlled.

What Medicines Will I Take After My ICD Surgery?

• Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
  
  
• Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Implantable Cardioverter Defibrillator (Inpatient Care)