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Management of Pacemaker or Implantable Cardioverter Defibrillator (ICD) Devices in a Procedural Setting (HVC)

Management of Pacemaker or Implantable Cardioverter Defibrillator (ICD) Devices in a Procedural Setting (HVC) - Policies, Clinical, UWHC Clinical, Department Specific, Heart and Vascular Care Clinic

HVC

HVC Management of Pacemaker or Implantable Cardioverter Defibrillator (ICD) Devices in a Procedural 
Setting  
Category:  UWHC Departmental Policy   
Policy Number:  HVC    
Effective Date:  August 28, 2013   
Version:  Revision    
Manual:  Heart and Vascular Care Clinic    
Section:  Management of Pacemaker or Implantable Cardioverter Defibrillator (ICD) Devices in a 
Procedural Setting   
 
 
I. PURPOSE

The purpose of this guideline document is to establish a process for the safe management of patients with
implantable cardiac devices around the time of surgeries or procedures.

II. POLICY

To provide safe management of implantable cardiac devices during surgeries or procedures.

III. PROCEDURE

A. The department initiating surgery/procedure will complete the Pre-Procedure Request Sheet for a device
check (Appendix M) and fax to the Device Clinic at (608) 265-8857.
B. One business day prior to scheduled surgery/procedure, the device nurse will call pre-procedural care area
to set up a time for interrogation. If the patient is followed routinely at UW Health Device Clinic, or if a
recent report is available from another device clinic within the past 12 months for pacemakers (PM) and
within the past 6 months for implantable cardioverter defibrillators (ICDs), an interrogation may not be
needed.
C. On the day of the procedure, the device nurse will inform the anesthesiologist or nurse about the settings
and function of the PM or ICD and indicate the response the device will have with magnet placement.
D. For unscheduled emergent situations outside of clinic hours, please contact the Cardiovascular Medicine
Fellow on Call, to assist with the management of the PM or ICD.
E. Post-operative device interrogation will be needed in the following scenarios:
1. Device programming changes were performed preoperatively.
2. A magnet was placed over specific models of ICDs (see Appendix J for list) which are capable of
remaining deactivated after magnet use.
3. A magnet was placed over a pacemaker due to electromagnetic interference (EMI).
4. Procedures in the chest.
IV. LIST OF APPENDICES

Appendix A: NASPE/BPEG Generic Pacemaker Code (NBG)
Appendix B: No intervention recommended
Appendix C: Possible needs for reprogramming
Appendix D: Possible device response to magnet placement
Appendix E: Electrocautery use
Appendix F: External defibrillation or direct current cardioversion
Appendix G: Electroconvulsive therapy (ECT)

Appendix H: Gastroenterology procedures
Appendix I: MRI appropriate for MRI conditional systems
Appendix J: Tissue Expander
Appendix K: ICDs that need to be checked post magnet placement
Appendix L: Device manufacturer contact information
Appendix M: Pre-procedural request sheet for a device check

V. REFERENCES

2011 Heart Rhythm Society “The Heart Rhythm Society Expert Consensus Statement on the perioperative
management of patients with implantable defibrillators, pacemaker and arrhythmia monitors: Facilities and patient
management”
Heart and Vascular Care Clinic – Implantable Cardioverter Defibrillator (ICD) Clinic Check, Routine
Heart and Vascular Care Clinic - Pacemaker Clinic, Routine Visits
Heart and Vascular Care Clinic – Pacemaker Transtelephonic Check
Heart and Vascular Care Clinic – Remote Loop Recorder
Heart and Vascular Care Clinic – Remote Transmission of a Pacemaker, Implantable Cardioverter Defibrillator (ICD)

VI. WRITTEN BY

Clinical Program Coordinator, Heart and Vascular Care Clinic
Dr. Michael Field, Assistant Professor, Director of Electrophysiology
Dr. Scott Springman, Professor, Department of Anesthesiology

VII. REVIEWED AND APPROVED BY

Ambulatory Policy and Procedure Committee
Clinic Manager, Heart and Vascular Care Clinic
Clinics Administration
Dr. Michael Field, Assistant Professor, Director of Electrophysiology

SIGNED BY

Deborah D. Tinker, MSN RN CENP, Director, Ambulatory Nursing