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Implantable Cardioverter Defibrillator ICD Clinic Check, Routine (HVC)

Implantable Cardioverter Defibrillator ICD Clinic Check, Routine (HVC) - Policies, Clinical, UWHC Clinical, Department Specific, Heart and Vascular Care Clinic

HVC

HVC Implantable Cardioverter Defibrillator ICD Clinic Check, Routine  
Category:  UWHC Departmental Policy   
Policy Number:  HVC    
Effective Date:  August 28, 2013   
Version:  Revision    
Manual:  Heart and Vascular Care Clinic    
Section:  Implantable Cardioverter Defibrillator ICD Clinic Check, Routine   
 
 
I. PURPOSE

The policy is to provide guidance to the Device Nurse, who is specially trained in Cardiovascular Implantable
Electronic Devices (CIED) and who is checking the Implantable Cardioverter Defibrillator (ICD). This policy will
provide optimal safety and security for the patient with an ICD while maximizing the life and performance of the
ICD. Staff will monitor that the ICD recognizes and treats rhythms appropriately.

II. POLICY

To provide guidance for obtaining precise ICD parameter measurements, episode interpretation and generator
reprogramming performed as needed.

III. PROCEDURE
A. The Device Nurse completes a verbal assessment with the patient, which allows them to focus
on/document any specific problems, including episodes, shocks, symptoms, and assess the integrity of the
pocket site.
B. The Device Nurse saves two 6 second ECG strips. Strips are saved either by utilizing Paceart, the charting
system that supports CIED, or by using the device programmer, including the presenting rhythm and
underlying rhythm, if different from presenting. Staff will:
1. Verify that the ECG strips demonstrate appropriate rate and modes, looking for proper capture
and sensing, based on their ICD programming.
C. View initial interrogation information, implant date, programmed parameters, percent paced battery
life/voltage, charge time, lead impedances, recorded episodes and heart rate histograms.
1. If battery voltage or charge time shows elective replacement indicator, appropriate for the
device, the patient will be scheduled to see the Electrophysiologist (EP) in clinic to discuss the
procedure.
2. Document findings in patient’s electronic medical record.
3. For episodes in the treatment zones, the EP will interpret rhythm to determine if the appropriate
detection and treatment occurred.
D. Measure and document the following:
1. P and R waves;
2. Lead stimulation thresholds; and
3. Lead impedances.
E. Confirm that all parameters are programmed with appropriate safety margins. Amplitude 2:1 when using
voltage or 3:1 for pulse width, not to go lower than 1.5 V @ 0.4 ms (Right Atrium [RA]), 2.0 V @ 0.4 ms
(Right Ventricle [RV]). RA sensitivity should be programmed at least one-half the measured amplitude
unless undersensing or oversensing occurs. An order is needed from EP Physician to change RV
sensing. Change settings as required.
F. If the rate modulation feature is enabled, assess the patient’s heart rate response to the indicator used
and adjust according to the patient’s needs.
G. Print and read final report from the programmer.

H. Transfer interrogation to Paceart for charting.
1. Verify transferred information.
2. Fill in any added information and chart narrative specific to findings, changes and outcomes.
I. Print all needed copies of the Paceart report.
1. All copies will go to the EP Physician for reading and signing, before being sent to the
corresponding destinations.
2. One each for hospital medical records, entered into patient’s electronic medical record and
Referring Physician(s) outside the UW Health systems.
J. Complete Outpatient Encounter in electronic medical record, file charges accordingly.
K. Routine follow up for patients with ICDs.
1. Two week post implant.
2. Checks are done every 3 months with a combination of home transmissions and clinic checks.
3. Devices without elective replacement indicators, alert notifiers contact device company when ICD
is four years old, they will calculate estimated battery life.
4. More frequent checks if medically needed or battery status indicates.
IV. REFERENCES

Heart and Vascular Care Clinic - Pacemaker Clinic, Routine Visits
Heart and Vascular Care Clinic – Remote Transmission of a Pacemaker, Implantable Cardioverter Defibrillator (ICD)
Heart and Vascular Care Clinic – Remote Loop Recorder
Heart and Vascular Care Clinic – Pacemaker Transtelephonic Check
Heart and Vascular Care Clinic – Management of Pacemaker or Implantable Cardioverter Defibrillator (ICD) Devices
in a Procedural Setting

V. WRITTEN BY

Clinical Program Coordinator, Heart and Vascular Care Clinic

VI. 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