Post cath/pacemaker teaching

  1. 0
    Hey there everyone, I am a new graduate on a tele floor and have noticed that different nurses give different information on post cath/pacemaker care directions for when patients go home. My floor doesn't have a standardized set of instructions to send patients home with. I'm wondering if I could get some input on post cath and especially post pacemaker care directions you give patients. For example some nurses tell pacemaker patients not to lift their affected arm above chest height for 2 weeks, while others say they can pretty much right away as long as they aren't lifting any weight. I've also heard some nurses say patients can shower right away as long as the site remains covered for 24 hrs, while others say not to allow the site to become wet for at least 1 week.

    I don't have questions about how to take care of these patients when they return to the floor, what to assess for, etc. but unsure about the correct teaching to send them home with, it bothers me that I don't have any set directions! Any help/input would be great.. thank you so much!

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  2. 0
    Don't have time this morning, off to work soon, but will gather ours and post 'em for you.
  3. 1
    Confusion might be occurring because of distinction between post-instructions for new pacer implant VS generator replacement.

    With new implant, the whole system is new.
    Leads (usually two, sometimes one, sometimes three) are placed into the heart via access from the subclavian vein.
    Dual chamber = one in the right atrium and one in the right ventricle.
    Single chamber = one in the right ventricle (commonly)
    There are exceptions but for the sake of this issue, we'll stick to the usual.
    The ends of the leads (extending from the subclavian) are then attached and secured to the generator.
    Generator is then tucked into the prepared pocket, and pocket sutured close.

    Biggest fear (besides infection) is dislodging the leads from their position in the heart.
    We try to prevent this by giving the following instructions:
    Patient name
    Your unit was implanted on _______________________________.
    Please report to Cardiology Department, fourth floor, at 1:00 p.m. on Tues Thurs (in one week)
    ________________________________ for a pacemaker wound check.
    Dressing/Wound Care:
    You may remove the large dressing the day after the procedure.
    Keep a light dressing on the incision, to keep your clothes from rubbing it.
    Allow the steri-strips (little pieces of tape over the incision), if present, to fall off by themselves.
    Do not shower upper body for one week.
    Keep the incision clean and dry.
    Keep the shoulder immobilizer on for the first 24 hours.

    For the next Four Weeks:
    Do not lift anything over five pounds.
    Do not raise the affected arm/elbow above shoulder level.
    Do not reach the affected arm/elbow behind you.
    If you raise your arms above your head while sleeping, you may wish to wear the shoulder immobilizer at night.

    Do not drive for
    ____ two weeks (new pacemaker)
    ____ four weeks (new ICD or pacemaker-dependent)

    For the next Eight Weeks (two month
    No golf, swimming or tennis.
    Do not do any strenuous work or exercise with the affected arm.

    Additional Instructions:
    No arc welding.
    Do not go in an MRI scanner.

    Additionally,
    Call the Cardiologist or Nurse Case Manager at
    ----------------------------- if:

    • The incision becomes red, painful or hot (looks infected)
    • Any part of the pacemaker protrudes from the skin
    • You experience new shortness of breath, dizziness, fainting, prolonged hiccups (longer than two hours) or excessive fatigue
    • You have any major concerns.


    If you experience any of the above in the evening or on the weekend,
    go to the Emergency Department


    MedicWifeRN likes this.
  4. 1
    Instructions for patients having a generator change are different.
    The leads are already in the heart.
    They are left in.
    An incision is made near the implanted generator, and the generator is removed from its position.
    The leads are disconnected from the old generator and reconnected to a new generator.
    The new generator is placed into the original pocket and the pocket is sutured closed.

    As no new leads are implanted, there is no risk of dislodgement.

    Post instructions/education are:

    Patient name
    Your device was implanted on _______________________________.

    Report to the Infusion Center on fourth floor (4SE) the next day at __________________ for an additional dose of intravenous antibiotics, which will take 1.5-2 hr. The physician will remove the large dressing, inspect the wound and place a new dressing before you leave.

    Please report to Cardiology Department, fourth floor,at 1:00 p.m. on Tues Thurs (within one week) ____________________________ for a pacemaker wound check.

    Dressin
    g/Wound Care:
    The physician will change your dressing the day after implant.
    Keep the new dressing on the incision until your wound check appointment.
    Keep the dressing clean and dry; change only if it becomes soiled or wet.
    Do not shower upper body for one week.

    Additional Instructions:
    No golf or tennis for two weeks.
    Avoid MRI scanner and arc welding.

    Call the Cardiologist or Nurse Case Manager at
    ----------------------------- if:

    • The incision becomes red, painful or hot (looks infected)
    • Any part of the pacemaker protrudes from the skin
    • You experience new shortness of breath, dizziness, fainting, prolonged hiccups (longer than two hours) or excessive fatigue
    • You have any major concerns.


    If you experience any of the above in the evening or on the weekend,
    go to the Emergency Department


    Hope this helps.
    MedicWifeRN likes this.
  5. 0
    Dianah, thank you so so much for taking the time to post these... extremely helpful!!! I think I will print them out and put them in my work binder for reference. I'm pretty surprised that we don't have a handout like this at work, I think I may propose getting one for our patients.

    Thank you again for the detailed response!!
  6. 0
    Your cath lab may very well have pamphlets and patient education they dispense post-procedure.
    And, a disclaimer: ours were reviewed by our Cardiologists and Electrophysiologist so their preferences were included.
    There are no cookie-cutter instructions, that ALL CVLs will use.
  7. 0
    Here are post-cath orders (inpt), femoral approach:

    Education for the In-Patient Post Cardiac Catheterization

    Immediately post-procedure:
    To prevent bleeding, for the next ______ hours
    1. Lie in bed and keep your head on the pillow.
    2. Keep the right / left leg straight and still
    3. If you feel any pain, aches or soreness at the site, notify the nurse
    4. If you have a warm, wet feeling at the site, press down firmly on it and call for the nurse.

    ___ If checked, the site was sealed with an external Clo-Sur P.A.D. (date/time) __________________
    Keep the dressing on the site for 24 hours. After 24 hours, remove the dressing and gauze. If the yellow Clo-Sur P.A.D. sticks to your skin, soak it with water to soften it, then remove it and you may then shower.

    Do not drive for the next 24 hours
    For the next 48 hours do not exercise or lift more than 10 pounds
    You may shower the day after the procedure; do not scrub the procedure site.
    For the next 7 (seven) days do not soak in a bathtub, hot tub, jacuzzi or pool.
    You may have a bruise or small lump at the site. This will usually fade in 3-4 weeks.
    Continue to take all prescribed medications.

    Call your nurse if
    You notice that a lump forms at the procedure site
    The leg of the procedure site feels cold, numb or tingly
    The procedure site becomes tender, swollen, painful, warm to the touch or begins draining fluid.
    You have a fever over 100 degrees F.

    If any of the above occurs after your discharge from the hospital:

    Call ----------------
    Mon-Fri 8:00 a.m.-4:30 p.m.
    or
    Call the the Nurse Advice Line -------------------------
    after 4:30 p.m. Monday through Friday or on the weekend
    or
    Go to the nearest Emergency Room

    Procedure Cardiologist(s): __________________________________________________ _______

    RN Case Managers: --------------, RN, MSN; ------------------, RN


    Instructions differ if the radial artery approach is used.
  8. 0
    Be helpful to your patients and tell them that Steristrips will clog their bathtub/shower drains and to be sure to catch them before they do.
  9. 0
    Some of our cardiologists have strict preferences about when people can shower/lift their arm/remove dressings/etc. Check with the cath lab, they often have different post-procedure orders for each MD.

    Your facility should have either software or some place on the intranet where you print out new medication education and other teaching such as diabetes, cholesterol, etc. Check there for your post-procedure discharge instructions, rather than posting what someone else sent you on the Internet. No offense to the above poster, those sound great: But the ones on your facility intranet have been approved by your powers that be, and I would not deviate from them. If there is nothing there that suits your needs, contact the nurse educator or, in the absence of one, your manager who can contact medical staff and have them whip something up.


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