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:
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.
- 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.
- No arc welding.
- Do not go in an MRI scanner.
Call the Cardiologist or Nurse Case Manager at
- 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