Pacemakers and AICDs in patients coming to surgery

[staceyp413]

I've been going round and round with this so am HOPEFUL that I can utilize your experiences on what your OR's do. We presently have a policy that when a case is scheduled we have the MD tell us and/or ask if the pt has a AICD or pacer. If they do have one we have the scheduling offices contact the Cardiologist and gets an order on what to do w/the device pre, intra, and post op. If we don't know ahead of time we contact the Cardiologist who again gives us an order.

Our Anesth Dept and Cardiologists assisted with creating this set up and policy, however, now the Cardiologists are having issues with it as they are often busy doing other things and not available to either come over to look at the pts chart or they don't want to.

Please help!! Also, our facility does not have pacemaker nurses.

[Rose_Queen, BSN, MSN, RN]

We have a step on our preop checklist for inhouse patients where the RN is supposed to say whether the patient has a pacemaker or AICD, and they are supposed to contact pacemaker services, who have a tech on call 24/7. Cardiologists don't get involved just to tell us what to do with the device, they pretty much just tell us whether or not the patient has clearance for surgery.

As for patients coming in from home for elective surgery, we have a preanesthesia clinic who are responsible for finding out if the patient has one, and it's noted on the schedule. Pacemaker services gets a list 2 days ahead of time and lets us know what to do.

The only time it's an issue is when we have a trauma or ruptured AAA or something that truly cannot wait until we get a definitive answer, and in that case we just slap a magnet on the patient and hope for the best.

[IsseyM]

We have a step on our preop checklist for inhouse patients where the RN is supposed to say whether the patient has a pacemaker or AICD, and they are supposed to contact pacemaker services, who have a tech on call 24/7. Cardiologists don't get involved just to tell us what to do with the device, they pretty much just tell us whether or not the patient has clearance for surgery.

As for patients coming in from home for elective surgery, we have a preanesthesia clinic who are responsible for finding out if the patient has one, and it's noted on the schedule. Pacemaker services gets a list 2 days ahead of time and lets us know what to do.

The only time it's an issue is when we have a trauma or ruptured AAA or something that truly cannot wait until we get a definitive answer, and in that case we just slap a magnet on the patient and hope for the best.

We do the same here.