Implantable Cardioverter Defibrillator (ICD)

Caring for your wound

There are a number of things that you can do to look after your wound, to lower the chance of infection and encourage healing. These include:

• Keeping the dressing clean and dry. Leave the dressing in place for 1 week - this means no showers or bathing for 1 week
• Avoid wearing tight clothing such as braces or bra straps over the wound
• Take care when wearing a seatbelt to avoid excess rubbing over the wound

Wound care

When an ICD is implanted, the wound is closed with either dissolvable stitches or stitches that will need to be removed.

Dissolvable stitches

Please remove the dressing after 1 week following the procedure. If you have any concerns, contact the Arrhythmia Specialist Nurse for advice. The contact details are at the end of this page.

Non-dissolvable stitches

Before you are discharged, you will be given a letter informing you to contact your GP’s practice to make an appointment to have your stitches removed.

If you are concerned about your ICD wound

Please contact your Arrhythmia Specialist Nurse immediately if you are concerned about your wound and/or surrounding skin. Report any redness, swelling, oozing or new tenderness of your wound or surrounding skin as these may be early signs of wound infection. Also contact us if you are concerned about the skin over the ICD.

Out of hours

Most wound problems can wait until normal working hours when you can contact your Arrhythmia Specialist Nurse for advice. However, if the wound or surrounding skin is opening and/or if you can see pus (discharge) then please attend your nearest Emergency Department. We would expect you to be admitted to hospital.

Restriction of arm movement

If your ICD has been implanted in the left upper chest, the leads which are placed inside the heart will need time to settle in. Therefore, for the first 4 weeks, we advise you not to lift your left arm (right arm if the ICD is on that side) above shoulder height or take part in any heavy lifting, pushing or pulling. This will help to prevent the ICD leads from moving out of place.

We also advise you to move your arm gently and regularly to minimise the risk of a frozen shoulder or shoulder stiffness.

If you have a subcutaneous ICD, placed in your lower left side, under your armpit, there is no arm restriction as there are no leads inside the heart. However, for healing of your wound and comfort, you may need to move your arm gently for 1 to 2 weeks.

Pain relief

It is normal to feel some discomfort or pain after the implant of an ICD. When the local anaesthetic begins to wear off, you are likely to feel uncomfortable and will need to consider taking pain relief.

Paracetamol is used to treat mild to moderate pain and the dose is 1 gram (2 x 500 mg tablets), which can be taken every 4 to 6 hours. The pain relief can take up to an hour to take effect.

Do not wait for the pain to become severe; mild pain is easier to control. However, if further pain relief is required Codeine can be used to treat moderate to severe pain. This can be purchased at your local pharmacy. You can use this as needed, alongside the paracetamol.

Driving restrictions

If you drive during this period your car insurance will not be valid.

Your Arrhythmia Specialist Nurse or consultant will tell you more about your driving restrictions. You will need to let the DVLA know that you have had an ICD implant.

Follow-up appointments

You will need to attend your ICD appointments as these are an important part of your ongoing care. Attending the appointments will allow us to check that your ICD is working properly.

Your first ICD follow-up appointment will be at

6 weeks. At this appointment you will be issued with a remote monitoring device. The team will explain how to set this up at home. Remote monitoring allows us to check your device from the hospital.

ICD information/passport

Details of your ICD and leads will be given to you at your 6 weeks follow-up appointment. This will be a printed document that you should keep with you at all times. You may wish to take photocopies of this document. If you plan to travel by air, you will need to show this document at the airport.

What to do if you have a shock from your ICD or experience a ‘blackout’

Often patients will have very little or no warning that their ICD is about to deliver a shock. However, some patients may experience fast palpitations, feel dizzy or feel lightheaded. Some people have no symptoms and experience a blackout.

If you think you are about to receive a shock from your device you should try to:

• lie or sit down
• let someone else know how you are feeling

Following an ICD shock or blackout within normal working hours

However, if you have had a shock or blackout and you feel well, please contact your Arrhythmia Specialist Nurse or Pacing Department who will arrange an appointment for an urgent review. Do not drive yourself to the appointment.

If you are having other surgery or treatment

There are certain instances when the shock treatment of your ICD should be temporarily turned off, for example:

• If you have surgery where diathermy is required
• If you have radiotherapy

If you require surgery or other treatment, please let your surgical or radiotherapy team know that you have an ICD.

This will allow discussions to take place to decide if your device will need re-programming before and after the procedure. The surgical or radiotherapy team will contact the Cardiac Investigations Department, if re-programming is needed.

Deactivating ICD shocks

When we approach end of life, it is necessary to consider whether or not it is still appropriate to have an active ICD. It is important for us to discuss this with you, your family and/or carers so that your wishes can be respected.

Exercises to prevent shoulder stiffness

Visual images inside the PDF below.

• Let your affected arm hang straight down. Swing your arm as if drawing a circle on the floor. Change direction. Repeat 10 times.
• Let your other arm hang straight down. Swing your arm to your left and then to your right. Repeat 10 times.
• Let your arm hang straight down. Swing your arm forwards and backwards. Repeat 10 times.
• In a sitting or standing position roll your shoulders in both directions. Repeat 10 times.
• Tilt your head from side to side. Repeat 10 times.

Contact information

Arrhythmia Nurse Specialists

Gloucestershire Royal Hospital

Tel: 0300 422 8420

Monday to Friday, 9:00am to 4:00pm

Patient Advice and Liaison Services (PALS)

Tel: 0800 019 3282(Free phone)

Tel: 0300 422 6830

Tel: 0300 422 6831

Email: ghn-tr.pals.gloshospitals@nhs.net

Further information

Arrhythmia Alliance

Helpline: 01789 867 501

www.heartrhythmalliance.org

British Heart Foundation

Heart Helpline: 0300 330 3311

www.bhf.org.uk

The Cardiomyopathy Association

Tel: 0800 018 1024

www.cardiomyopathy.org

Driving and Vehicle Licensing Agency (DVLA)

Tel: 0300 790 6801

www.gov.uk/pacemakers-and-driving

Gloucestershire Carers Hub

Tel: 0300 111 9000

carers@peopleplus.co.uk

www.gloucestershirecarershub.co.uk

Let’s Talk (Gloucestershire)

Tel: 0800 073 2200

www.talk2gether.nhs.uk

Now We’re Talking – For Healthy Minds (Herefordshire)

Tel: 01432 220 507

www.healthyminds.whct.nhs.uk