Summary of Medicines and Health Regulatory Authority guidance for perioperative care of patients with implantable electronic devices where the use of surgical diathermy is anticipated
| Preoperative | Intraoperative |
|---|---|
| Identify patients through preadmission screening | CPR facilities and specialist cardiac staff should be available |
| Contact the patient's pacemaker/ICD clinic to confirm the cardiac condition and confirm device details | The patient should be monitored using ECG plus a second method of confirming heart rate (such as pulse oximetry or arterial line) |
| Liaise with device follow-up clinic to advise on required support by cardiac pacing/ICD physiologist before, during or after surgery | If pacing inhibition occurs the surgeon should be informed immediately |
| An appointment is made to ensure device functionality after surgery | Minimise monopolar diathermy to short bursts |
| Ensure the return electrode is positioned so that the current pathway is as far from the device as possible | |
| ICDs should be deactivated and the patient fitted with external defibrillator pads if access to the anterior chest would interfere with surgery |
ICD, implantable cardioverter defibrillators; CPR, Cardiopulmonary resuscitation.