Medical screening
Psychosocial screening
Anticipatory guidance
Update health history
Child/family response to planned procedure
Ask parent/guardian to identify concerns; address concerns
Identify co-morbidities
Assess family composition, support systems and coping methods
Describe procedure, post-procedure care, discharge plan, restrictions
Develop plan as needed
Consult with specialist as needed
Obtain brief family health history including anesthesia reaction, bleeding problems, allergies
Identify any current psychosocial problems needing plan or referral
Describe recovery period including return to physical activities
Identify and obtain missing medical information (documentation of arrhythmia, echocardiogram)
Identity social needs; financial, insurance, transportation, housing
Offer information to patient and child if needed
Determine other testing needed
Refer to social work as needed
Refer to child life as needed
Table 24.2
Preoperative education: device implantation
Operative detail | Device details | Restrictions |
|---|---|---|
Length of procedure | ICD vs. pacemaker: purpose of device | No overhead reaching for 6 weeks for transvenous system |
Incision type: axillary vs. subcutaneous | If ICD, discuss risk of inappropriate shocks | Avoid heavy lifting for 6 weeks |
Length of hospital stay | Single vs. dual chamber | Return to school/work: 1 week |
Battery and lead longevity | ||
Device features: anti-tachycardia pacing, MRI compatibility, etc. | ||
Remote monitoring education |
Table 24.3
Preoperative education: day of ablation
Procedure details | Restrictions |
|---|---|
Length of procedure | Return to school: 1–2 days |
Description of catheter ablation | Return to sports: 3 days or when groin sites are well healed |
Cryoablation vs. radiofrequency ablation |
APNs provide detailed education to patients and families prior to EP procedures tailored to their individual needs. Anticipatory education, especially important for those undergoing device implantation, emphasizes the planned follow-up care and the importance of long-term device monitoring; it decreases anxiety for the patient and family (Table 24.2). Education regarding generator replacement is dependent on the type of device selected. For example, wound care for a device generator change is similar to that of an implantation of new devices, but overhead arm movement restrictions are usually not necessary.
On the day of the procedure, APNs work closely with the EP physician, nurses, and technical staff throughout the patient’s experience. APNs perform preoperative history and physical that is reviewed by the anesthesia team and the EP physician. Throughout the procedure APNs provide continued support, education, and updates to the family. Following the procedure, APNs communicate with the recovery room nurses and physicians to ensure continuity and high quality care. APNs order and review post-procedure testing, provide pain/anti-nausea medication, and address other patient care needs.
At discharge APNs, in collaboration with attending physicians, ensure appropriately programmed pacemaker function and determine necessary clinic follow-up to monitor device safety and continued normal device function. APNs provide detailed information about the procedure outcome and follow up care to the family (Tables 24.4 and 24.5). APNs follow up with patient and families via telephone following the procedure to assess for concerns. APNs assess for complications, recurrences and other concerns and can manage these issues if they occur. Lastly, for patients who underwent device implantation, telemedicine has become increasingly useful. Wounds can be accessed via digital photo and emailed to the APN through a smart phone, making follow-up extremely convenient for the patient, especially those who live far from the implanting center.
Table 24.4
Discharge instructions for device implantation
Wound care | Activity instructions | Follow-up |
|---|---|---|
When to remove initial dressing | If transvenous lead(s), avoid overhead reaching for 6 weeks | Discharge with Holter ×24 h |
Cover with light dressing and protect from clothing and leave open to air as much as possible | Use sling as needed for comfort | Wound check in 1–2 weeks (via telemedicine or PCP) |
Post-implant oral antibiotics often advised | With reaching restrictions, promote range of motion of that arm to prevent stiffness | In-office interrogation and appointment 2–6 weeks after implant |
Avoid shower for 72 h; protect from water until that time | Return to school/work in a week | Remote monitoring education |
Avoid complete submersion water (swimming/bath) until well-healed | Schedule routine remote monitoring schedule | |
Encourage remote monitoring transmission with any concerning symptoms | ||
Call immediately with signs of infection: fever, wound redness/drainage/tenderness/swelling | Return to sports/gym in 6 weeks | Discuss triage/access to medical system with concerns |
Table 24.5
Discharge instructions for ablation
< div class='tao-gold-member'>
Only gold members can continue reading. Log In or Register to continue
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
