From the Guidelines
A 78-year-old female status post pacemaker generator replacement should avoid direct manipulation of the pacemaker site, keep the incision clean and dry, and restrict arm movement to prevent lead dislodgement, as recommended by the most recent guidelines 1. The patient should take prescribed antibiotics, commonly cephalexin 500mg four times daily for 5-7 days, to prevent infection, and monitor for signs of infection or device malfunction, such as redness, swelling, drainage, fever, dizziness, fainting, or return of pre-pacemaker symptoms. Key recommendations for post-pacemaker generator replacement care include:
- Avoiding direct manipulation of the pacemaker site and keeping the incision clean and dry until fully healed, typically for 7-10 days
- Restricting arm movement on the side of the pacemaker implant, avoiding lifting that arm above shoulder level or lifting objects heavier than 5 pounds for 4-6 weeks to prevent lead dislodgement, which occurs in 1% to 2% of cases after pacemaker insertion 1
- Taking prescribed antibiotics to prevent infection
- Monitoring for signs of infection or device malfunction
- Regular follow-up appointments, typically at 1-2 weeks post-procedure for wound check, then at 1-3 months for device interrogation, and subsequently every 6-12 months, as outlined in the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1 Most patients can resume normal activities within a few weeks, but should permanently avoid strong magnetic fields and inform all healthcare providers about having a pacemaker, as the new generator needs time to properly integrate with surrounding tissue, and the connection between the generator and existing leads must remain stable during the healing process.
From the Research
Post-Pacemaker Generator Implantation Care
- Patients with permanent pacemakers are a vulnerable population with special needs and considerations for management 2
- Critical care nurses should be equipped with the knowledge to care for patients immediately postoperative cardiac implantable electronic device placement and for patients admitted to critical care units with these devices already in place 2
Anticoagulation Therapy
- Anticoagulation with warfarin reduces the risk of thromboembolic stroke in high-risk patients with chronic atrial fibrillation by approximately 70% 3
- Apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality in patients with atrial fibrillation 4
- A mixed treatment comparison meta-analysis found similarity between warfarin and new anticoagulants, such as apixaban, dabigatran, edoxaban, and rivaroxaban, in reducing the risk of stroke in patients with nonvalvular atrial fibrillation 5
Hematoma Formation
- Hematoma formation after pacemaker or implantable cardiac defibrillator implantation is rare, even among patients who are anticoagulated 6
- The use of dual-antiplatelet therapy, such as concomitant aspirin and clopidogrel, increases the risk of hematoma formation after device implantation 6