Before you are discharged from the Day Unit, your doctor and nurse will go over the procedure with you. The nurse will tell you how to take care of your insertion site. Also, they will discuss any changes in your medications. This will also be a good time to talk about returning to work and when you can drive.
Before you leave the Day Unit, you will need to have your intravenous (IV) line removed and you may require a prescription to take to your pharmacist.
In a week or so, you will receive a temporary registration card for your ICD in the mail from the Heart Institute.
Expect to receive an appointment card in the mail for your follow-up clinic appointment. If you do not receive an appointment in the mail within a week of having your ICD inserted, please call the Pacemaker and Defibrillator Clinic at 613-696-7076.
Discharge Checklist
Before you leave, make sure you have received information about:
- Medication changes
- Driving restrictions
- When you may be able to return to work
Caring for Your Insertion Site
The area around your insertion site, including the incision, must stay dry. Avoid taking a shower until it is well-healed – usually a week to 10 days. You may take a bath but keep the insertion site completely dry.
Remove the initial bandage two days after your procedure. Leave the area open. Do not wash or put any creams or ointments on it. If you are more comfortable with the area covered, apply a small, dry gauze dressing with one piece of tape to keep it secure.
There are no stitches to be removed. Steri-strips (strips of tape) are used to help with healing. Do not remove the Steri-strips . The Steri-strips may start to loosen and come off on their own in five to seven days. If they remain after two weeks, gently remove them when they are damp after a shower.
Mild discomfort at the insertion site is normal and may be treated with acetaminophen (Tylenol®) as directed on the bottle. If your pain is not settling, call the Pacemaker/Defibrillator Clinic. You may need a stronger pain medication.
Check the insertion site every day and call the Pacemaker/Defibrillator Clinic at 613-696-7076 if you have any of these problems:
- A lump that keeps getting bigger
- Redness or tenderness, or warmth around the incision
- Yellow pus or other fluid seeping from the incision
- The incision site starts to become severely painful
- You develop a fever or chills
If you have questions, call the Pacemaker/Defibrillator Clinic
Monday to Friday 8:00 a.m. to 4:00 p.m. Phone 613-696-7076
If you need to speak with someone during off hours, the nursing coordinator
can be reached at any time at 613-696-7000. Press 0 and ask to speak with the nurse coordinator.
Activity Guidelines
It can take up to four weeks for the ICD leads inside your heart to become firmly embedded. To avoid dislodging the leads, follow the activity guidelines in the table below:
| Timeline | Avoid These Activities | You Can Do These Activities |
|---|---|---|
| First 24 hours | Avoid moving your shoulder on the side of the insertion. | You can bend your elbow. |
| First 2 weeks | Do not lift your affected arm over your head. | After the first 24 hours, you can move your arm freely below your shoulder. |
| First 4 weeks |
Do not lift anything heavier than 10 lbs. (5 kg).
Avoid any kind of sports or other vigorous activities, such as golf, tennis, swimming or sweeping. |
After two weeks, you can begin to do most of the regular activities you did before the procedure. |
| First 8 weeks | Avoid any kind of shovelling. | After four weeks, you can begin to do all of the regular activities you did before the procedure. |
Driving
Returning to driving is an important question that many patients ask us about.
The Ontario Ministry of Transportation is responsible for deciding when it is okay for you to drive and your doctor is legally obligated to inform the Ministry if you have a medical condition that may impact your fitness to drive.
It is well known that medical conditions such as ventricular arrhythmias can make even the best drivers unsafe and the Ministry takes this information into account when making decisions about your license.
If you have had a Primary Prevention ICD inserted which means that, although you are at risk, you have not actually had an episode of ventricular arrhythmia, then you cannot drive for one month after your ICD implant. Your license will not be suspended and your doctor will not inform the Ministry of Transportation.
If you have already had an episode of ventricular arrhythmia and are at risk for having another episode, then you have a Secondary Prevention ICD. In this case, you will not be able to drive for at least six months. Your license will be suspended by the Ministry of Transportation.
In order to have you license reinstated, you will need to provide the Ministry with a report that involves having your ICD activity checked by the Pacemaker/Defibrillator Clinic. Please discuss this further with the nurse in the clinic so that your follow up appointments can be timed properly.
If you have a commercial license, the rules are stricter and you need to discuss this with the doctor during your first consult appointment.
What to Do If You Feel a Shock
Because the shock can be sudden and unexpected, it is normal to feel upset and anxious afterwards.
If you receive a single shock and feel fine, there is no need to go to an emergency room. Call the Pacemaker/Defibrillator Clinic at 613-696-7076 on the next working day. They will arrange for you to come to clinic.
Go to the nearest Emergency Department if:
- You receive a shock and continue to feel unwell
- Your symptoms get worse
- You receive multiple shocks
***If you do visit an emergency department, ask that any reports or tests be faxed to the Pacemaker/Defibrillator Clinic at 613-696-7158.
Follow-Up Appointment at the Pacemaker/Defibrillator Clinic
You will need to be seen in the Pacemaker/Defibrillator Clinic within two to four weeks after your ICD insertion.
You will receive a follow-up appointment card from the Pacemaker/Defibrillator Clinic within a week. If you do not receive an appointment card, call the clinic at 613-696-7076.
At the same time, please schedule an appointment with your family doctor to talk about your ICD and how it may affect any other health problems that you have.
For your follow-up appointment, please bring the following:
- Your medication list and your medications in their original packaging
- The name of your family doctor and cardiologist (if you have one)
- A list of any questions or problems that you wish to discuss
About the Pacemaker/Defibrillator Clinic
The Pacemaker/Defibrillator Clinic is an outpatient clinic designed to care for patients who have had a device implanted to correct or address arrhythmia problems. The clinic is staffed with cardiologists and registered nurses who specialize in the care of patients with pacemakers or internal cardiac defibrillators (ICD).
The clinic is open Monday to Friday from 8:00 a.m. to 4:00 p.m. Phone messages left over the weekend will be answered on Monday. Clinic appointments may be scheduled any day of the week but are usually scheduled on Monday, Tuesday, Wednesday or Thursday.
Clinic visits are by appointment, if you are not feeling well or if you have questions, call the clinic and speak to one of the staff. They may be able to help you over the phone or, if needed, they will schedule an appointment for you to be seen in clinic.
Please call the Pacemaker/Defibrillator Clinic to cancel or change an appointment 48 hours in advance of the appointment.
The Goals of the Clinic are to:
- Look after aspects of your health related to your ICD device
- Educate you and your family about your device
- Maintain patient records regarding how your device is functioning
At each clinic visit expect to see a nurse or a nurse and a doctor. During your clinic appointment, the nurse will interrogate your device to obtain information on how it is functioning. The information about your device will be reviewed and any necessary changes will be made.
At the same time, the clinic staff will be available to answer any questions you or your family might have about your particular device or how it is functioning.
Who We Work With
Monitoring and care of your device is only one part of your care. The clinic staff works in partnership with your other doctors. It is our responsibility to communicate the details of your visits to your family physician and your cardiologist.
If you already have a cardiologist, you will continue to see them for all general cardiology check-ups. If you don’t have a regular cardiologist, please ask the clinic staff and they will help you to find one.
The Pacemaker/Defibrillator Clinic is located on the 1st floor of the University of Ottawa Heart Institute.
Patients who have had an ICD implant are routinely seen at the clinic every six months or more often if necessary.