Discharge Instructions for Implantable Cardioverter-Defibrillator

You had a procedure to insert an implantable cardioverter-defibrillator (ICD).  This device is also called an ICD or defibrillator. A defibrillator monitors your heart rhythm. If this rhythm becomes too fast or too slow, the device sends out electrical signals. These signals help bring the rhythm back to normal. As you recover, follow the instructions below. Also, follow any other directions you’re given.

Activity

• Do not drive until your doctor says it’s OK. 

• Do not operate heavy machinery for 24 hours after the procedure. 
• Do not make any important decisions or sign legal documents for 24 hours after the procedure.  

• Limit your activity as instructed.

• If you are fitted with an arm sling, keep your arm in the sling for as long as your doctor tells you to. However, make sure that your arm is not completely immobilized. This can lead to a stiff shoulder or stiff elbow.

• Do not raise your arm on the incision side above shoulder level or stretch the arm behind your back for as long as your doctor recommends. This gives the device lead wires time to attach securely inside your heart.

• Ask your doctor when you can expect to return to work. Ask if you will have any restrictions in your work duties for any period of time. Keep in mind that if you have a job that requires a commercial driver's license, an ICD implant is a restriction for this type of license.

Home care

• Every day, take your temperature and check your incision for signs of infection (redness, swelling, drainage, or warmth). Do this for 7 days.  If you notice swelling at the site, apply pressure and call your doctor's office right away.  Your doctor may want you to come to the office for a check-up.

• Take your medicines exactly as directed. Don’t skip doses or stop medicines without discussing this first with your doctor. Tell your doctor if you are having any new symptoms that might be a side effect.

• Do not rub or twist the defibrillator.  

Wound / Incision care

• Follow your doctor's instructions carefully for wound/incision site care. 
• Always wash your hands before touching your incision and changing your bandage.
• Do not use any creams or ointments on your incision site.
• Avoid wearing tight clothing over the incision.  

Other precautions

• You should have been given a temporary ID card with information about your device on it. You will get a permanent card in 4 to 6 weeks.   Carry the card with you.  You can show this card if your device sets off a metal detector. You should also show it to avoid screening with a hand-held security wand.

• Before you receive any treatment, tell all health care providers (including your dentist) that you have a defibrillator.   

  • You will need to wait 6 months after this procedure before you have any dental work or cleaning.  If you need emergency dental work let your doctor know.    

• Keep your cell phone away from your device. Don’t carry your phone in your shirt pocket, even when it’s turned off.

• Avoid strong magnets. Examples are those used in MRIs or in hand-held security wands.  Some devices are now safe to use in an MRI scanner.  Ask your doctor if you have this type of device.

• Avoid strong electrical fields. Examples are those made by radio transmitting towers, “ham” radios, and heavy-duty electrical equipment.

• Avoid leaning over the open hood of a running car. A running engine creates an electrical field. Other than your car, most items around the house, such as your microwave, are perfectly safe. Most common yard work equipment, such as your lawn mower, is safe. If you use commercial-grade tools, such as an arc welder, check with your doctor for recommendations. 

Follow-up care

• You will see your doctor in about 2 weeks to check your implant site. If you do not have an appointment already scheduled, call your doctor's office and make an appointment.
• Keep all follow-up appointments. 
• Ask your doctor about remote monitoring of your defibrillator. Your device may have a remote monitoring system that can transmit information over the phone or the internet to your doctor.
• If you are not able to have your device monitored remotely, you will have periodic checkups in your cardiologist's office to check the function and battery life of your ICD. On average, plan to have your device checked every 6 months. The generator battery can last as long as 5 to 7 years.

When to seek medical attention

Call your doctor right away if you have any of these:

• A “shock” sensation from your ICD and you feel okay. This may feel like being kicked in the chest. 

• Fever above 100.4°F (38°C) 

• Signs of infection at your incision site (redness, swelling, drainage, or warmth)

• Twitching in your chest or abdominal muscles

• Increased pain around your ICD

• Bleeding at the incision site

• Arm swelling on the side of the incision

• Uncontrolled hiccups

• A "shock" sensation from your ICD and you do not feel well
• You receive more than 1 "shock" sensation from your ICD