Hospital Preparation for first time PM installation

Hospital prep

by Sisterwash65 - 2020-11-04 04:16:55

I'm not sure where you're located but I'll tell you what most PM patients in the US are accustomed to. You will likely stay overnight in the hospital so you will need any toiletries plus items you mentioned. As far as clothes, wear something comfortable, easy to take off. When you get checked in you'll change into a hospital gown. The staff will get your IV set up, a catheter placed ( probably have a choice on the catheter) and ready for your PM. After your procedure is over, you'll go back to your room. You will have EKG attached as well as your IV and nurses will check on you throughout your stay. Before you're released to go home, the device rep from the Pacemaker company will come and check on your PM. This is just to see if all settings, leads, etc. are doing as they're supposed to. Then you'll have a chest X-ray to confirm PM is in place. After that usually your EP comes in to check on you and then you'll be released to go home. At that point the nurses get you " unplugged" and you can get dressed again in the clothes you wore to the hospital. I decided to go with a catheter because it's difficult to go to the bathroom with IV and EKG wires everywhere. Do you know what kind of PM you're getting ? The one I have is Bluetooth enabled so I don't have a monitor box to send PM data. It goes automatically to my clinic. 
Hope this has answered your questions and I'm sure you'll get along great !

what to take

by Tracey_E - 2020-11-04 09:37:14

Kindle is fine, you can charge if needed. 

Wear a button up shirt. You won't want to be pulling anything over your head the first week or so. 

You should always have a will and (if you want) a living will and durable power of attorney. Not sure how the legalities work where you are but in the US the last two make it much easier for a spouse/family member to make decisions on our behalf when we can't. There's no reason at all to expect to need them but it is always a good idea to have them up to date whether you were getting a pacer or not, esp since you have kids. My husband is a slacker about that too, and I've always been a bit resentful that he won't take care of it. If something suddenly happened to him, not having his affairs in order would put extra unnecessary stress on me at a time that would arguably be the worst in my life. Just do it, then tuck it away and move on. (sorry to get preachy! that's a sore point with me. No one will live forever, don't leave your family a mess to clean up)

Pacemaker Installation

by Marybird - 2020-11-04 12:14:41

Hi Koala,

Did they tell you you would be staying overnight after your PM was put in?. I know that used to be the norm, but at least in this neck of the woods, if you're basically healthy other than the CHB, they have allowed people to go home the same day as their implant,  though it will be hours later after they observe you, do the pacer checks, x-rays, etc. I went home the same day (though it was 8 hours later) after my pacemaker was put in, as my daughter also did after she had her pacer generator replaced in August. They seem to be doing that more here after all this covid stuff.

If your doctor or staff informed you that you would be staying overnight, though, your plans and preparations sound just about right. Book or Kindle is a matter of preference.

I've never heard of a foley catheter being placed in a patient for a pacemaker implantation. Generally this surgery doesn't take more than 45 minutes to an hour or so, and most often it seems patients are given light conscious sedation, so you're either in lala land and feeling no pain, or you might sleep through the procedure. There is no deep general anesthesia where you're intubated and the anesthesiologist controls your breathing. You're given an opportunity to use the restroom just before your surgery, so you won't have to heed the call of nature during surgery.

I know sometimes a foley catheter is placed when a patient is undergoing a cardiac ablation, as sometimes these procedures may last several hours ( my daughter had one ablation that lasted 8 hours) and since they insert catheters to the heart via the femoral blood vessels ( arteries I think), the patientnmust remain flat on his/her back for several hours afterwards. But I couldn't see a reason for a foley for pacemaker implantation unless the patient has a reason not related to that surgery.

no cath

by Tracey_E - 2020-11-04 15:02:40

They don't do a catheter for a pacer insertion. They usually use conscious sedation or a local so not necessary.  

no cath

by AgentX86 - 2020-11-04 15:36:59

Agreed. I can't imagine why they'd need to. The procedure takes usually less than hour.

An ablation is a completely different kettle. They go into the femoral vein. The procedure may be rather quick (sometimes not so) but it requires a few to several hours laying on one's back after, until the vein completely clots. Recently they've been using collegen plugs to reduce this time. They tend to pump fluids into you, also, so things can get tense. Every time I've had an ablation it's a toss-up whether my back or bladder hurt more. Watched clocks never move.

No urinary catheter for my ablations or PM/leads

by crustyg - 2020-11-04 15:54:14

I don't think in the UK you'd get away with that.  There is evidence that insertion of a urinary catheter may provoke a transient bacteraemia (much like vigorous toothbrushing), and although the bugs aren't actually growing in your bloodstream at this stage (hence why it's different from a septicaemia) they can stick onto damaged heart valves, foreign bodies (leads in the heart) etc. and then you're in real trouble.

My two ablations and PM/leads were day cases, no overnight stay.

WHAT ???

by ROBO Pop - 2020-11-04 16:12:18

WHAT, they don't do a cath? Well what was that thingy they shoved up my ...

Don't over think it. Ask your doc if you'll be incarcerated over night, most are. If so, reading material (electronic or hard copy) and by all means wear some clothes. What you suggested is fine. You might also enquire what model you are getting, if it's the Harley Hog model take some heavy boots to kick start that puppy. Oh and have a designated driver.

Good luck

Catheter or not ??

by Sisterwash65 - 2020-11-04 16:29:08

As we often read here, every case is different I checked into the hospital at 1:30 in the afternoon.Then a heart cath at 3:30 pm, quickly progressed to the decision for a pacemaker. The EP said he could do it right away. That was at 5:30. Then he was called to the ER for a patient with a heart attack. I was then given a Covid test prior to being moved to the 3rd floor to wait on the doctor. Finally, at 8:45 pm I was taken back down to the Cath Lab for PM placement. I got back to my room at 11:15pm. 

So yes, the catheter decision was a no brainer for me. Having had 5 Lithotripsy ( kidney stone ) treatments I knew the drill. :)

Catheter or not

by AgentX86 - 2020-11-04 20:02:32

My cardiologist does heart catheters though the radial artery so there is no real recovery time. As soon as the sedation wears off (and you're told the bad news) you're good to go. No back time needed. Much easier than using the femoral artery. They did that when they were going to stent my carotid (didn't happen). That was BAD.

jeez ya'll

by Tracey_E - 2020-11-05 13:27:32

He asked about kindles and what shirt to wear, everyone goes off on catheters lol. 

Y'all

by AgentX86 - 2020-11-05 15:00:58

Some things are more important than others.  ;-)

Any distraction is a good thing....

by crustyg - 2020-11-05 16:12:19

You make a good point Tracey.  But anything that provides a distraction is probably a good thing for Koala ATM.

I blame Sisterwash65 - she started the catheter hare running!  And some of it's been very funny.   I've looked after quite a few ureteric stone patients and it's not a pain I would wish to experience, and post lithotripsy I would be begging for assistance. Not really relevant for a PM+leads.  In fact, I was so dehydrated by 09:00 that they put me head down for 10min to make my axillary vein big enough to get the sheath in.  Doh!  No bladder urgency for me for *hours* after the procedure.  Not very smart.

I hope it all goes well Koala.  Very best wishes.

Any distraction...

by Sisterwash65 - 2020-11-05 18:46:43

Nothing like mention of a catheter to get everybody going !!!  I was just relating my experience for Koala. 

Ohnwell, we definitely got distracted ! Lol !

snacks!

by koala - 2020-11-06 09:48:32

I've added some clif bars into my bag. I know they'd feed me and being totally bed bound, I probably won't be hungry, but just in case. I've also washed my dusty buttoned up shirt (short sleeves) in preparation.

Question, when wearing the gown, do I get to keep wearing my long pants, or do I have to strip down to just undies?

I just hope no cathether, I can only imagine how painful it must be for a guy. I'll just remember not to drink too much before the op.

more

by Tracey_E - 2020-11-06 09:57:17

Usually there is no food or drink after midnight the night before, so needing a bathroom is not an issue. 

For surgery usually it's just the gown. In your room, they won't care. At least, here they do not. I've always worn gym shorts when I was in the hospital. 

They won't want you pacing the halls and wandering around, but we aren't usually told we can't get out of bed at all. 

My experience was get admitted, wait for surgery, sleep a lot, sleep some more, get up in the morning, see the doc and have the pacer interrogated, go home.

If you are feeling anxious, ask for the meds as soon as they get the iv going, they are usually pretty generous with them. They like us calm and happy, not freaking out. 

long night

by dwelch - 2020-11-06 15:09:50

I dont know about this catheter thing, 5 devices and nothing of that sort...anway

As with most of the real answers.  you dont want a pull over shirt, something button up for days to weeks.

They would give me two gowns one open front one open back.  basically you just wear what they give you and some underwear.  For the ladies I assume that means no bra, but that is a Tracey_E question or others.

The first day sucks that night sucks you wont sleep, so if you can concentrate on a book, bring one, probably a kindle is easier, less movement to flip pages, but you need a charger perhaps.

You will have an IV prep, stub, or whatever they call it is in your arm or hand for the duration of the stay (all night) they come in and flush it with a syringe every 6 hours. basically if you do manage to sleep they will come in and wake you up...

Last one I moved back and forth between a bed and chair.  And also a few sessions on antibiotics during the stay

Interrogation from the rep or a tech in the morning.  and not long after go home. I have never had a post surgery before I go home xray.  I have had three with new leads, three of the five, the first one, the second one the doc broke a lead and the last one to switch to a biventrical, those were overnight, the other two were go home right after.

My first two I was awake (mild sedation, I could see and hear but couldnt quite figure out how to speak) my third one I supposedly talked to the doc all through it like a drunk person asking the same question over and over again.  but remember none of it, until I asked her the question when fully awake later and she laughed.

I dont know that I have remembered talking to the surgeon after the last two, my wife said the last two I had a conversation with him.  Later I said I wish I could have talked to the surgeon.  But you did, you had a long conversation.   no memory of it whatsoever. was coming off the meds.

Night two is much better than night one.  takes a while to sleep through the night and to be able to sleep on that side (like a week or two)

Dont be discouraged it is what it is it is all well worth it.  maybe you will want to walk the halls if they let you.  Sometimes the sling helps sometimes not you want to dump the sling as soon as you can if not immediately after leaving the hospital.  The transmitters probably get smaller each time and vary but the ekg monitor is several leads stuck to you and the monitor which may have its own belt/strap that you have around your neck or waist or whatever.  have to drag that around.

The time passes quickly though, no worries.  I might have brought an audio book the last time, dont remember now.  Very strange though esp in these days of lawsuites for 33 years they always make you ride a wheelchair down to the car.  The last one, nurse said okay get dressed you can go.  we waited a bit thinking they were going to come back, we might have enve asked, but nope I walked out no wheelchair.  strange...

We have almost all here been through this at least once, it really is a very small part of the experience and relatively a short period of time.  CHB is super easy to fix with a pacer this is the right thing to do.  I would think more about around the house stuff rather than one night away stuff, find button up clothes get them washed and ready.  slip on shoes, anything that makes dressing easier, and housework reduced.  anything heavy that needs to be moved, do it now not three/four weeks from now.  extra pillows for the bed if that might help you sleeip in different positions, blankets if you want to sleep on the recliner instead.  implant is one day, recovery is weeks, then the rest of it is many years, so relatively small but the night of is an even smaller percentage of the whole thing.

Overnight stay?

by stormynw - 2020-11-06 17:39:18

I agree with Marybird and no overnight stay. Here in Washington State, USA it's a same-day procedure meaning you're in and out the same day. I'm getting my dual-chamber replaced with a CRT-P on the 19th and they said to expect to be there about 6 hours. Which to me doesn't seem long enough especially considering I have a 90 minute drive. Well... I won't be driving but my son or cousin will be. ;)
Good luck,
Damie Rodriguez

Pacemaker Implant Apparel

by Marybird - 2020-11-06 19:40:46

My pacemaker implant was basically an outpatient procedure-I came in through the hospital's outpatient surgery department, but was admitted to the telimetry floor in the hospital for about 6-7 hours after the surgery. Was told I could go home later ( after 6 hrs observation IF everything was ok), but the doc didn't write the discharge orders till the last thing was done and he had reviewed the results so I wasn't sure I would go home that night. 

I changed into a gown for the surgery, and they let me keep my undies on. Had to remove the bra, I imagine that'd be somewhat of an obstacle in an operative/sterile field. I kept the gown on afterwords till I went home. They do let you walk around, use the bathroom as needed, though I pretty much stayed put as I felt a bit like I'd been run over by a train for a while there, and between the telimetry leads and the arm restraint ( it was an actual arm restraint that kept my left arm pinned to the side) I was instructed to wear for 24 hours post surgery, then take it off, and a bit groggy, I didn't feel much like doing anything else. 

No overnight stay

by CLE - 2020-11-06 20:06:00

Hi,

Had my PM 2 weeks ago today. I wore a button shirt to make it easier to get dressed after the procedure. Got to the hospital around 9:30 am. They took blood and sent me to admission. I was only there for a few minutes and went to pre-op where they had me strip including under wear. I took a kindle with me and read some. There was a lot going on on pre-op.  After a hour or so I was rolled back to the procedure room. All was great until they strapped my left arm down. At that point I told them them needed to knock me out if they were going to strap the right arm down or we were going to have a problem.  They did and I woke up in recovery.  After a couple of hours I was taken down for an x-ray and after it was read I got dressed and went home around 7:30. 
 

Coy

Overnight

by AgentX86 - 2020-11-07 00:06:34

As I said, I did stay overnight because of the dependency.  I bring, or my wife does laer, PJ bottoms with me anytime I might have a hospital stay.  I can't stand my bottom hanging out of the gown.  ;-) 

I've never been allowed to take anything into the cath lab (where they do all heart caths, ablations, and PMs).  I really haven't wanted to anyway.  I've usually had these things done with local anesthetic only, though they've slipped a general in when they've had to do a cardioversion after (didn't work once - don't recommend it).  During my PM implant I was chatting with the EP doing the PM all the time (my EP was doing the ablation at the other end of the table).

The night after I had no problem sleeping, well, between the multiple times they woke me up. I wasn't confined to the bed at all but I did have a heart monitor to cary around.  I was able to use the bathroom and even walk the halls some.  There were marks on the floor and was told not to cross them because of the monitor's range.  My wife was able to sleep in the room with me (the rooms all have a futon).  She slept in the room most of the nine nights I was hospitalized after my CABG too.  She ran for Cokes and candy bars (missed diner) from the machine downstairs.  ;-)  After 24hrs, I was hungry as hell.

If you need to know what's going to happen to you, ask.  They may, or not, know the specifics and it may change after they start.  For all of my ablations and and even cardioversions I was told to bring stuff for an overnight stay.  I might need it but they couldn't say until they were done.  It was about 50/50.  As we can see from the responses here, there is no one answer for any of this stuff.