How to explant an insertable cardiac monitoring (ICM) device

Learn about the equipment needed for ICM explantation, the possible complications you'll encounter, and what to do with an ICM device once it has been removed.

Andrew R. Houghton, MD
Andrew R. Houghton, MD
1st Dec 2019 • 3m read

Learn all about the ICM explantation process in this step-by-step video from our Insertable Cardiac Monitoring Essentials course. You'll cover the equipment needed, the possible complications, and what to do with the device once it has been removed.

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Arrhythmias can be difficult to detect. Insertable cardiac monitors (ICMs) can spot rhythm problems when other devices can’t. In our Insertable Cardiac Monitoring Essentials course, you’ll learn about the indications for an ICM implant, the different types of ICMs available, and the techniques used to insert and explant these devices. You’ll also cover data download methods, troubleshooting, and how to make the most out of your ICM devices.

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Video transcript

In this lesson we're going to show you a typical ICM device x plant procedure using Medtronic reveal link device as an example. Whichever device you're exploiting, always be sure to read the manufacturer's recommendations for how the device should be removed. Before you start, ensure that you have all the necessary equipment ready for the device, excellent procedure.

Here we have a antiseptic for cleaning a patient's skin and the sterile surgical drape for placing over the area where we're going to be expanding the ICM device. We have a syringe and suitable needles for the administration of local anesthetic. And we have a scalpel and suitable instruments for the actual explant procedure. We also have some goals.

In case of any blood loss palpate the anterior chest wall to locate the ICM device, and then clean the skin over device using an appropriate antiseptic solution. identify where you're going to make your decision to remove a device and then administer local anesthetic in that area. We normally use lighter cane with adrenalin also known as epinephrine to provide good local anesthesia with a reduced risk of bleeding.

Check for the local anesthetic is working and if so make a small skin incision at one end of the device for Which you intend to explanted.
Pay careful attention to hemostasis throughout your procedure using blunt dissection and with careful attention to hemostasis throughout slowly and carefully work the ICM device loose.

This can sometimes be tricky, as the device may have become adherent to surrounding tissues. Once the device is freely mobile, it can then be extracted through the incision using the forceps. Put the explanted device safely to one side for the moment. Once you've completed the extraction procedure, the device should be cleaned using a solution of at least 1% sodium hypochlorite followed by rinsing in water.

The device should then be returned to the manufacturer for environmentally friendly disposal. The device must never be incinerated because the presence of a lithium battery means there is a risk of explosion. Once he may stay sis has been achieved. Close the wound using surgical glue, surgical adhesive strips or with a suture depending upon your preference.

Finally, apply a suitable Dressing over the wound. Remove the surgical drape and ensure that a patient is well before the patient leaves the department answer any questions and ensure that they understand any subsequent follow up arrangements.