Managing the potential complications of ICM implantation

Learn about the five main risks associated with ICM implantation and how to deal with them.

Andrew R. Houghton, MD
Andrew R. Houghton, MD
12th Nov 2019 • 4m read

An ICM implantation comes with potential risks, and creating a safety checklist beforehand is a great way to prepare for them. In this video, from our Insertable Cardiac Monitoring Essentials course, you'll learn about the five main risks associated with ICM implantation and how to deal with each of them, should one arise.

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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

The best way to minimize risk during an ICM insertion procedure is by careful patient preparation. For this reason, we recommend that you use a safety checklist to anticipate problems that may occur. There is always a risk of allergy or anaphylaxis during an ICM insertion procedure. Patients may have an allergy to be antiseptic, used to clean the skin at the start of a procedure.

They may have an allergy to the local anesthetic agent such as light again or they may have an allergy to prophylactic antibiotics if you choose to use these. If you administer analgesics to treat procedural pain, the patient may have a reaction to these or they may have an allergy to one of the device components.

Such as for titanium casing. There's also a risk of allergic reaction to any wound dressings that you use. And even a risk of allergic reaction to the latex in your surgical gloves is therefore prudent to specifically ask if the patient is known to have any previous history of allergic reactions before starting your ICM insertion procedure.

As with any invasive procedure, ICM insertion carries a risk of bleeding and hematoma. To minimize the risk of this, it's important that we appropriately assess the patient's calculation status prior to undergoing the procedure itself. The likelihood of bleeding complications is increased by several factors. For example, always check whether your patient is taking any anti platelets or anticoagulant medication.

Single antiplatelet medications seldom causes problems and can be continued for procedure. For patients on jewel anti platelets for risk of bleeding needs to be weighed carefully against the risk of withholding one of the agents. For patients taking warfarin, ICM insertion can take place as long as the international normalized ratio or INR is no greater than free.

For patients anticoagulated with direct oral anticoagulants or doacs interruption of these drugs is not usually necessary for the insertion procedure. Don't forget also about simple procedures that can improve hemostasis. For example, at the end of the ICM insertion procedure, apply pressure over the insertion site and then sure but adequate hemostasis has been achieved before closing the wound.

Simple measures such as best can significantly reduce the likelihood of bruising and hematoma. with adequate local anesthesia, it's unusual for patients to experience much pain during or after an ICM insertion procedure. nonblack. Nonetheless, if patients do experience significant discomfort, then simple analgesia will usually suffice. As with any invasive procedure, there is always a risk of infection.

To reduce the risk of bacterial infection, one might consider the use of antibiotic prophylaxis for pros and cons of which have been covered in an earlier lesson. There is no consensus on the use of antibiotic prophylaxis for ICM insertion procedures. And this decision is left to clinician discretion according to local protocols, the theoretical risk of reducing the risk of device infection should be weighed against the risk of allergy or anaphylaxis, antibiotic resistance and be increased costs for procedure as a whole.

In the effort to prevent procedural infection, careful attention to pre procedural skin preparation with an antiseptic agent is also important. Another risk of ICM insertion is that the device will erode back through the wound. In other words, the device can basically end up poking out of the skin. To reduce the risk of device erosion, it's essential to ensure that the device is deployed correctly.

And this means ensuring that a typical device lies around 10 millimeters from the device insertion point. This ensures that there is some leeway to reduce the likelihood that the device will work its way back out of the wound. Keloid scarring is a risk of any invasive procedure and ICM insertion is no different. Check whether the patient has any prior history of keloid scarring and warn all patients of this possibility.

Remember, but it is important to discuss the benefits as well as the risks and complications with the patient prior to ICM device insertion so that they are fully informed about a procedure that you plan to undertake.