Implantable Cardioverter-Defibrillator
An implantable cardioverter-defibrillator (ICD) is an electronic device implanted in the body that continually monitors the heart for bradycardia, ventricular tachycardia, and ventricular fibrillation (VF). The device then administers either shocks or paced beats to treat the dangerous arrhythmia. In general, ICDs are indicated for patients in whom drug therapy, surgery, or catheter ablation has failed to prevent the arrhythmia.
The system consists of a programmable pulse generator and one or more lead wires. The pulse generator is a small computer powered by a battery. The generator is responsible for monitoring the heart’s electrical signals and delivering electrical therapy when it identifies an abnormal rhythm. It also stores information on the heart’s activity before, during, and after an arrhythmia, along with tracking which treatment was delivered and the outcome of that treatment. Many devices also store electrograms, electrical tracings similar to electrocardiograms (ECGs). With an interrogation device, a physician can retrieve this information to evaluate ICD function and battery status and to adjust ICD system settings.
The leads are insulated wires that carry the heart signal to the pulse generator and deliver the electrical energy from the pulse generator to the heart.
Today’s advanced devices can detect a wide range of arrhythmias and automatically respond with the appropriate therapy, such as bradycardia pacing (both single- and dual-chamber), antitachycardia pacing, cardioversion, and defibrillation. ICDs are also available for patients with atrial arrhythmias such as atrial fibrillation. (See Types of ICD therapies.)
Procedure
ICD implantation is most often performed in the cardiac catheterization laboratory
by a specially trained cardiologist. Occasionally a patient who requires other surgery (such as coronary artery bypass) may have the device implanted in the operating room. (See Location of an ICD.)
by a specially trained cardiologist. Occasionally a patient who requires other surgery (such as coronary artery bypass) may have the device implanted in the operating room. (See Location of an ICD.)
Complications
Early complications include serous or bloody drainage from the insertion site, swelling, ecchymosis, incisional pain, and impaired mobility. Other complications include venous thrombosis, embolism, infection, pneumothorax, pectoral or diaphragmatic muscle stimulation from the ICD, arrhythmias, cardiac tamponade, heart failure, and abnormal ICD operation with lead dislodgment. Late complications include failure to function, resulting in untreated VF and cardiac arrest.
Key nursing diagnoses and patient outcomes
Anxiety related to lack of understanding of ICD unit function. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
express fears and concerns related to the ICD
cope with anxiety by obtaining information about ICD function from appropriate sources.
Decreased cardiac output related to decreased left ventricular filling time caused by arrhythmia due to failure of the ICD. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
not exhibit signs of decreased cardiac output, such as hypotension and altered tissue perfusion
recover a normal cardiac rhythm that will remain normal
communicate understanding of medical therapy to treat and prevent arrhythmias.
Risk for injury related to potential for ICD malfunction. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
identify reportable signs and symptoms of ICD malfunction
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