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Implantable Cardioverter Defibrillator ICD

Nursing Policy & Procedure Manual

Implantable Cardioverter Defibrillator (ICD) 

Goal: 

To ensure residents with ICDs do not experience complications from the device and can lead a normal, active life. 

Definition: 

An Implantable Cardioverter Defibrillator (ICD) is a small electronic device implanted inside the body that continuously monitors the heartbeat. If it senses a dangerous rapid heart rhythm, it delivers pulses or shocks to restore a normal rhythm. The ICD has two main parts: 

I. Pulse Generator: 

  • The pulse generator is a smooth, lightweight metal case containing a small computer and a battery. It continuously checks the heart’s electrical signals and delivers electrical energy to return the heart to a normal rhythm if a life-threatening rapid rhythm is detected. 

  • The generator’s memory stores information for the physician to retrieve, including the number and types of treatments received, their effectiveness, the heart's activity during events, and the ICD’s battery status. 

  • The physician determines the type of treatments needed to correct the heart rhythm. These treatments can be programmed into the pulse generator and delivered to the heart when the ICD senses an arrhythmia. 

II. Leads: 

  • Leads are insulated, flexible wires placed in the heart. They carry electrical energy from the pulse generator to the heart and help the ICD keep track of the heart's activity by carrying signals back to the pulse generator. 

  • Most leads are threaded through a vein from the ICD to the inside of the heart. Depending on the type of ICD, one or more leads may be used. 

  • In some cases, a patch electrode may be used to help the ICD function. The patch is placed under the skin or muscle near the heart. 

Notes: 

  • For the first few weeks after implantation, residents may feel numbness or fullness around the ICD, which is normal. They may also have pain and stiffness around the incision. The physician will likely prescribe pain medication. Residents may also initially be very aware of the pulse generator under the skin but should gradually adjust. 

Procedure: 

I. Obtain orders from the physician regarding bathing, walking, and exercising. 

II. Obtain orders from the physician regarding the need to limit arm movements that could affect the lead system. 

III. Observe the incision site every shift for signs of infection (redness, swelling, warmth). Notify the physician immediately if symptoms occur. 

IV. Call the physician if the resident has: 

  • Twitching chest muscles. 

  • Hiccups that won’t stop. 

  • Any swelling of the arm on the incision side. 

  • Experiences dizziness, chest pain, or shortness of breath. 

V. Instruct the resident not to wear tight clothing over the pulse generator. 

VI. Always inform the dentist, other physicians, emergency personnel, and other caregivers that the resident has an ICD. 

VII. If the ICD “beeps,” notify the physician as the ICD may have been shut off due to interference. 

VIII. Instruct the resident to inform staff when they feel a “shock” from the ICD. If the resident does not feel well after the “shock,” notify the physician. 

NOTE: If the resident has a cardiac arrest and is a full code: 

  • Call 911. 

  • Check for a pulse. If pulseless, start CPR. A slight buzzing sensation may be felt if the defibrillator delivers a shock; this is not harmful. 

Tags
Implantable Cardioverter Defibrillator ICD
ICD care
implantable cardioverter defibrillator
cardiac health
Resident Care
nursing home policy
CMS compliance
State Operations Manual
Long-Term Care Facility
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