Box change

Patient Information Leaflet

Introduction

You have been given this leaflet as your doctor has suggested you would benefit from having a device box change. This leaflet gives more information on what will happen to you before and after the procedure. It is designed to make sure that you know as much as possible about the procedure before you agree to it and sign the consent form.

Why do I need a device box change?

The battery in your device is approaching the end of its expected life span. Generally, only the battery needs to be replaced, the leads will be checked but should not need to be changed.

Most devices are powered by a lithium-ion battery and last between 8 and 10 years before needing to be replaced.

This is a surgical procedure performed under local anaesthetic. It usually takes an hour to perform.

Most procedures can be done as a day case. If there are no complications, you will be allowed to go home after three to four hours

Consent

We must seek your consent for any procedure or treatment beforehand which will be a two-stage process.

Stage one will be with your doctor in a clinic setting where they will explain the risks, benefits and alternatives where relevant, before they ask for your written consent. If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information.

Stage two will be a re-confirmation when you attend for the procedure and will be undertaken by a healthcare professional (either physiologist or the operator

What are the benefits of having this procedure?

• The device battery will eventually stop working, your device will not work, and you could feel very unwell.

What are the risks of having this procedure?

• Bleeding from the insertion site.
• Pain during injection of local anaesthetic
• Blood collection (haematoma) at the insertion site.
• Small risk of surgical wound infection.
• Death is a rare complication of a device box change.
• Damage to leads, requiring new leads.

What if I decide not to have a box change?

If you choose not to have a box change, you will feel very unwell. Usually, there is no alternative way of treating the condition.

What preparation is needed?

On the day of the procedure:

• You must not eat for six hours before the procedure.
• You must not drink milky drinks six hours before the procedure. Clear fluids only.
• You can drink sips of water.
• Bring all medication with you.
• Please take your normal medications, with a sip of water on the morning of your procedure- see the note regarding Warfarin and anticoagulation
• Have a bath or shower.
• Remove jewellery, contact lenses, make-up and nail varnish. Wedding rings can remain but will be taped for the procedure.
• Be prepared to stay overnight, pack a small bag.
• Bring a book or something to do whilst you wait.
• Bring reading glasses.
• Avoid bringing large sums of money or valuables.
• Please arrange for a relative or a friend to take you home after your procedure by car/taxi. You will not be able to drive home or use public transport. Your relative or friend will need to stay with you overnight.

Medication

What to do if on Warfarin or newer anticoagulants (NOACs):

• Stop anticoagulation (Apixaban, Dabigatran, Edoxaban or Rivaroxaban) 48 hours before the procedure.
• Warfarin, please contact the day case unit 01384 456111 ext. 2573 to discuss when to take your last dose.

Diabetes (controlled by diet or tablets)

• Do not eat at least four hours before the procedure
• You can drink clear fluids up to 2 hours before the procedure
• If you are missing breakfast do not take your diabetes medication.
• Stop taking Metformin 48 hours before the procedure and 24 hours post procedure
• Remember to bring all your diabetes medication, dextrose tablets and blood testing equipment
• If your procedure is in the afternoon, take your tablets as normal with your breakfast.
• Your blood glucose will be tested by a finger prick when you arrive and monitored

Diabetic taking insulin:

• Day before STOP SGLT2 inhibitor (dapagliflozin, empagliflozin or canagliflozin)
• Stop taking Metformin 48 hours before procedure and 24 hours post procedure
• Usually, we will try to put you first on the list. We advise you not to eat any breakfast and to omit your usual morning insulin before the procedure.
• Remember to bring all your diabetes medication, dextrose tablets and blood testing equipment
• If you are on the afternoon list, you need to take half of your morning dose of mixed insulin (minimum 10 units) with breakfast.
• If you are on insulin four times a day, please remember to take your morning dose.
• Your blood glucose will be tested by a finger prick when you arrive and monitored

What happens on the day:

• We will provide you with a gown to change into. A small canula (tube) will be inserted into a vein in your arm, this will allow us to give intravenous antibiotics.
• Pre-procedure tests will include blood pressure, temperature, and ECG.
• A doctor will discuss your consent. Please use this opportunity to raise any concerns that you may have.
• A physiologist will discuss the ‘Living with a Pacemaker’ or Living with a Defibrillator information sheet and homemonitoring.
• A post operative appointment will be arranged for 6-8 weeks in the devices clinic.

What happens during the procedure

The procedure is performed in a dedicated Xray room within the Cardiology Department. You will be cared for by a team of doctors, nurses, radiographers and cardiac physiologists.

• You will lie on an X-ray bed.
• Your ECG, blood pressure and oxygen levels will be monitored throughout the procedure.
• You may be given a sedative to help you relax during the procedure.
• We may give you oxygen using a face mask.
• Your upper chest will be cleaned with a cold antiseptic and covered with sterile drapes. We will make a gap so you can peep out.
• After injecting the area with local anaesthetic, a small incision is made, and the old device removed.
• The doctor and physiologist will run a series of tests on the leads and program your device.
• Your incision will be closed with dissolvable stitches and a dressing applied.
• You will be taken back to recover in the Day Case Unit.

What happens after the procedure?

• You will be taken back to recover in the Day Case Unit.
• Your heart rate, blood pressure and wound site will be monitored.
• Once the sedation has worn off you may eat, drink and gently mobilise. You can have painkillers if required.
• You will be issued with a new device identification card.

Going Home Advice

• You will be given oral antibiotics to take home.
• You may be given a monitor to take home

Driving

The DVLA regulations state that if you hold a normal driving licence, you must stop driving for ONE WEEK post device box change.

If you are a HGV/PSV licence holder then you must stop driving for SIX WEEKS post box change.

Wound Care

Remove the wound dressing after 48 hours. You MUST keep    wound dry for the next 7-10 days to avoid infection. The stitches are dissolvable.

If an infection occurs then the site would appear red, swollen, and painful, be warm & may ooze fluid. If this happens you MUST phone the device clinic.

Diabetic patients

You will be discharge when you are eating and drinking normally and your blood glucose is at a safe level.

However, if you are unwell with:

• Continuous vomiting /diarrhoea or high fever
• Unable to keep food down for 4 hours or more
• High blood glucose (>15mmol)
• High ketones (0.6mmol)

You should seek medical help. Contact your usual diabetes nurse or doctor

How to contact us:

Pacemaker Clinic

Cardiology Department

Russells Hall Hospital

Dudley

DY1 2HQ

Tel: 01384 456111 Ext 2156

Monday- Friday 08.00 – 17:00

Cardiology Day Case Unit

Russells Hall Hospital

Dudley

DY1 2HQ

Tel: 01384 456111 Ext 2573

Wednesday & Thursday 08.00 – 20.00

Cardiology Ward

Russells Hall Hospital

Dudley

DY1 2HQ

Tel: 01384 456111 Ext 2138

Additional information:

British Heart Foundation

Tel: 0808 802 1234

www.bhf.org.uk

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on 01384 456111 and ask for the relevant department who issued this leaflet.

If you have any feedback on this patient information leaflet please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.