ABSTRACT
Objective: Pocket infection in patients after total removal of implanted pacemaker has many problems for their electronic system; our research intends to explore the feasibility of conservatively treating such infection and retain the electronic system. Methods: A total of 4 patients with pacemaker pocket infection in our hospital from 2015-01 to 2016-02 were studied. Thorough debridement and disinfection were conducted in infected pockets and devices, meanwhile vacuum sealing drainage was applied. Electrode wire was kept and intravenous antibiotics were given for (7-10) days after the operation in all patients. Results: The average time of infection occurred at 14.75 months after operation with the type of isolated pacemaker pocket infection. Pocket vacuum suction drainage was performed, with the mean of 7.25 (5-10) months follow-up observation, infection was disappeared and the patients had good wound healing. Conclusion: With thorough debridement of infected pocket, rational treatment of residual electronic system and vacuum sealing drainage, the infection might be effectively controlled for complete recovery without lead extraction in relevant patients.
ABSTRACT
Objective To explore the influence of nursing intervention on the pocket infection and other related problems following CRT-D therapy in chronic heart failure patients.Methods The causes of pocket machinery burst and skin incision dehiscence,pocket bleeding or hematoma and pocket infection following CRT-D therapy from March 2008 to March 2011 were reviewed,then analyzing and summarizing them to work out a detailed nursing interventions plan.During April 2011 to June 2013,nurses carried out the nursing intervention on patients who accepted CRT-D implantation.At last we compared the occurrence of pocket machinery burst and skin incision dehiscence,pocket bleeding or hematoma and pocket infection during the period of 6 months after CRT-D therapy between the two groups.Results After the implementation of nursing interventions,the incidence of pocket infection and other related problems following CRT-D therapy in chronic heart failure patients reduced significantly.Conclusions The interventions such as rigorous preoperative skin preparation,eliminating the potential factors of infection,intraoperative strict aseptic operation,choosing the appropriate position of pocket,the implementation of interventions to prevent bleeding,meticulous and rigorous postoperative nursing,providing healthy knowledge sufciently and strengthening follow-up,finding problems and solving them timely can prevent the pocket machinery burst and skin incision dehiscence,pocket bleeding or hematoma and pocket infection following CRT-D therapy effectively.
ABSTRACT
Aim of The Study: A totally implantable venous access port (TIVAP) has become an essential prerequisite for many chemotherapy protocols. It is serving its purpose very well, but its use is not without complications. We are presenting our experience with these devices (TIVAPs). Subjects and Methods: We retrospectively reviewed the totally implantable venous access ports in 81 patients at our hospital between January 2009 and March 2011 for long-term problems which include postoperative and follow-up problems, excluding the immediate complications which occur at the time of insertion. Results: Catheter malfunction was the most common complication (9.87%, 0.40/1000 device-days of use/observation). Catheter-related bloodstream infections were present in 5 (6.17%) patients (0.25/1000 device-days of use/observation). The mean life of the catheter was 246 days. Only 11.1% ports required removal during the treatment period. Overall, patients either completed treatment (82.8%) or died (6.1%) while receiving treatment. Conclusion: TIVAPs provide safe and reliable vascular access for patients on chemotherapy but require utmost care by a dedicated team of trained medical professionals and paramedics experienced with the use of such ports, in order to minimize the complications and their continued use while administering treatment.
Subject(s)
Adult , Aged , Catheter-Related Infections/pathology , Catheter-Related Infections/therapy , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Drug Therapy/adverse effects , Female , Humans , Male , Middle Aged , Neoplasms/drug therapyABSTRACT
In the cases of severe arrythmia and conduction failure, a permanent implanted pacemaker is considered an essential treatment modality with less complication rate, broad indications and low morbidity. However, some pacemakers needs to be removed or replaced due to infection, in need of a lead upgrade, elective replacement, conduction failure or insulation failure. The most common indication for pacemaker extraction is infection. Conservative treatments such as administration of intravenous antibiotics and limitation of debridement are not effective and the removal of the entire pacing system is considered to be the best approach to pacemaker pocket infection. Although a locking stylet, a laser sheath and other newer methods of transvenous lead extraction have been proven to be effective, all leads cannot be removed. Moreover, major complications such as, cardiac tamponade and respiratory arrest during leads extraction procedure should not be ignored. We experienced two cases of exposed pacemakers in the subclavicular region. After removing the pacemaker body, exposed proximal lead was pulled out and cut off. The end of remnant external insulation tube was tied to prevent infection propagation between external insulation tube and inner metalic coil. Wounds were covered by local flap coverage. No other problems were detected during the one-year follow-up. Since there are few reports on lead-preserving method of treating limited infection of exposed pacemakers, we would like to present our new method for treating exposed pacemakers.