33222 Relocation of skin pocket for pacemaker

Name of the Procedure:

Relocation of Skin Pocket for Pacemaker

• Common Names: Pacemaker Pocket Relocation, Pacemaker Repositioning

Summary

This procedure involves moving the existing pocket of skin under which a pacemaker is placed to a different location. This may be required due to complications such as infection, skin erosion, discomfort, or device malfunction.

Purpose

Relocating the pacemaker pocket addresses issues like infection, erosion, or discomfort caused by the pacemaker's position. By moving the pacemaker to a new location, the goal is to ensure patient comfort, reduce infection risk, and maintain effective cardiac pacing.

Indications

• Chronic pain or discomfort at the pacemaker site
• Infection at the current pacemaker pocket
• Skin erosion or ulceration over the pacemaker
• Technical issues with the pacemaker's function due to its position
• Need for easier access to the pacemaker for medical reasons

Preparation

• Patients may need to fast for several hours before the procedure.
• Any blood thinning medications may need to be adjusted.
• Pre-procedure assessment including blood tests, ECG, and imaging studies to assess the current pacemaker placement.

Procedure Description

1. The patient is typically given local anesthesia with sedation or general anesthesia.
2. An incision is made at a new site, usually in the chest area.
3. The current pacemaker and leads are carefully removed from the old pocket.
4. A new pocket is created in a different location under the skin.
5. The pacemaker and leads are re-implanted and tested to ensure proper function.
6. The new incision is closed, and sterile dressings are applied.

Duration

The procedure usually takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Cardiothoracic Surgeon or Cardiac Electrophysiologist
• Surgical Nurse
• Anesthesiologist or Nurse Anesthetist
• Surgical Technicians

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Pain at the new incision site
• Damage to the pacemaker or leads
• Rarely, damage to nearby organs or tissues

Benefits

• Reduced risk of infection or erosion
• Improved comfort and reduced pain
• Ensured continued effective functioning of the pacemaker
• Better cosmetic outcome

Recovery

• Patients typically stay in the hospital for observation for 24 hours.
• Post-procedure care includes keeping the incision clean and dry, and possibly taking antibiotics.
• Avoid strenuous activities and heavy lifting for a few weeks.
• Follow-up appointments are necessary to monitor healing and pacemaker function.

Alternatives

• Conservative management with antibiotics in case of mild infection.
• Pain management strategies for discomfort.
• Consideration of different types of cardiac devices or systems.

Patient Experience

During the procedure, the patient is under anesthesia, so they should feel no pain. Post-procedure, mild to moderate discomfort at the new site is common, managed with pain relief medications. Most patients can return to normal activities within a few weeks, with follow-up care to ensure proper healing and device function.