33223 Relocation of skin pocket for implantable defibrillator

Name of the Procedure:

Relocation of Skin Pocket for Implantable Defibrillator

Summary

This procedure involves moving the skin pocket that houses an implantable defibrillator (a device that corrects life-threatening heart rhythms) to a different location within the chest or abdomen. It is usually done to address complications such as discomfort, skin erosion, or infection around the current implant site.

Purpose

The medical condition this procedure addresses includes complications related to the current positioning of the implantable defibrillator. The goals are to alleviate discomfort, prevent or treat infection, and ensure the proper functioning of the defibrillator.

Indications

• Persistent pain or discomfort at the site of the defibrillator
• Skin erosion or visible device under the skin
• Infection at the current implant site
• Need for device repositioning due to body growth or changes

Preparation

• Patients may be advised to fast (not eat or drink) for several hours before the procedure.
• Medications might need to be adjusted, especially blood thinners.
• Pre-procedure diagnostic tests, such as blood work or imaging studies, may be performed to assess overall health and device positioning.

Procedure Description

1. Anesthesia: The patient is given local anesthesia combined with sedation, or general anesthesia.
2. Incision: A new incision is made at the desired location.
3. Pocket Creation: A new pocket is created in the tissue to house the defibrillator.
4. Device Relocation: The implantable defibrillator is carefully moved from the old pocket to the new one.
5. Reconnection: Leads attached to the device are tested and reconnected to ensure proper positioning and function.
6. Closure: The incision is closed with sutures.
7. Dressing: A sterile dressing is applied to protect the new implant site.

Duration

Approximately 1 to 2 hours.

Setting

Typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Cardiothoracic or cardiac surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses or technicians

Risks and Complications

• Infection at the new implant site
• Bleeding or hematoma formation
• Device malfunction or lead displacement
• Allergic reaction to anesthesia
• Scar tissue formation

Benefits

• Alleviation of discomfort or pain
• Prevention or resolution of skin erosion
• Reduction of infection risk
• Enhanced device functionality

Recovery

• Patients may need to stay in the hospital overnight for monitoring.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments to check on the incision and device functionality.
• Recovery time generally spans 1 to 2 weeks, with limited strenuous activity.

Alternatives

• Conservative management with pain relief or antibiotics.
• Surgical revision or replacement of the implantable defibrillator leads.
• Consultation with a cardiologist to explore non-surgical treatments.

Patient Experience

• During the procedure, the patient will likely be asleep or sedated and should not feel pain.
• After the procedure, it is common to experience some soreness or discomfort at the new site.
• Pain can be managed with prescribed medications, and full recovery is expected within a few weeks.