Safety Flashcards
Covers aspects of patient and practitioner safety peri/post procedurally. Currently weighted 3% in the CCDS exam.
List 5 considerations that reduce risk to the device patient undergoing a surgical procedure.
- Avoid electrocautery where possible
- Electrocautery is contraindicated within a few inches of device
- Electrocautery return electrode to be placed on leg, away from device
- Program DOO or VOO or place a magnet over device
- Test device pre and post surgery to identify any anomaly
What is a likely outcome in the device patient undergoing surgery when none of the 5 considerations from card 1 are applied?
Electrocautery causes inhibition of pacemaker output (asystole in CHB patients).
Prevent by either contraindicating electrocautery or programming a non-sensing mode (DOO, VOO).
True / False
When using an external defibrillator, the pads should be placed more than 10cm away from the device.
True.
True / False
When using an external defibrillator, the pads should be placed parallel to axis of the pacemaker leads.
False.
Pads should be placed perpendicular to the axis of the pacemaker leads. This minimises the current induced by the leads.
For planned cardioversion it is important to test the generator pre and post defibrillation.
True.
Although devices have a protection circuit (zener diode), its not impossible for this circuit to be overwhelmed and damage sustained.
List 3 types of electromagnetic interference (EMI) respondent to treatment therapies.
- MRI
- Radiotherapy
- Shock Wave Lithotripsy
List a common source of EMI experienced by tradesmen/mechanics/engineers.
ARC welding.
This is contraindicated as it may cause oversensing, which can potentially lead to pacing inhibition.
List common benign sources of EMI interference that occur outside the hospital.
- Cell Phones
- Metal detector security gates
- Electronic article security gates
- Microwave oven
- Induction cooker top
Generally these items are not contraindicated but it’s advisable to maintain distance where possible.
Define the safety feature ‘pacemaker reset’.
A reversion to VVI programming respondent to significant EMI interference.
High level interference can erase programming stored on RAM (such as event recordings and diagnostics) but not safety functions stored on ROM (such as pacing mode).
True / False
Fever within 24 h before implantation is not associated with the development of device infection.
False.
Fever is linked to device infection and should be screened accordingly. If patient presents with a fever the device implant should be delayed.
Should all remote infections be treated prior to implant.
Yes.
However if urgent, the risk of infection should be balanced against intervention timing. An alternative would be a tempoaray pacing wire to maintain haemodynamics until infection is treated.
True / False
There is an increased risk of site infection in patients undergoing preoperative hair removal.
True.
Perioperative hair removal isn’t recommended except when hair is at or around the incision site.
True / False
Perioperative antiseptic skin preparation should be performed with an approved antiseptic agent.
True - Normally chlorhexidine or iodine solution.
Antiseptic should be applied over the incision site in concentric circles starting from the incision site and moving toward the periphery.
Why are systemic prophylactic antibiotics at the time of implantation recommended despite the low incidence rate of infection?
Extremely severe outcome if it does happen with entire system removal necessary.
Device infection is arguably the worst complication to treat.
The following are types of _____ devices and are used to protect against _____.
‘Masks, caps, gowns, drapes, and shoe covers’.
Barrier devices are designed to maintain sterility and protect against infectious blood / bodily fluids.
True / False
Physicians should perform a surgical scrub for ~5 min with an appropriate antiseptic agent.
True.
True / False
Good surgical technique reduces the risk of infection.
True.
What can be done for lean or small subjects who are thought to be at risk of pocket erosion.
Implant device subpectorally.
What type of dressing is applied post-procedure to reduce infection and haematoma formation risk.
Pressure dressing.
Typically applied for 12-24hrs post implant.
True / False
Should a hematoma form, is it recommended to drain it.
False - unless skin tension is severely increased.
Needle aspiration should be avoided due to risk of skin flora introduction into the pocket and ensuing infection.
True / False
Evidence suggests that a short course (2days) of postoperative antibiotics is just as effective as a longer course (7days) in preventing device infections.
True.
True / False
As one moves away from the ionising radiation source, dose is decreased by square of the distance as described by the inverse square law.
True.
How do you calculate exposure time.
Exposure rate x Time.
With regards to radiation safety monitoring, what is one piece of equipment all staff should wear.
Radiation tag.
