21
Implantation
Precautionary Measures while Programming
Performing standard tests
and monitoring the patient
Critical conditions can occur for the patient even during standard tests due to inad-
equate parameter settings or interrupted telemetry.
•
Ensure sufficient patient care even during tests.
•
After the threshold test, check to determine whether the threshold is clinically
and technically justifiable.
•
Continuously monitor the ECG and the patient's condition.
•
Cancel testing if necessary.
Cancelling telemetry
Programmer interference or interrupted telemetry during performance of tempo-
rary programs (follow-up tests) can result in inadequate pacing of the patient. This
is the case if the programmer can no longer be operated due to a program error or
a defective touch screen and therefore the temporary program cannot be termi-
nated. Under these circumstances, it is helpful to cancel telemetry, in which case
the device automatically switches to the permanent program.
•
In the case of telemetry with programming head: lift the PGH by at least 30 cm.
•
In the case of RF telemetry: switch off and reposition the programmer.
•
Turn off possible sources of interference.
Avoiding critical parameter
settings
No modes and parameter combinations that pose a risk to the patient should be
set.
•
Prior to setting rate adaptation, determine the patient's capacity for strain.
•
Check compatibility and effectiveness of parameter combinations after making
settings.
Check for leads suitable for
shock path
Three shock paths can be set, two of which form an electrical path to the device
housing.
•
A second shock coil (dual shock coil) must be available for the shock path RV -
> SVC.
Monitoring the patient
when setting asynchronous
modes
The asynchronous modes V00 and D00 can only be set if tachyarrhythmia sensing
is deactivated. This would leave the patient without sensing and therefore without
ICD therapy.
•
Continually monitor the patient.
•
Keep an external defibrillator ready.
Setting sensing
Manually set parameters can be unsafe. For example, unsuitable far-field protec-
tion may impede sensing of intrinsic pulses.
•
Note automatic sensitivity control.
Preventing device-induced
complications
BIOTRONIK devices feature several functions to prevent device-induced complica-
tions to the greatest extent possible:
•
Measure the retrograde conduction time.
•
Set PMT protection.
•
Set the VA criterion.
