Page 136 - Simplicity is Key in CRT

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Figure 3
Pre-assessment checklist. Designed to ascertain thorough procedural planning and therefore eliminating unpredictable situations during and after implantation for physician as well as patient.
Implantation Procedure
Pre-assessment
On admission, a short re-assessment should be performed ruling out current infections or decompensation by evaluating complaints and a clinical exam including blood pressure, pulse and temperature. Also, discharge planning can be adjusted if any unforeseen (at pre-assessment) circumstances should emerge at re-assessment.
If the patient is on anticoagulation that has been intentionally continued, an INR value is obtained upon admission; with a target INR of 2.0-2.5 during the implantation procedure. In case of use of NOACs the patient is asked whether the medication was stopped as recommended at pre- assessment. The patient is prepared for implantation and prophylactic antibiotics are administered.
Device Implantation
Before the implantation, the WHO surgical safety checklist is used to ascertain safe surgical care [26]. The physician checks patient data, planned procedure and its requirements, allergies and operation site with the patient in a standardized order. Compliance with fasting, preoperative medication strategy (anticoagulation), preoperative antibiotics and proposed sedation strategy are checked.
Next, the CRT device implantation takes place. General recommendations for equipment, environment and staffing are reported elsewhere in detail [13]. This is also the case for recommendations about which side to implant the device, venous access, and order of lead implantation [7, 13].