Insertion of miniaturized cardiac monitors outside the catheter operating room: experience and practical advice.
Minor surgical procedures are increasingly being performed as outpatient procedures in settings outside hospital operating rooms (ORs). In electrophysiology, the recent miniaturization of insertable cardiac monitors (ICMs) has enabled the routine insertion of the device as a minimally invasive procedure without the need of a catheter OR. However, a shift to office-based environments for minor surgical procedures is associated with some concerns, particularly with respect to patient- and procedure-related safety in the new setting. In the present document, the authors provide practical advice on facilities, practices, and adaptations necessary when performing ICM insertions in office settings, based on available recommendations as well as their own experience with the use of the novel Reveal LINQ ICM. The main differences from in-hospital implant settings are simplified requirements of room, equipment, and insertion procedures, while ensuring and maintaining an adequate, sterile environment. Patient selection is important: certain groups of patients are recommended to be treated in the catheter OR (e.g. those at increased risk for bleeding or very frail elderly individuals). Insertion in alternative positions, as is sometimes performed for cosmetic reasons, should be referred to dedicated hospitals. Quality assurance and internal quality control are critical in the new procedural landscape, and it is important not to trivialize minor surgical procedures. Operators' sharing of experiences and lessons learned, e.g. in the form of registries, should be encouraged.
Division of Electrophysiology and Devices, University Heart Center Zurich, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland.
Jan
J
Steffel
Liverpool Heart and Chest Hospital, Liverpool, UK.
David Jay
DJ
Wright
Katholisches Klinikum Essen, Essen, Germany.
Harald
H
Schäfer
Accure Health Consultancy, Bristol, UK.
Tabinda
T
Rashid-Fadel
Peter Osypka Heart Center Munich, München, Germany.
Thorsten
T
Lewalter
D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards; D000556:Ambulatory Surgical Procedures / Q000295:instrumentation* / Q000592:standards; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000592:standards; D000066491:Clinical Decision-Making; D002985:Clinical Protocols; D003935:Diagnostic Techniques, Cardiovascular / Q000295:instrumentation* / Q000592:standards; D004867:Equipment Design; D006801:Humans; D008904:Miniaturization; D061214:Patient Safety; D011237:Predictive Value of Tests; D011786:Quality Control; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D013686:Telemetry / Q000295:instrumentation* / Q000592:standards; D014159:Transducers / Q000592:standards
Insertable loop recorder; Outpatient surgery; Quality control