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Microsoft word - pacemaker insertion.rtf

Pacemaker
• Unexpected pacemaker failure. There is a risk of battery (generator) or lead failure. This is A. INTERPRETER / CULTURAL NEEDS
uncommon but means the battery or lead will need to be removed and a new one put in. • Infection of the pacemaker site. This will need treatment with antibiotics and/or removal of the Rare risks (less than 1%) include;
• A punctured lung. This may require a tube to be B. CONDITION AND TREATMENT
inserted into the chest to reinflate the lung. The doctor has explained that you have the following • A hole is accidentally made in the heart or heart valve. This will need surgery to repair. This condition requires the following procedure. • A stroke. This can cause long term disability. • Death is possible due to the procedure or other You will have the following procedure: You will have an injection of Local Anaesthetic. The D. SIGNIFICANT RISKS AND
pacemaker is put in below the left or right collarbone, TREATMENT OPTIONS
just under the skin. The skin is cut to put the pacing wires (leads) into a vein which leads to the heart. The leads are threaded down the vein, into the heart. The doctors can see the lead by using x-rays. Once positioned in the heart, the leads are tested to make sure they are working properly. They are then connected to the ‘pulse generator’. The pulse generator is placed under the skin and the skin is sewn back together. C. RISKS OF A PACEMAKER
In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead. This is a very complicated assessment. The risks/complications of this procedure are; Common risks (more than 5%) include;
Uncommon risks (1- 5%) include;
• The pacemaker lead can move. The lead will need to be put back into place by repeating this procedure. • Bad bruising if you are taking blood thinning drugs such as Warfarin, Aspirin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Fig 1. National Heart, Lung and Blood Institute Pacemaker
options. My questions and concerns have been E. RISKS OF NOT HAVING A
discussed and answered to my satisfaction. PACEMAKER
• I understand I have the right to change my mind at any time before the procedure, including after I have signed this form but, preferably following a discussion with my doctor. I REQUEST TO HAVE THE PACEMAKER
Name of Patient/
F. ANAESTHETIC
Substitute decision
maker and relationship : .

This procedure may require an anaesthetic. Signature : .
Substitute Decision-Maker: Under the Powers of Attorney Act 1998 and/or the
Guardianship and Administration Act 2000.
If the patient is an adult and unable to give
G. PATIENT CONSENT
consent, an authorised decision-maker must give consent on the patient’s behalf. I acknowledge that the doctor has explained; • my medical condition and the proposed procedure, H. DOCTOR’S STATEMENT
including additional treatment if the doctor finds something unexpected. I understand the risks, I acknowledge that I have explained to the patient all including the risks that are specific to me. the above points under the Patient Consent section (G) and I am of the opinion that the patient/substitute the anaesthetic required for this procedure. I decision-maker has understood the information. understand the risks, including the risks that are other relevant procedure options and their Doctor : .
• my prognosis and the risks of not having the Des ignati on : Cardiologist
• that no guarantee has been made that the Signature : .
procedure will improve my condition even though it has been carried out with due professional care. • the procedure may include a blood transfusion. • tissues and blood may be removed and could be condition, stored and disposed of sensitively by of the consent form and assisted in the provision of • if immediate life-threatening events happen any verbal and written information given to the during the procedure, they will be treated patient/parent or guardian/substitute decision-maker • if I am a a doctor other than my Cardiologist may conduct the procedure. I understand this could be Interpreter :.
Signature : .
I have been given the following Patient
Information Sheets;
Local Anaesthetic and Sedation for your
procedure
Pacemaker
• I was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment Consent Information - Patient Copy
Pacemaker
PACEMAKER?
A pacemaker will treat a slow heart beat. There are three types of Pacemakers. The doctor will decide which Pacemaker suits your condition. Single Chamber – one lead to the upper or lower chamber of the heart Dual Chamber – two leads. One to the upper chamber and one to the lower chamber of the heart Biventricular – three leads. One to the upper chamber and two to the lower chambers of the heart A Pacemaker is made of two parts, a pulse generator, which gives off impulses and a lead(s), which sends impulses to and from the heart. The pacemaker is ‘programmed’ to your needs by the doctor who puts the device in. An external machine is used to check the pacemaker. The rate of the pacemaker can be set using this machine. As part of Fig 1. Nat ional Heart , Lung and Blood Institut e the clinic test, the pacing speed of your pacemaker may be temporarily increased and decreased. Then it 3. WHAT ARE THE RISKS OF THIS
SPECIFIC PROCEDURE?
Pacemakers ‘stand by’ until the heart rate falls below the set rate of the pacemaker. It will then step in and In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going Before the procedure, you may be given antibiotics. ahead. This is a very complicated assessment. These are given to prevent an infection from occurring. The risks/complications of this procedure are; A needle with a tube connected to it will be put in your arm. This is called an intravenous line or IV. Common risks (more than 5%) include;
You will have an injection of local anaesthetic. The pacemaker is put in below the left or right collarbone, Uncommon risks (1- 5%) include;
just under the skin. The skin is cut to put the pacing • The pacemaker lead can move. The lead will wires (leads) into a vein which leads to the heart. The need to be put back into place by repeating this leads are threaded down the vein, into the heart. The doctors can see the lead using x-ray imaging. Once • Bad bruising if you are taking blood thinning drugs positioned in the heart, the leads are tested to make such as Warfarin, Aspirin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin). Then they are connected to the ‘pulse generator’. The • Unexpected pacemaker failure. There is a risk of pulse generator is placed under the skin and then the battery (generator) or lead failure. This is uncommon but means the battery or lead will Pacemaker Device
need to be removed and a new one put in. The battery is checked each time you come to your • Infection of the pacemaker site. This will need clinic appointment. The battery lasts between 6 and 8 treatment with antibiotics and/or removal of the years and cannot be recharged. When the battery needs changing, it will require a procedure similar to Rare risks (less than 1%) include;
• A punctured lung. This may require a tube to be You cannot drive for 2 weeks after a Pacemaker.
inserted into the chest to reinflate the lung. ANAESTHETIC
• A hole is accidentally made in the heart or heart This procedure will require an anaesthetic. valve. This will need surgery to repair. See Local Anaesthetic and Sedation for your
procedure information sheet for information about the
anaesthetic and the risks involved. If you have any • A stroke. This can cause long term disability. concerns, talk these over with your doctor. If you have not been given an information sheet, please ask for Death is possible due to the procedure or other

Source: http://www.canberraheart.com.au/admin/documents/patient_proc_sheet_pdf_15_0.pdf

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