Surgical Wound Nursing Assessment and Clinical Outcomes in Patients with Cardiac Implantable Electronic Devices

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Universitário Lisboa Central / Hospital Santa Marta With the gains in life expectancy of patients (P) with heart disease, population with cardiac implantable electronic devices (CIED) therapy for the treatment of heart failure and life-threatening arrhythmias has increasingly became a challenge, regarding the number of complications following an implantation. Aim: To analyze clinical outcomes of P with CIED participating in an integrated nursing approach in an outpatient clinic of a tertiary center. Methods: Systematic review of clinical follow-up data of P undergoing CIED implantation who were observed by a specialized nursing team after discharge. Data regarding complications related to the surgical wound, treatment, timings and outcomes were collected. Results: In 2020, out of 927 P treated with CIED in our center, 157 were referred to the nursing outpatient clinic due high risk features such as anticoagulation and frailty, previously identified surgical wound related complications or advanced hearth failure. The CIED observed were replaced devices (17%), cardioverter defibrillator (41%), cardiac resynchronization therapy with defibrillator (27%), pacemakers (11%), and event recorders (4%). In average, the first appointment took place 16 days after the procedure. In 73 cases, presenting with pocket complaints (hematoma - 34%, local edema or pain - 10%, wound scab - 36%, exteriorized suture or staple - 20%), the average number of days until medical discharge was 36 days, with an average of 5 appointments per patient. In this group, 42% were under oral coagulants, 38% under antiaggregant drugs and 11% under both. Treatment options included antibiotic prescription in 25% of the cases, cryotherapy in 22%, dressing of the surgical wound in 10% and absorbable suture or staple removal in 10%. Four P (0.43%) were submitted to complete system removal due to CIED infection. Conclusions: Surgical wound related complaints in CIED P are relatively common and represent a factor of morbidity and increase in public health spending. An integrated trained team may aid in the prompt identification and management of these complications.