Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Cardiology
Upper Extremity, Movement, Heart
Background: There is no consensus across providers and healthcare systems regarding the duration of upper extremity movement restrictions following implantation of transvenous cardiac devices. A recent study surveyed health care systems and found a wide variation in practice ranging from restricting all activity for up to six weeks 6 weeks to no activity restriction. Maine Medical Center uses the following discharge instructions “avoid excessive lifting, reaching, or strenuous activities for one week in the arm on the side where the device was placed, then slowly increase activity to normal over two to three weeks.” It is undetermined if these instructions lead to fewer complications than national averages. In a state where ? of the population relies on manual dexterity for their occupation, it is also uncertain if work limitation is justified. Due to upper extremity movement restrictions many patients are dependent on others for the completion of activities of daily living and those that work experience loss of wages. It is hypothesized that 1 week of upper extremity movement restrictions will not result in an increased risk of complications compared to the national average.
Research Objectives: To identify all patients at Maine Medical Center who had implantation of transvenous cardiac devices and of this population the rate of complications compared with the national average.
Methods: All patients at Maine Medical Center who had a transvenous cardiac device placed between July 2016 to July 2018 will be identified using retrospective electronic medical record analysis. Of the patients who had a transvenous cardiac device placed all patients who were hospitalized for a complication resulting from implantation will be identified by searching for CPT codes associated with common complications from implantation.
Results: Using a retrospective review of the electronic medical record, 790 patients were identified as having a transvenous cardiac device placed over the study period. Of these patients; 5 (0.6%) had a complication that resulted in hospitalization within 2 years. Of the 5 subjects identified with readmission, 2 subjects were diagnosed with Twiddler's syndrome, 2 with lead failure and 1 with a pocket infection.
Conclusion: Based on the results, the rate of complication is far below the national average, which is approximately 5% of patients experience a complication within 2 years of implantation that leads to hospitalization. Maine Medical Center’s complication rate would suggest that discharge instructions are appropriate and activity restriction does correlate with decreased complications.
Geissler, Andrew; Starobin, Benjamin; and Sesselberg, Henry, "What is the appropriate length of time to restrict movement of the upper extremity after cardiac implantable electronic device placement?" (2020). Costas T. Lambrew Research Retreat 2020. 110.