Cervical RFA with ICD defibrillator

[donaldduck]

Do y'all put magnets over the ICD if having a cervical RFA? Also, what is the consensus when doing SCS with cardiac devices?

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[Ducttape]

not over an ICD.

get the rep to turn it off.


if you do SCS with cardiac devices, id suggest you contact the cardiac device rep and generally speaking use the same company's stim product.

 

[callmeanesthesia]

I do bipolar if AICD, or if pacemaker and cervical or thoracic RF. I posted description of my technique recently but I can’t recall what thread at the moment.

 

[so55b]

I do bipolar too. Not putting the grounding pad just in case

 

[oneforfighting]

I do bipolar too. Not putting the grounding pad just in case

Why would it matter whether you place the grounding pad?

 

[so55b]

Why would it matter whether you place the grounding pad?

It doesn’t matter but just in case my staff or I forget and do the unipolar burn. My staff used to place the grounding pad either uni or bipolar and it is a waste.

 

[Timeoutofmind]

Every ICD and pacer behaves differently if you put a magnet over it so I would reach out to the cardiologist to get a formal recommendation for C RF. But 90% of the time they will just tell you to put a magnet over it during the case and remove it afterwards. This will typically deactivate the AICD function and not influence the pacer function. They will typically not recommend the device needs to be interrogated afterwards, but sometimes they may.

As far as the ICD plus Scs…
I explain to the patient there is some very small but real risk that the stimulation from the stimulator could inappropriately inhibit or trigger ICD therapy, which could be catastrophic. However, quite a bit of case reports, etc. and this is commonly done without any issue in the real world.
So I just would have the ICD Rep present at the trial and when you turn the stimulator on have them verify no interference. I’ve never heard of their actually been interference. And then if that is the case OK to proceed and I don’t have them come for the permanent…

 

[kstarm]

Are people doing anything for lumbar in these cases or just going ahead without clearance

 

[Timeoutofmind]

Anything below umbilicus no precautions needed

 

[painfree23]

Is this really a concern even on new aicds?

 

[SpineandWine]

Just had a complication.
ICD + cervical RFA. Had put magnet but must have slipped off and shocked the patient during RFA. Used silk tape for placement.

People routinely use magnets? For cervical RFA
Or contact device rep.

 

[MitchLevi]

Cervical and thoracic ablations in pts with devices need magnets. Lumbar L3-S1 no precaution is required.

 

[clubdeac]

Just had a complication.
ICD + cervical RFA. Had put magnet but must have slipped off and shocked the patient during RFA. Used silk tape for placement.

People routinely use magnets? For cervical RFA
Or contact device rep.

Did you really? What happened? Did you stop? Did you have to call back up

 

[SpineandWine]

Did you really? What happened? Did you stop? Did you have to call back up

Patient alarmed, I stopped procedure
Was fine. Sent to interrogation clinic

 

[RoloTomassi]

Same exact thing happened to me years ago, managed the same, too. I was more scared than the patient. He thought the RFA needles were zapping him, which in a way they were.

 

[SpineandWine]

Same exact thing happened to me years ago, managed the same, too. I was more scared than the patient. He thought the RFA needles were zapping him, which in a way they were.

Same.
Lot could have happened. He could have completely jumped and ruptured his carotid if needles hit c arm

He could have had R on T phenomenon

In retrospect, I should have ensured sound by magnet
- issue with having device rep turn it off is that it won’t fire if needed
- with magnet, you can always take it off and it’ll shock but in this case, if it slipped off/not placed properly, can shock inappropriately

Not sure what my protocol will be. May be better to just have it turned off by device rep and have external pads close by

—-
I discharged him to his interrogation clinic rather than ER
Got EKG, monitored him for half hour.

 

[clubdeac]

Same.
Lot could have happened. He could have completely jumped and ruptured his carotid if needles hit c arm

He could have had R on T phenomenon

In retrospect, I should have ensured sound by magnet
- issue with having device rep turn it off is that it won’t fire if needed
- with magnet, you can always take it off and it’ll shock but in this case, if it slipped off/not placed properly, can shock inappropriately

Not sure what my protocol will be. May be better to just have it turned off by device rep and have external pads close by

—-
I discharged him to his interrogation clinic rather than ER
Got EKG, monitored him for half hour.

I know my protocol for the last 10 years. Don't offer cervical RF in pacemaker patients. Someone else in the group can do it

 

[au bon pain]

Not sure what my protocol will be. May be better to just have it turned off by device rep and have external pads close by

I always have a code cart in the room with pads plugged in (but not on patient) for these cases. Wards off evil spirits

 

[bedrock]

I know my protocol for the last 10 years. Don't offer cervical RF in pacemaker patients. Someone else in the group can do it

lol. That has been mine approach as well.

I always want less Medicare patients as I’m at 105% capacity all year round.

One tool is transferring their care to another doc if a Medicare patient needs C1-C2 injections or cervical/thoracic RFA (and has a pacemaker).

 

[so55b]

Same.
Lot could have happened. He could have completely jumped and ruptured his carotid if needles hit c arm

He could have had R on T phenomenon

In retrospect, I should have ensured sound by magnet
- issue with having device rep turn it off is that it won’t fire if needed
- with magnet, you can always take it off and it’ll shock but in this case, if it slipped off/not placed properly, can shock inappropriately

Not sure what my protocol will be. May be better to just have it turned off by device rep and have external pads close by

—-
I discharged him to his interrogation clinic rather than ER
Got EKG, monitored him for half hour.

I know my protocol for the last 10 years. Don't offer cervical RF in pacemaker patients. Someone else in the group can do it

Why not just bipolar and forget about the magnet and other worries?

 

[lobelsteve]

Just had a complication.
ICD + cervical RFA. Had put magnet but must have slipped off and shocked the patient during RFA. Used silk tape for placement.

People routinely use magnets? For cervical RFA
Or contact device rep.

Have heard of a handful. Where was grounding pad?

 

[buddababa]

i routinely do cervical rfa with pacemaker/icd - no issues, grounding pad far away

 

[SpineandWine]

Have heard of a handful. Where was grounding pad?

Ankle….
I know.
My mistake for not checking- he was draped by ASC

Or I guess let me re ask- what’s best place for grounding pad?

 

[lobelsteve]

Ankle….
I know.
My mistake for not checking- he was draped by ASC

Or I guess let me re ask- what’s best place for grounding pad?

As close to needle entry site as possible.
As a car builder, this is electrical common sense. Battery up front and starter in rear will require 1-0 gauge cable. Shielding will help. Neither are possible in the body.
Pull current towards the grounding pad and away from where it may interfere.

 

[Force440]

lol. That has been mine approach as well.

I always want less Medicare patients as I’m at 105% capacity all year round.

One tool is transferring their care to another doc if a Medicare patient needs C1-C2 injections or cervical/thoracic RFA (and has a pacemaker).

This kind of BS kills me. Why not just tell the patient that you make too much money and they aren't worth your time . . . or tell them that the procedure is inappropriate? "Transfer to another doc" without having this conversation. . . well I guess that it cuts into your profits.

 

[lobelsteve]

This kind of BS kills me. Why not just tell the patient that you make too much money and they aren't worth your time . . . or tell them that the procedure is inappropriate? "Transfer to another doc" without having this conversation. . . well I guess that it cuts into your profits.

Porsches aren't cheap.

 

[SSdoc33]

This kind of BS kills me. Why not just tell the patient that you make too much money and they aren't worth your time . . . or tell them that the procedure is inappropriate? "Transfer to another doc" without having this conversation. . . well I guess that it cuts into your profits.

uh oh.... here comes the rant.....

 

[bedrock]

This kind of BS kills me. Why not just tell the patient that you make too much money and they aren't worth your time . . . or tell them that the procedure is inappropriate? "Transfer to another doc" without having this conversation. . . well I guess that it cuts into your profits.

If my partners would let me establish a max percentage of Medicare patients per day, then I wouldn’t have to do this.

I already work 50hrs per week. My family is the most important thing to me as well as my sanity/health.

If you don’t like it, I don’t give a rats ass.

 

[SpineandWine]

If my partners would let me establish a max percentage of Medicare patients per day, then I wouldn’t have to do this.

I already work 50hrs per week. My family is the most important thing to me as well as my sanity/health.

If you don’t like it, I don’t give a rats ass.

I’m like 20% medicaid
I love my medicares- which is 60%

 

[bedrock]

I’m like 20% medicaid
I love my medicares- which is 60%

I love my Medicare patients. I just want 10% fewer patients overall.

 

[callmeanesthesia]

Bipolar RF. No worries. Takes maybe 1-2 minutes extra.