SCS trials

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PinchandBurn

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how many days are you guys trialing patients? Traditionally, I've been doing 5 days. I think most people do a week.

I was at a conference recently. Someoen suggested that if the patient gets 100% or >75% relief for 3 days or so, they pull it. Basically advocating 3 day trials.They were like, it answers the question, why expose patient to an externalized device tht can harbor infections,etc....

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how many days are you guys trialing patients? Traditionally, I've been doing 5 days. I think most people do a week.

I was at a conference recently. Someoen suggested that if the patient gets 100% or >75% relief for 3 days or so, they pull it. Basically advocating 3 day trials.They were like, it answers the question, why expose patient to an externalized device tht can harbor infections,etc....

I agree with the conference guy. 3-4 days is plenty and that's all I do.
Most patients know in the first 1hr, they don't need weeks to decide.
I don't see a reason to trial beyond 5 days, just exposing them to increased risk of infection for little clinical return.
 
I like to trial on Monday, pull on Friday. It's a four day trial. It doesn't usually take the patient very long to decide. It either makes them feel better or doesn't. On Friday, if they really, really need an extra few days to decide, I'll give them till Monday and pull it then. However, I don't really want some call from the ER on a Saturday at 2 a.m. because there is some question about, or problem from "those wires" hanging out the patient's back. Or because the patient spiked a fever and everyone is convinced they have infected leads.

I like the Monday- Friday trial.
 
I like to trial on Friday and then pull Monday if they work full time. they can take Friday off and only half of Monday. for the non working crowd (80% of patients) they can keep it in as long as they want with a limit of next friday. currently trialing Mondays and pulling Friday but it's cumbersome for people with jobs to take the week off
 
7 days. Rarely 10. Pns to 14 if patients want.

Infection curve is flat to 10 days and rises after 14 days.

Will pull sooner in summer due to sweat and discomfory of dressing. Or if they hate it.
 
Yes, our trials are that long, unless the leads migrate, but that became much less of an issue with the Merit Catheter Securing device.... Have never had an infection, and the patients enjoy a week to play with it. In Holland, the trials are 3 months. If there is a potential for a long trial, it is very easy to tunnel the lead(s) to a lateral location using the Tuohy needle/stylette.
 
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I still just don't see utility of a trial beyond 4-5 days. I've never had a patient dislike it by day 4 and then suddenly starting liking it on day 6.
 
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I still just don't see utility of a trial beyond 4-5 days. I've never had a patient dislike it by day 4 and then suddenly starting liking it on day 6.

only reason i do more than 5 days if there is a weekend, and i am gone or something.

4 days is pretty good. Monday in friday out. tuesday in, monday out would be only time i go 6 days. i dont get why leaving it in more than a few days is necessary
 
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Yes, our trials are that long, unless the leads migrate, but that became much less of an issue with the Merit Catheter Securing device.... Have never had an infection, and the patients enjoy a week to play with it. In Holland, the trials are 3 months. If there is a potential for a long trial, it is very easy to tunnel the lead(s) to a lateral location using the Tuohy needle/stylette.

This is very interesting algos. I highly value your opinion but have thought longer trials only lead to increased risk. I even had one surgeon tell me that epidural scarring starts after 7 days. He therefore recommended trials < 5 days. I may reconsider my stance on this after reading your post.
 
does cms or anyone have a rule on this?

Clearly just doing ONE day and pulling is not appropriate.

3 days seems reasonable.

5 days good.

But I'm also thinking if someone really likes the thing and it has been 3 days and 100% coverage occurs, why mess around with the trial and deny the implant for so long. Typically i wait about 2-3 weeks before implant anyways. I just remember reaidng somewhere that you should wait a bit in order to mk sure there's no infections from the trial that are dormant. Probably anecdotal....
 
No showering for 14 days, my pt's are stinky enough already!
 
does cms or anyone have a rule on this?

Clearly just doing ONE day and pulling is not appropriate.

3 days seems reasonable.

5 days good.

But I'm also thinking if someone really likes the thing and it has been 3 days and 100% coverage occurs, why mess around with the trial and deny the implant for so long. Typically i wait about 2-3 weeks before implant anyways. I just remember reaidng somewhere that you should wait a bit in order to mk sure there's no infections from the trial that are dormant. Probably anecdotal....

I had a workers comp company tell me the trial had to be a minimum of 3 days for them to pay (3-5 day range preferred). CMS does not have a required length, at least not in my LCD.
 
I do 5-7 days. However, I had a funny but somewhat concerning story of a longer trial. One patient I trialed decided to no show his appt, and then went MIA on me. Mind you he passed the psych screen and seemed like an ordinary guy if not a bit goofy. I called and called and his phone number did not have an associated voicemail/answering machine. Tried his pcp. A week went by, i was getting really worried. Checked a local hospital. Stimulator company couldn't track him down either. I was thinking of going to his house and breaking down his front door and see what the heck happened to him. Did he have some kind of bad complication? Infection? Meningitis? Epidural bleed?

So he just shows up in clinic one day, happy as can be and says he's sorry but he's been really busy and forgot when his appt was and never bothered calling the office. Whew! He said the trial was the best 2.5 weeks of his life. I told him lets hold off on implant. I need him to prove to me he is more compliant before I implant a device in him.
 
I do 5-7 days. However, I had a funny but somewhat concerning story of a longer trial. One patient I trialed decided to no show his appt, and then went MIA on me. Mind you he passed the psych screen and seemed like an ordinary guy if not a bit goofy. I called and called and his phone number did not have an associated voicemail/answering machine. Tried his pcp. A week went by, i was getting really worried. Checked a local hospital. Stimulator company couldn't track him down either. I was thinking of going to his house and breaking down his front door and see what the heck happened to him. Did he have some kind of bad complication? Infection? Meningitis? Epidural bleed?

So he just shows up in clinic one day, happy as can be and says he's sorry but he's been really busy and forgot when his appt was and never bothered calling the office. Whew! He said the trial was the best 2.5 weeks of his life. I told him lets hold off on implant. I need him to prove to me he is more compliant before I implant a device in him.

Did he not shower for two and a half weeks?
 
Yes, our trials are that long, unless the leads migrate, but that became much less of an issue with the Merit Catheter Securing device.... Have never had an infection, and the patients enjoy a week to play with it. In Holland, the trials are 3 months. If there is a potential for a long trial, it is very easy to tunnel the lead(s) to a lateral location using the Tuohy needle/stylette.
Algos, I just looked up the device and it looks interesting. Do you use one catheter securing device per lead, assuming a 2 lead trial? are they expensive?
 
He sponge bathed for 2.5 weeks. Usu patients find all the tape and gauze is uncomfortable and are very compliant about their f/u appt, but not everyone apparently.
 
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