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Permanent Pacemakers

Understanding How the Heart Works:

The heart consists of 4 chambers. The upper two chambers (atria) fill the lower chambers (ventricles) which pump blood to the lungs and body. The heart’s natural ‘beat’, the sino-atrial (SA) node, is located in the right atria. In order for the heart to beat, this node sends regular impulses to the atria and stimulates the atria to contract and empty blood into the ventricles. The impulse then continues down a pathway to the atrio-ventricular (AV) node where the impulses spread down the ventricles causing the ventricles to contract and pump blood to the lungs and body.

What is a Permanent Pacemaker:

A permanent pacemaker is required when there is a disturbance in the heart’s ability to transmit electrical impulses. This may result in the heart beating too slow and / or too fast or irregularly. The effect of the heart rhythm disturbance could possibly cause symptoms such as dizziness, fatigue, fainting spells or shortness of breath.
A permanent pacemaker delivers electrical impulses to the heart via one or two flexible insulated wires to restore normal function and rhythm.
In brief, the Doctor will inject local anaesthetic into the chest wall. A small pocket will be made under the skin and the electrodes (wires) are introduced into the right side of the heart via a vein. The electrodes are positioned under x-ray and tested. The pacemaker is then attached and the skin is sealed with dissolvable stitches.

Your Appointment:

  • Following your visit to your Cardiologist the secretary will schedule a booking at the earliest time available.
  • You will be sent a letter of confirmation from The Sutherland Heart Clinic or Sutherland Hospital detailing your instructions.
  • You will be required to phone the Clinic the day before your procedure between 10am and 3pm for your admission time and any further instructions regarding fasting and medications. For Monday procedures call the prior Friday.
  • If you have any special dietary needs let the Clinic know e.g. vegetarian or gluten free.
  • Please inform the secretary if you need an interpreter preferably at least a week before your procedure.

Fasting:

You will be required to fast for 3 hours prior to your procedure. Fasting means no food or fluids- except a sip of water with medications. You may be allowed to have a light early breakfast and tea/coffee on the morning of your appointment. You will be informed when you phone.

Hygiene:

No special requirements – shower or bath as per usual.

Medications

All usual medications (including Aspirin, Clopidogrel -Plavix or Iscover) must be taken on day of procedure with a sip of water with the exception of the below medications:

Warfarin

If you take the medication Warfarin you will need to consult with the cardiologist performing the procedure who will advise you if you need to stop taking your Warfarin, and if so how soon before your procedure. You may also be advised to take a substitute anticoagulant (blood thinner) and the arrangements for this. It is very important that you do not stop taking your Warfarin without medical advice.

Insulin

If you are prescribed insulin we suggest you eat a light early breakfast and take half your regular insulin dose. Remind the booking staff that you are on insulin and we will attempt to schedule your procedure as early as possible.

Diabetic Patients

 

 

 

 

  • If Insulin Controlled:
  • You should have an early morning breakfast (ie 0600 hours) and half (1/2) regular insulin (please bring in insulin).


  • If Tablet Controlled:
  • You should withhold your oral agent on the morning of the procedure.

     

    (Metformin - and its other names: Diabex, Diaformin, GenRX, Glucohexal, Glucomet, Glucophage and Meformin BC - should be ceased 48 hours prior to the morning of the procedure).

     

    You may have a light early breakfast if not fasting from midnight.


  • If Diet Controlled:

    You may have a light early breakfast if not fasting from midnight.

     

    If Changing Your Medication

    Please discuss the changes with your cardiologist.

REMEMBER -ALL PATIENTS ARE TO BRING IN WITH THEM THE MEDICATIONS THEY ARE ON AS WELL AS THEIR BLOOD RESULTS

What to bring with you

A list of your current medications and safety net card if you have one

  • Your appointment schedule and any other pertinent papers we have sent you
  • Health insurance details, Medicare card, Veteran affairs details if applicable or Worker’s Compensation Third Party details including insurance claim numbers
  • X-rays and pathology results
  • Items to pass the time, such as reading material, knitting, crosswords etc
  • Reading glasses
  • A small overnight bag and toiletries in case a stay in hospital is required
  • Referral letter /s
  • Do not wear nail polish

On The Day :

Privately Insured Patients
All patients coming to Sutherland Heart Clinic as private patients come directly to the clinic for their admission.
Public Hospital Patients
All patients coming to Sutherland Heart Clinic as public patients must first go to the Public Admissions office of The Sutherland Hospital before being directed to the Sutherland Heart Clinic.

 

On a typical day events will occur in the following stages

  • Stage 1. Check in:
    When you arrive at the clinic reception you will be asked to fill in some admission forms
  • Stage 2. Initial preparations:
    Nursing staff will call you in and show you where to change into a hospital gown and where to store your belongings.
  • Stage 3. Pre Op:
    A detailed nursing and medical admission will be taken. An electrocardiogram (ECG) will be performed and an intravenous needle (IV) will be inserted into your arm for fluids and medications. You will be required to read your consent form and sign it with your cardiologist.
  • Stage 4. The procedure:
    You will be taken into one of the procedure rooms on your bed. Members of the team will ask you to lie down on the table while they carry out various preparations such as attaching monitoring cables to your chest and preparing equipment. You will then be covered with sterile surgical drapes. We will respect your privacy at all times. A number of procedures performed at the clinic require only local anaesthetic whereas others require a general anaesthetic. The nursing and medical staff will inform you of your level of anaesthetic prior to the procedure.
  • Stage 5. Clean up and transfer to Recovery:
    Once the procedure is completed the surgical drapes will be removed and the insertion site cleaned. You will then be transferred to the recovery unit.
  • Stage 6. Recovery:
    After arriving in recovery the staff will attach you to our cardiac monitors and assess your vital signs. If you are a day only patient you will undertake a controlled recovery and mobilisation process. If you are staying in hospital overnight you will be in the recovery area until you are stable and transferred for ongoing care to The Eastern Hospital or the Sutherland Heart Clinic Coronary Care.
  • DAY STAY PATIENTS SHOULD EXPECT TO BE AT THE CLINIC FOR AT LEAST 6 – 8 HOURS FROM TIME OF ADMISSION TO TIME OF DISCHARGE

  • Stage 7. Discharge:

    Once you are ready for discharge the nursing staff will ask you to get changed and will then take you through the discharge process. You will have your intravenous needle removed from your arm, your X-rays will be returned and the nursing staff will give you your discharge instructions. It is good if a relative/carer/ custodian can be with you at this time to hear these instructions.

    IT IS ADVISABLE THAT ALL DAY STAY PATIENTS HAVE SOMEONE STAY WITH THEM OVERNIGHT ON THE DAY OF THEIR DISCHARGE. PLEASE ENSURE YOU TAKE ALL YOUR BELONGINGS WITH YOU AND LEAVE THE LOCKER KEY IN THE DOOR OF THE LOCKER ON YOUR DEPARTURE.

Procedure Time

Insertion of a permanent pacemaker takes approximately one hour.

Length of Stay

You will be required to stay in the recovery ward for approximately 1 1/2 to 2 hours following the procedure. Your Cardiologist may require you to stay overnight, this decision will be made in consultation with you after the procedure.

Visitors

Your immediate family or carers can see you after the procedure when you are up and walking around. The staff will advise you of the time your family can collect you.

Driving

You will not be permitted to drive a car for a period of 7 days so please make alternative transport arrangements.

Discharge

Following the procedure your Cardiologist and the pacemaker technician will speak to you and provide you with detailed information on your pacemaker and instructions on taking care of your wound. In addition you will also be given a course of antibiotics and some tablets to take for any discomfort.

Flying Home    

Please be aware that the airlines may place restrictions on patients flying after certain procedures, such as angioplasty and stent insertion. Sutherland Heart Clinic advises that patients who are having a pacemaker that they must not fly home on the day of the procedure. If you are intending to fly home after your procedure you need to speak to the airlines when making your flight arrangements to ensure you comply with their guidelines.

Security

Secure lockers are provided for your belongings, however please do not bring large amounts of cash or valuables with you on the day.

Parking  

For patients and Visitors the Public Car park costs $4 per day (coins are needed).

Relatives and Friends .

are welcome to wait at the Clinic but cannot go in with the patient once they are called for their procedure. Our staff are happy to answer any of your enquiries and will give you an estimated discharge time.

Please note that Sutherland Heart Clinic is part of a tertiary referral centre and at times we are required to undertake emergency procedures as a priority. This may at times lengthen your stay at the clinic.

Depending on the results of certain investigations, for example a coronary angiogram, it may be necessary for the patient to stay in hospital overnight. Our staff will endeavour to keep you informed of any changes in circumstance.

Day stay patients should expect to be at the clinic for at least 6 – 8 hours from time of admission to time of discharge.

It is advisable that all day stay patients have someone accompany them home and to stay with them overnight on the day of their discharge.

The Clinic advises patients NOT to drive after their procedure for at least 24 hours or longer for certain procedures. The medical and nursing staff will advise you when you may drive again.

Treatment Report

If the doctor who carried out your procedure was not the doctor who referred you then a full report of findings and recommendations will be forwarded a few days after the procedure to your doctor.

Health Insurance Coverage

Sutherland Heart Clinic has contracts with all private health insurance funds. Sutherland Heart Clinic is a NO GAP facility. Please confirm details with us and your fund prior to your procedure. If you have an excess or co-payment on your health insurance cover then you may incur some out of pocket expenses.

Medical Research

Sutherland Heart Clinic, like most specialist centres, undertakes ongoing research projects. Research projects undergo stringent screening from a panel of scientists, doctors and members of the community who verify that methods used are sound, safe and ethical. You may be asked if you would like to participate in a current research project while you are at the clinic.
Participation is entirely voluntary. If you think you might be interested you will be given a full explanation and information about what is to be tested, if any
alternatives are available and any risks and / or benefits you may experience. Written consent is a participation requirement of the study but is by no means a contractual arrangement as you can withdraw at any time.

What You can Reasonably Expect while in our Care:

You are entitled to be treated with care and dignity. You are entitled to a
clear explanation by your doctor of:

  • Your condition, problem or disease.
  • Any planned treatment or investigation.
  • Any alternative procedures available.
  • Possible side effects, the chances of success and any serious risks involved.

By presenting yourself to the Clinic you have implied general consent for treatment. However for specific procedures and for patients who may be having a general anaesthetic you will be required to give written consent after suitable information is given. You may withdraw your consent and refuse further treatment at any time. You have the right to know the identity and professional status of the individuals providing service to you. Staff employed by the Clinic are required to wear identification badges. You have the right to privacy when undergoing any treatment or procedure. Sutherland Heart Clinic respects and upholds patient rights to privacy protection under the National Privacy Principles contained in the Privacy Act 1988. The National Privacy Principles apply to the Clinic from their introduction on December 21st 2001.

The Clinic has in place a Personal Information and Privacy Policy which outlines how the Clinic:

  • Collects your health information
  • What we do with it
  • The quality and security of your data
  • Your rights to access and correct information

You may access our Privacy Policy at anytime whilst at the Clinic.
You should expect the clinic environment to be safe and comfortable.

Your Responsibilities:

Try to be well informed about your condition and treatment. Please ask questions if you do not understand something. You have the responsibility to provide, to the best of your knowledge, accurate and complete information about your present condition, past illnesses, hospitalisations, medications and any other matters relating to your health.
It is in your interests to comply with the prescribed treatment or care and the pre and post operative instructions. You will be responsible for your own actions if you do not follow the prescribed instructions or refuse medical treatment. You should attend the recommended follow up appointments, or advise those concerned if this is not possible.
It is your responsibility to provide accurate details of your Medicare information and/or private health insurance. Please show consideration for other patients, staff and property of the Clinic. By complying with your responsibilities you are helping us help you.

If a Problem Arises:

Please tell your Doctor or the Nurses if a problem arises, in most cases they will be able to help you. Should you not receive a satisfactory outcome you should request to see the Director of Nursing for clinical issues or the Office Manager for administrative issues. They will investigate your complaint and advise you of the outcome or of options if further action is required.
If you wish to take your complaint further you may utilize the following options:

Private Health Insurance Ombudsman
Suite 1201, Level 12, St Martin’s Tower
31 Market Street
SYDNEY NSW 2000
Telephone: (02) 9261 5855 Toll Free: 1800 640 695

NSW Health Care Complaints Commission
Level 13, 323 Castlereagh Street
SYDNEY NSW 2000
Telephone: (02) 9219 7444

Director General NSW Health
73 Miller Street
NORTH SYDNEY NSW 2060
Telephone: (02) 9391 9000