St. Boniface Hospital Pacemaker/Defibrillator Pre-Op Guidelines (Revised July 2016) Establish IV with Normal Saline (usual rate 20 ml/hr). IV to be established on the LEFT unless otherwise noted. IV antibiotic will be administered at SBH. NPO after midnight, HOLD all medications unless otherwise directed. Baseline vital signs and temperature. If patient is febrile please notify the Pacemaker Nurse @ 204-237-2431 Leave hearing aids and glasses in place. Record height and weight on the medical record. Clip the hair on the chest and shoulders on the left unless otherwise directed. Replacement devices are usually inserted on the same side as currently located. Chlorhexidine 4% wash to upper chest, shoulder and axilla of the appropriate side. 8.1 If chlorhexidine is not available, use a surgical scrub. BLOODWORK: CBC, INR, Na, K+, urea, Cr, within seven days prior to procedure. If bloodwork is abnormal, contact the Pacemaker Nurse and plan to repeat the bloodwork the day prior to the procedure, or as otherwise directed. If on diuretics and the patient is stable, hold diuretics the morning of the procedure. If on diuretics, repeat the potassium on day prior to procedure. If potassium is <4.0, consider giving supplements. 11. If diabetic, check the glucose by glucometer the morning of the procedure. If glucose is <5 mmol/L or >17 mmol/L notify the physician at the referring hospital for management. 12. If on oral diabetic medications, hold them in the morning of the procedure. Some of these are glyburide, gliclazide, metformin, rosiglitazone, and pioglitazone 13. If on subcutaneous Insulin the following schedules are suggested: 13.1.1 BEDTIME prior to the procedure: Half the usual dose of long acting Insulin e.g. Glargine, NPH) and a full dose of short acting Insulin (e.g. Aspart, Lispro, Regular). 13.1.2 MORNING prior to the procedure: Half the usual TOTAL morning dose using long acting Insulin only AFTER the intravenous is established and glucometer check. 14. If on warfarin, hold 4 days prior to and the day of the procedure.
St. Boniface Hospital Pacemaker/Defibrillator Pre-Op Guidelines (Revised July 2016) Establish IV with Normal Saline (usual rate 20 ml/hr). IV to be established on the LEFT unless otherwise noted. IV antibiotic will be administered at SBH. NPO after midnight, HOLD all medications unless otherwise directed. Baseline vital signs and temperature. If patient is febrile please notify the Pacemaker Nurse @ 204-237-2431 Leave hearing aids and glasses in place. Record height and weight on the medical record. Clip the hair on the chest and shoulders on the left unless otherwise directed. Replacement devices are usually inserted on the same side as currently located. Chlorhexidine 4% wash to upper chest, shoulder and axilla of the appropriate side. 8.1 If chlorhexidine is not available, use a surgical scrub. BLOODWORK: CBC, INR, Na, K+, urea, Cr, within seven days prior to procedure. If bloodwork is abnormal, contact the Pacemaker Nurse and plan to repeat the bloodwork the day prior to the procedure, or as otherwise directed. If on diuretics and the patient is stable, hold diuretics the morning of the procedure. If on diuretics, repeat the potassium on day prior to procedure. If potassium is <4.0, consider giving supplements. 11. If diabetic, check the glucose by glucometer the morning of the procedure. If glucose is <5 mmol/L or >17 mmol/L notify the physician at the referring hospital for management. 12. If on oral diabetic medications, hold them in the morning of the procedure. Some of these are glyburide, gliclazide, metformin, rosiglitazone, and pioglitazone 13. If on subcutaneous Insulin the following schedules are suggested: 13.1.1 BEDTIME prior to the procedure: Half the usual dose of long acting Insulin e.g. Glargine, NPH) and a full dose of short acting Insulin (e.g. Aspart, Lispro, Regular). 13.1.2 MORNING prior to the procedure: Half the usual TOTAL morning dose using long acting Insulin only AFTER the intravenous is established and glucometer check. 14. If on warfarin, hold 4 days prior to and the day of the procedure.
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