Advice after your nerve block for surgery
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This leaflet has been written for patients undergoing a permanent pacemaker box change at Frimley Park Hospital and their carers and gives important information regarding the box change, about going home and for activity afterwards.
Why do I need to have a pacemaker box change?
Your pacemaker’s box is like any other battery and eventually needs to be replaced, although it can last up to 10 years. This will be identified during routine pacemaker checks.
What are the risks involved?
To consent for the box change you should understand that possible risks are involved such as:
- A small risk of bleeding and infection to the incision site.
- Wires leading from the pacemaker generator to the heart may occasionally become displaced during the procedure.
- Very occasionally the wires may need replacing.
What alternatives do I have?
All pacemaker boxes will require changing at some point to enable the pacemaker to continue to work.
Pre-operative assessment and care
We invite you to attend a pre-assessment appointment as a telephone call, with a Cardiac Nurse Specialist before your pacemaker box change. The nurse will describe the procedure, discuss the risks involved and give guidance on preparing for the procedure, including any changes required to medications, when to stop eating and what to bring with you. procedure as a day case) you will receive
Blood Tests
You will have been sent blood form to have blood taken, ideally at least a couple of days before the procedure. This can be done at your GP surgery or via an online booking appointment at Frimley Park Hospital, Aldershot Centre for health, Heatherwood Hospital and Farnham hospital. Please visit the Trust website to book online
If there are any problems with this then please let the nurse know during your telephone call.
Warfarin
If you take warfarin your INR will be checked on admission. It needs to be between 2-3 for the procedure to be performed. Therefore, have your INR checked 5-7 days before your procedure and discuss this with your GP or nurse as your warfarin dose may need to be amended in preparation for your procedure.
Direct oral anti-coagulants (DOACs)
If you take a DOAC such as apixaban, rivaroxaban, dabigatran or Edoxaban please continue as normal, unless instructed otherwise.
Diabetes
If you are diabetic using insulin maintain your regime as you are not starved for this procedure, unless otherwise advised.
On the day of your box change
- On the morning of the procedure please shower or bathe.
- We recommend you have a light meal and drink before you come in. You will be offered a sandwich and drink after your procedure.
- You should take your medications as usual on the day unless otherwise instructed.
- Please bring all your medications in the original boxes or dosette box with you on the day of the test as you will be taking as these as normal.
- During your admission you will stay in the cardiac catheter day ward. Your details will be checked and a name band placed on your wrist.
- We will give you a gown to wear.
- Please bring a dressing gown and slippers/slip on shoes with you.
- Remember your reading glasses and something to read or occupy you.
- Avoid bringing any valuables or cash with you other than small change for paper as they may be left unattended while you are undergoing your test.
Please be aware that procedures are occasionally delayed or possibly cancelled due to unforeseen emergencies. The ward nurse will keep you informed.
The Cardiac Cath Lab Team aims to ensure that patients have their dignity and confidentiality always respected.
Due to lack of space and layout of the day ward, it is not possible for relatives/carers to stay with the patient for the duration of their stay. However, if the nurse in charge considers it appropriate for a carer to stay then this will be considered.
Please arrange for a responsible adult to collect you from the Cardiac Catheter Labs. They will need to drive you home and stay with you overnight.
How is the procedure done?
The procedure is done in a special x-ray room which looks like a small operating theatre. You will be asked to walk to the x-ray room or if unable to walk, a wheelchair will be provided.
You will normally be awake during the procedure, but you will be given a local anaesthetic to numb the skin. There will be several members of staff in the room during the procedure including a doctor, nurse, cardiac technician and a radiographer.
You will lie on your back with a pillow under your head, on the x-ray table. The skin around your chest is cleaned and numbed with local anaesthetic.
The doctor will make a small cut in the skin usually above the original incision. If you feel any pain, you should inform the staff.
The pacemaker’s old box which is positioned underneath your skin is removed, usually leaving the original wires in place. A new box is then put in place where the old box was, and the original wires are screwed into the new box.
If your heart is dependent on your pacemaker to make it beat, you may have a temporary pacemaker inserted via your groin while the box is changed.
After the procedure – what to expect
The procedure will take approximately 1/2hr after which you will be taken back to the day ward.
You will be provided with a hot drink, a sandwich and water. Providing there are no complications, you will be allowed to go home later in the day.
You will be given a new pacemaker registration card which you must carry with you and show to any medical professionals that are treating you.
Going home from hospital
Your wound site may feel tender or bruised. You can take painkillers such as Paracetamol but not Aspirin.
The stitches are usually dissolvable and will disappear within 1-2 weeks.
The dressing may be removed the day after the procedure. It does not need to be replaced if the wound is clean and dry. It is important to keep the wound dry for at least a week.
You must not drive or fly for 1 week following the procedure.
Bruising is common, especially if taking blood thinning medication. Monitor the wound site for redness, swelling, oozing, pain or excessive bruising. Seek medical advice if concerned.
If you need further advice or have any problems after you have been discharged please contact:
- Cardiac Catheter Lab day ward 0300 613 9572
- Coronary Care Unit 0300 313 4524
- Your GP emergency number or go to your nearest Emergency Department
- Should you need to re-arrange your appointment please contact the Cardiac Bookings Office on 0300 613 3344
Contact us
If you have any queries relating to this information, please contact the Cardiology service.
About this information
Service:
Cardiology
Reference:
C/023
Approval date:
9 January 2025
Review date:
9 January 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.