Toxicity is 5mg/L, severe toxicity is greater than 9mg/L. (K.K’s level was 16.8)
Toxicity symptoms persist for as long as drug levels are toxic in the blood (Peralta, 2007).
Half-life: The amount of time it takes for the drug level to decrease by 50% (Deglin & Vallerand, 2007).
Terminal half-life of lidocaine = 2 hrs
Wooten, J.M., Earnest, J., & Reyes, J. (2000). Review of common adverse effects of selected antiarrhythmic drugs. Critical Care Nusing Quarterly, 22 (4), 23-38. 2.1 6 4.2 4 8.4 2 16.8 0 Concentration Hour
An ICD monitors the heartbeat and delivers shock when it detects lethal dysrhythmia. Implantable Cardioverter Defibrillator
Discharge Instructions for ICD
Information from table 36-9 in Lewis medical/surgical textbook
Follow up with PCP
Report any s/s of infection at the incision site
Keep incision dry for 4 days
Avoid lifting arm on ICD side above shoulder until approved by PCP
Discuss resuming sexual activity with PCP. It’s safe once the incision is healed.
Avoid driving until cleared with PCP
Avoid direct blows to ICD site
Avoid large magnets and strong electromagnetic fields because they may interfere with the device
Never have an MRI
Inform airport security when traveling because it may set off the metal detector.
IF your ICD fires, call health care provider immediately
IF your ICD fires and you do not feel well, contact EMS
Wear a medic alert ID or bracelet at all times
Always carry the ICD identification card and a current list of your medications
Family members should learn CPR.
According to a 2003 study in Critical Care Nursing:
Patients need written education tools specific to sexual issues for patients/partners
Health care professionals need educational resources to pass on to patients
42.5% of ICD patients in the study reported a concern that sexual activity would trigger the device.
82% of subjects reported that their ICD had not fired during sex
ICD firing only happened in 3 patients within a year (there were about 387 participants)
ICD patients can resume sexual activity after incision is healed
Alter positions to decrease physical activity and strain
Slow down, make sex relaxing
Alternative ways of expressing sexuality (touching, holding, etc.)
“ Is there a better way to go?” – Dr. Carr
Fluid Volume Excess
Risk for infection
Confusion (possibly chronic)
Ackley B.J. & Ladwig G.B. (2006). Nursing diagnosis handbook: A guide to planning care (7th ed.). St. Louis: Mosby Elsevier.
Channer, K., & Morris, F. (2002). ABC of clinical electrocardiography: Myocardial ischaemia. British Medical Journal, 324 (7344): 1023–1026. Retrieved March 2, 2008 from http:// www.pubmedcentral.nih.gov/articlerender.fcgi?tool = pmcentrez&artid =1122957%20 .
Deglin J.H., & Vallerand A.H. (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia: F.A. Davis Company.
Dougherty, C.M., Lewis, F.M., Thompson, E.A., Baer, J.D., & Kim, W. (2004). Short-term efficacy of a telephone intervention by expert nurses after an implantable cardioverter defibrillator. Pacing & Clinical Electrophysiology, 27, 1594-1602.
Dougherty, C.M., Pyper, G.P., & Benoliel, J.Q. (2004). Domains of concern of intimate partners of sudden cardiac arrest survivors after ICD implantation. Journal of Cardiovascular Nursing, 19 (1), 21-31.
Kamphius, H., Verhoeven, N., De Leeuw, R., Derksen, R., Hauer, R., & Winnubst, J. (2004). ICD: a qualitative study of patient experience the first year after implantation. Journal of Clinical Nusing, 13, 1008-1016.
Lewis S.L., Heitkemper M.M., Dirkesen S.R., O’Brien P.G., & Bucher L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby Elsevier.
Mayo Clinic Staff (2006) Implantable cardioverter-defibrillators: Controlling a chaotic heart. Retrieved March 2, 2008 from http://www.mayoclinic.com/print/implantable-cardioverter-defibrillator/HB00003/METHOD=print
Pagana K.D., & Pagana T. J. (2006). Mosby’s manual of diagnostic and laboratory tests (3rd ed.). St. Louis: Mosby Elsevier.
Peralta, Ruben. (2007) Lidocaine toxicity. Retrieved March 4, 2008 from http://www.emedicine.com/MED/topic1297.htm
Peskine, A., Picq, C., & Pradat-Diehl, P. (2004). Cerebral anoxia and disability. Brain Injury, 18 (12), 1243-1254.
Steinke, E. (2003). Sexual concerns of patients and partners after an implantable cardioverter defibrillator. Dimensions of Critical Care Nursing, 22 (2), 89-96.
Wooten, J.M., Earnest, J., & Reyes, J. (2000). Review of common adverse effects of selected antiarrhythmic drugs. Critical Care Nusing Quarterly, 22 (4), 23-38.