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YOUR PRACTICE WORKSPACE

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YOUR PRACTICE NAMEPacemaker / ICD generator change · Understanding

START HERE

Your pacemaker / icd generator change checklist

Keep this guide with your medication plan and discharge instructions.

Before you arrive

  • Read the medication and fasting plans. Your team must complete any intentional blanks before you follow them.
  • Complete scheduled tests. Bring your current medicine list and allergy information.
  • Arrange an adult driver and someone to stay with you after sedation.

Procedure date / arrival time:

Facility / check-in location:

Before you leave

Keep the current medication list, recovery instructions and follow-up details together. Have conflicting instructions resolved before discharge. Use the emergency warning signs in this guide.

Follow-up appointment or timeframe / booking instructions:

Practice phone: ____________________

After-hours number / route: ____________________

UNDERSTANDING YOUR PROCEDURE

Pacemaker / ICD generator change

Before and after replacement of the battery unit with existing leads retained

What the procedure does

The generator is the sealed battery-and-electronics unit of a pacemaker or implantable defibrillator (ICD). When it needs replacement, the old unit is disconnected and a new unit is connected to the existing working leads. This guide covers a generator-only change. It does not cover a leadless device, extraction, new leads, an upgrade or treatment of an infected system; those need a different plan.

On the day

The skin is numbed with local anesthetic and sedation is usually offered. Through an incision near the device, the team replaces the generator, tests the system and closes the wound. Antibiotics are given around the procedure. Most uncomplicated changes are day procedures, but observation may be longer when needed. Any change in the planned lead work must be reflected in your discharge instructions.

Benefits and risks

Replacement maintains the intended pacing or defibrillator treatment. Risks include wound bleeding or a blood collection, infection, pain, damage to an existing lead, device malfunction and need for additional surgery. Serious complications and death are uncommon but possible. Your team reviews whether the replacement device still fits your current treatment goals.

YOUR PRACTICE NAMEPacemaker / ICD generator change · Preparation

Getting ready

Medicines and fasting

Blood thinner and antiplatelet decisions balance pocket bleeding against clot or stent risk. Use the completed plan below; do not stop these medicines or add heparin bridging on your own. Restart timing must be documented before discharge.

Blood thinner / antiplatelet plan

Food and drink plan

SGLT2 medicines

GLP-1 medicines

Other preparation instructions

Any separate written instructions for insulin or other diabetes medicines take priority; do not apply a general morning-medicine instruction to them.

YOUR PRACTICE NAMEPacemaker / ICD generator change · Recovery

Recovering at home

What to expect

The new unit may feel slightly different under the skin. Mild improving soreness or bruising can occur. Rapidly increasing swelling, warmth, redness, drainage or opening needs prompt assessment.

Your recovery instructions

Dressing & shower
Activity with existing leads retained
Driving
Wound & device follow-up

Follow-up

Appointment / return-to-work details:

Driving clearance date / review plan:

If your replacement device is an ICD

The ICD shock plan still applies. After one shock while otherwise feeling well, sit somewhere safe and contact the device clinic promptly the same day; use the after-hours route if needed. Call 911 for more than one shock in a short period, or any shock with chest pain, breathlessness, fainting or feeling very unwell. Do not drive after a shock until the team reassesses you. A pacemaker does not deliver these shocks.

YOUR PRACTICE NAMEPacemaker / ICD generator change · When to get help

When to get help

Call 911

  • Severe or sudden chest pain or trouble breathing, fainting, or stroke symptoms such as facial droop, arm weakness or trouble speaking.
  • Heavy or continuing bleeding despite firm pressure, or rapidly growing painful swelling with weakness or faintness. Lie down, keep firm pressure on the bleeding site and have someone call 911.
  • Repeated ICD shocks, or a shock with chest pain, breathlessness, fainting or feeling very unwell.

Do not drive yourself. Do not wait for a message or remote-monitor response.

Contact the clinic the same day

Increasing redness, warmth, pain or swelling; drainage; wound opening; visible device material; fever or chills.

For warning symptoms after hours, use the contact route below. If you cannot reach the team and symptoms are worsening, seek urgent assessment. Use 911 for the severe symptoms listed above.

Practice phone: ____________________

After-hours number / route: ____________________

Follow your personalized medication and recovery plan. This guide supports, but does not replace, the consent discussion or your treating team’s instructions.

PatientReady · Pacemaker / ICD generator change · 24 Sep 2026
Evidence behind these instructionsPacemaker / ICD generator change · For your practice’s review

These notes explain the original template, not custom wording or older saved guides. Basis labels distinguish guidelines from manufacturer information and local protocols. A source-check date is not clinical approval. This provider-only section does not print.

Food, drink and morning medicinesPractice protocol — not a universal guideline
Template default
Nothing to eat or drink after midnight; approved morning medicines with small sips of water.
Why this choice
Midnight is this template’s selected local cutoff, not an ASA requirement. ASA allows clear liquids until 2 hours before anesthesia in appropriate healthy elective patients.
Exceptions & limits
Longer fasting is not automatically safer. Anesthesia must set the appropriate plan for aspiration risk, diabetes, delayed gastric emptying and procedure timing. Insulin and other diabetes medicines need a separate plan.

Sources last checked:

SGLT2 medicinesDrug-label-based guidance
Template default
Hold empagliflozin, dapagliflozin and canagliflozin at least 3 days; ertugliflozin at least 4 days.
Why this choice
The differing intervals address perioperative ketoacidosis risk. ACC summarizes the FDA intervals; the linked ertugliflozin label also specifies restart after clinical stability and oral intake resume.
Exceptions & limits
Applies to scheduled surgery/prolonged fasting. Urgent procedures, suspected ketoacidosis, poor intake or dehydration need individualized management. Combination tablets must be identified.

Sources last checked:

GLP-1 medicinesMultisociety clinical guidance
Template default
Continue for patients assessed as low risk for delayed stomach emptying.
Why this choice
The 2024 guidance uses risk assessment rather than a blanket one-week hold. Stopping therapy also has metabolic and access consequences.
Exceptions & limits
Dose escalation, significant GI symptoms, higher doses and other causes of delayed gastric emptying may require a 24-hour liquid diet, modified anesthesia or deferral. The routine text presupposes anesthesia screening; it does not perform that screening.

Sources last checked:

Procedure scope and anesthesiaGuideline / primary patient education
Template default
Before and after replacement of the battery unit with existing leads retained
Why this choice
Generator replacement retains existing functioning leads.
Exceptions & limits
Do not apply to extraction, infection, upgrade, new leads or leadless replacement.

Sources last checked:

Blood thinners and antiplateletsIndividualized plan; no universal hold
Template default
Leave the drug-specific before/restart plan for entry or handwriting.
Why this choice
Pocket bleeding, embolic risk and recent stents require individualized management.
Exceptions & limits
This is not an instruction to start, stop or bridge a drug without a completed plan.

Sources last checked:

Wound care, movement and drivingEditable clinic protocol — not universal guideline
Template default
Dry dressing 7 days (approved sealed closure: 3); comfortable movement with 2-week heavy-use limits.
Why this choice
Protect healing pocket skin while allowing shoulder motion; existing leads do not require new-lead immobilization.
Exceptions & limits
Dressing systems differ. These intervals and weight limits are local choices, not proven superior. Existing ICD/syncope driving restrictions remain.

Sources last checked:

Follow-up and monitoringEditable scheduling default
Template default
Wound check 7–14 days; device check 4–6 weeks.
Why this choice
Provide appointment details at discharge to avoid unnecessary scheduling questions.
Exceptions & limits
These are clinic-selected windows, not universal guideline mandates. PVC monitoring, flutter/AF surveillance and device-model-specific connectivity may require additional testing. Remote monitoring never substitutes for emergency assessment.

Sources last checked:

ICD shocks after replacementPrimary patient education
Template default
One shock while well: prompt same-day device-clinic contact. Repeated shocks or a shock with serious symptoms: 911. No driving until reassessed.
Why this choice
A generator change does not remove the underlying ICD indication or shock-response needs.
Exceptions & limits
Only for patients whose replaced device is an ICD, not a pacemaker. Device alerts and symptoms may need individualized instructions.

Sources last checked:

AI-assisted research; primary sources checked 24 September 2026. Not a live literature monitor or independent clinical certification. Local defaults need practice adoption. Patient-specific instructions take priority.

Check & record a practice version

No practice review recorded for this version.

    Advisory checks only—not a clinical safety check. Printing is never blocked. Intentional blanks can be completed by hand before handing the guide to a patient.

    Records the current wording and date; later edits require a new review. This is your practice’s attestation, not certification by PatientReady. Logo changes are not part of the clinical wording record.

    Reviewed version history

    Match the document ID printed on a saved guide to a record below. IDs identify wording, not the logo or later changes to a PDF. Review records are private to the issuing account and this procedure.

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    Compare & consider template updates

    Base 2026-09-25.2: follow-up wording accepts booked appointments or a timeframe with booking instructions. Follow-up intervals, warning signs and saved edits are unchanged. Prior update — Base 2026-09-24.2: new procedure-specific guide with optional defaults and provider evidence notes. Saved edits are never replaced automatically. Compare and adopt updates only after practice review.