Injectable loop recorder implantation in an ambulatory setting by advanced practice providers: Analysis of outcomes

Kipp, Ryan; Young, Natasha; Barnett, Arnold; Kopp, Douglas E.; Leal, Miguel A.; Eckhardt, Lee L.; Teelin, Thomas; Hoffmayer, Kurt S.; Wright, Jennifer M.; Field, Michael E.

doi:10.1111/pace.13155

Cited by 14 publications

(12 citation statements)

References 6 publications

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“…As such, when a nurse becomes more proficient in device implantation, the service can slowly move out of the catheter laboratory completely. This is consistent with the results reported by Kipp et al, where ILR implanted in an ambulatory setting by advanced practise providers had a high success and low complication rate with a single dose of IV antibiotics. Our study differs in that we did not administer IV antibiotics peri‐procedure.…”

Section: Discussionsupporting

confidence: 93%

“…The most recent iteration of these devices are significantly smaller than previous generations, for instance the Reveal LINQ ICM (Medtronic, Minnesota) is 87% smaller than its previous versions, and includes an implanting kit that allows the device to be injected. This new implant technique negates the requirement for a minor surgical procedure, and permits implantation to be undertaken in the outpatient setting . We hypothesized that this new implant method would be compatible with a nurse‐delivered implant service in the outpatient setting that would: (a) save physician time, releasing them and the catheter laboratory so other types of more complex procedures could be done, and (b) reduce overall cost.…”

Section: Introductionmentioning

confidence: 99%

“…This new implant technique negates the requirement for a minor surgical procedure, 6 and permits implantation to be undertaken in the outpatient setting. 7,8 We hypothesized that this new implant method would be compatible with a nursedelivered implant service in the outpatient setting that would: (a) save physician time, releasing them and the catheter laboratory so other types of more complex procedures could be done, and (b) reduce overall cost.…”

Section: Introductionmentioning

confidence: 99%

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A nurse‐led implantable loop recorder service is safe and cost effective

Lim

Papageorgiou

Sukumar

et al. 2019

Cardiovasc electrophysiol

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Introduction Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse‐delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost‐effectiveness of the introduction of this nurse‐delivered ILR service with contemporaneous physician‐led procedures. Methods Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed. Results A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician‐implants and two in nurse‐implants (P = .3). Procedural time for physician‐implants (13.4 ± 8.0 minutes) and nurse‐implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician‐implants against £279.95 with nurse‐implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse‐delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse‐delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures. Conclusion ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A nurse‐led implantable loop recorder service is safe and cost effective

Lim

Papageorgiou

Sukumar

et al. 2019

Cardiovasc electrophysiol

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“…Two observational studies (performed in Denmark and Australia) compared the safety of ICM insertions performed in a hospital procedure room vs. EP lab and also reported low rates of across insertion environments (0.6–1.7%), with no significant differences between settings [4, 5]. Absent or low complication rates have been observed in three single arm studies in which all device insertions occurred in either a hospital holding area or procedure room (0.0–0.8%) [6–8]. Importantly, the above findings demonstrate similar or lower complication rates than were observed in a combined analysis of the Reveal LINQ Usability and Reveal LINQ Registry studies (0.7 and 1.6%, respectively), where most device insertions occurred in a cath/EP lab [9].…”

Section: Discussionmentioning

confidence: 99%

Safety of in-hospital insertable cardiac monitor procedures performed outside the traditional settings: results from the Reveal LINQ in-office 2 international study

Sanders

Piorkowski

Kragten

et al. 2019

BMC Cardiovasc Disord

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Background Historically, the majority of insertable cardiac monitor (ICM) procedures were performed in the cardiac catheterization (cath) lab, electrophysiology (EP) lab, or operating room (OR). The miniaturization of ICMs allows the procedure to be relocated within the hospital without compromising patient safety. We sought to estimate the rate of untoward events associated with procedures performed within the hospital but outside the traditional settings and to characterize resource utilization, procedure time intervals, and physician experience. Methods The Reveal LINQ in-Office 2 (RIO 2) International study was a single arm, multicenter, prospective study. Patients indicated for an ICM and willing to undergo device insertion outside the cath/EP lab or OR were eligible and followed for 90 days after insertion. Results A total of 191 patients (45.5% female aged 63.8 ± 26.9 years) underwent successful Reveal LINQ ICM insertion at 17 centers in Europe, Canada and Australia. The median total visit duration was 106 min (interquartile range [IQR]: 55–61). Patient preparation and patient education accounted for 10 min (IQR: 5–20) and 10 min (IQR: 8–15) of total visit duration, respectively. Preparation and education occurred in the procedure room for 90.6 and 60.2% of patients, respectively. There were no untoward events (0.0, 95% CI: 0.0–2.1%) though four patients presented with procedure-related adverse events that did not require invasive intervention. Physicians rated procedure location as convenient or very convenient. Conclusions The Reveal LINQ™ ICM insertion can be safely and efficiently performed in the hospital outside the cath/EP lab or OR. Trial registration ClinicalTrials.gov identifier NCT02412488 ; registered on April 9, 2015. Electronic supplementary material The online version of this article (10.1186/s12872-019-1106-3) contains supplementary material, which is available to authorized users.

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“…In this issue of PACE, Kipp et al . present a provocative article describing their favorable experience with a simplified advance practice provider (APP) implant approach for implantable loop recorder (ILR) implantation.…”

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confidence: 99%

Injectable loop recorder (ILR): How to, where to, who to

Fisher

2017

Pacing Clinical Electrophis

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In this issue of PACE, Kipp et al. 1 present a provocative article describing their favorable experience with a simplified advance practice provider (APP) implant approach for implantable loop recorder (ILR) implantation.The method described amounts to a "no questions asked assembly line." For such an approach, Henry Ford was considered to be a villain in his time but he turned out to be correct. Initially. Everyone was invited to order any color Model T as long as it was black. We now know how many options can be ordered individually on an assembly line.The reviewers for this article were concerned about the options. Is the left sternal border optimal for everyone, or do some patients benefit or prefer an inframammary location? Are all skin and body textures such that a nonscalpel "injection" and medical adhesive (glue) closure would be optimal? Do such decisions benefit from expert electrophysiology (EP) physician input? Do the efficiencies and convenience of an office setting overbalance the resources of an EP lab?What is an acceptable complication rate, and how does this differ from an optimal rate? This editor has seen several extrusions and/or infections of ILRs, all in patients whose incisions were closed with medical adhesive (which allows the ILR to be squeezed close to the skin) rather than a stitch.Such events do not typically cause systemic infections, and the argument is therefore made that the risk:benefit ratio is acceptable. Kipp et al. have shown what can be done. Local circumstances may dictate actual practice. APPs (NPs, PAs) are valuable assets, and should be cherished for what they can do. Meanwhile, the challenge has been made.

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Injectable loop recorder implantation in an ambulatory setting by advanced practice providers: Analysis of outcomes

Cited by 14 publications

References 6 publications

A nurse‐led implantable loop recorder service is safe and cost effective

A nurse‐led implantable loop recorder service is safe and cost effective

Safety of in-hospital insertable cardiac monitor procedures performed outside the traditional settings: results from the Reveal LINQ in-office 2 international study

Injectable loop recorder (ILR): How to, where to, who to

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