Preoperative checklist to reduce the risk of cardiac implantable electronic device infections

Abstract

Cardiac implantable electronic device (CIED) infection represents a dramatic event with a high mortality rate (>3x) despite antibiotic therapy and device extraction; therefore, the real winning strategy in this situation could be represented by prevention. Antibiotic prophylaxis and antibiotic‐releasing envelope are effective in improving patient outcome; however, healthcare costs related to CIED infections remain high over the years. In this review we would keep the attention on a pre‐surgical checklist to reduce the risk of CIED infections. In fact, checklist is an effective instrument for medical care quality improvement mainly used in surgery, but not very commonly in cath‐lab and electrophysiology procedures. All steps of this checklist are of proven effectiveness in reducing the risk of CIED infections but, up till now, they are not considered together in a pre‐surgical approach.

Prevention of device‐related infections in patients with cancer: Current practice and future horizons

“…In addition to the general surgical recommendations described above, the identification of modifiable risk factors is important because it may allow for further preventive measures to reduce the risk of CIED infection. 39 These include preventive preprocedural measures supported by scientific consensus, such as: (1) provision of perioperative systemic antimicrobials 95 ; (2) use of a preoperative checklist 101 , 102 ; (3) delay of CIED implantation in patients with infection or fever for at least 24 hours; (4) avoidance of CVADs when introducing a CIED, when feasible 39 ; and (5) measures to decrease the risk of pocket hematoma (increasing platelet count to >50,000/μl, discontinuation of antiplatelet medications within 5–10 days before the procedure, avoidance of therapeutic low-molecular-weight heparin and a bridging approach with heparin, and holding of anticoagulation therapy until the risk of bleeding has diminished in patients with a history of deep venous thrombosis or CHA 2 DS 2 -VASc score <4). 39 The latter three measures are commonly encountered in the cancer population and should be closely addressed.…”