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The patients with Implantable Pulse Generator (IPG)
battery inside the body should take following precautions during
their lifetime:
- There
is a possibility of EMI - Electromagnetic Interference with following
devices and equipments so their use should be avoided.
-
Commercial electrical equipments e.g. Arc welders, Induction
furnaces, Resistant welders
- Communication
equipments e.g. microwave transmitters, power amplifiers,
- High-power
amateur transmitters
- High
voltage power lines
- Theft
detectors and screening devices
- Other
sources of EMI in the home or occupational environment unlikely
to interfere with Neurostimulator operation include the following:
- Home
appliances that are properly grounded and in good working
order.
- Cellular
phones - It is recommended that it should not be kept
in the pocket of the shirt over the area of pacemaker.
- Electrical
or fire cremation should not be performed with the IPG in-situ.
It may produce an explosion. IPG should be removed and safely
disposed off. (Return all explanted components to Medtronic for
analysis and safe disposal.)
- Diathermy
should not be used e.g. surgical diathermy, diathermy used for
dental procedure etc. If it is absolutely necessary to use the
diathermy then only bipolar diathermy should be used.
- The
neurostimulation system may affect the operation of other implanted
devices, such as cardiac pacemakers and implantable defibrillators.
Possible effects include sensing problems and inappropriate devices
responses. If the patient requires concurrent implantable pacemaker
and/or defibrillator therapy, careful programming of each system
may be necessary to optimize the patient's benefit from each device.
- It
can also interfere with ECG tracing. Repositioning the ECG leads
away from the pacemaker can rectify this interference.
- External
defibrillation may damage a Neurostimulator. If external defibrillation
is necessary and the situation permits, follow these precautions
to minimize current flowing through the neurostimulator and lead-extension
system:
- Position
defibrillation paddles as far from the neurostimulator as
possible.
- Position
defibrillation paddles perpendicular to the implanted neurostimulator-lead
system.
- Use
the lowest clinically appropriate energy output (watt seconds).
- Confirm
neurostimulation system function following any external defibrillation.
- Proper
shielding of the device should be done so as to exclude it from
the field of radiation.
- The
ultrasonic devices like Electrohydraulic Lithotriptor should not
be used. If the use is mandatory; the beam should not be focused
near the stimulator.
- Patients
with an implanted device should not be exposed to the electromagnetic
fields produced by magnetic resonance imaging (MRI). Use of MRI
may potentially change the neurostimulator settings, activate
the device, or induce voltages in the neurostimulator and/or lead.
An induced voltage through the neurostimulator or lead may cause
uncomfortable, "jolting," or "shocking" levels of stimulation.
Additionally, MRI may dislodge or heat the lead. Any of the above
effects may potentially injure the patient. Patients exposed to
the electromagnetic fields generated from an MRI should be closely
monitored, and programmed parameters verified upon cessation of
MRI. However, recent study by Tronnier et al., 1999 on the effects
of MRI on IPG has shown that there was no significant heat induction
due to MRI.
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