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Level 3Condition Workflows

Device / Wound Concern Calls

Triage pacemaker/ICD site and device concerns — infection signs, device symptoms, and escalation.

Intermediate~14 min

Learning Objectives

  • 1.Recognize device-pocket infection and wound red flags.
  • 2.Identify symptoms suggesting a device or rhythm problem.
  • 3.Route device/wound calls by urgency.

Purpose

After a pacemaker/ICD implant, the wound and device function are the watch points. Pocket infections and shocks need prompt attention.

What to ask

  • •Wound/pocket: redness, swelling, warmth, drainage, opening, increasing pain?
  • •Fever or feeling systemically unwell?
  • •ICD shock(s)? How many, and how do they feel now?
  • •Symptoms: dizziness, fainting, palpitations, prolonged hiccups (lead issue)?
  • •Following arm/activity restrictions; remote monitor set up?

Red flags

  • •Wound redness/warmth/drainage, opening, or fever (pocket infection).
  • •Single ICD shock → urgent contact; multiple shocks → emergency (911/ED).
  • •Fainting, near-fainting, or sustained palpitations.

Escalate

Multiple ICD shocks, or device-site infection signs (fever, drainage, spreading redness) → 911/ED or urgent provider contact per severity. A single shock with the patient feeling well → urgent same-day provider contact.

What to send the provider

  • •Wound description, fever, number/feel of shocks, associated symptoms, restrictions/monitor status, urgency read.

Patient education script

  • •"Watch the incision for redness, drainage, or fever and call us."
  • •"One shock: call us today. More than one shock, or you feel unwell: call 911."

Mini case

An ICD patient calls: received 3 shocks in the last hour and now feels dizzy.

What now?

Show answer

Multiple ICD shocks (a "shock storm") with symptoms is an emergency — direct to 911/ED and notify the provider/EP team immediately. Don’t schedule a routine device check.

Checklist

  • Assessed wound/pocket for infection signs.
  • Asked about number and feel of any ICD shocks.
  • Screened for fainting/palpitations.
  • Escalated multiple shocks and infection signs.

Knowledge Check Quiz

Disclaimer: This content is for educational purposes only. It is not medical advice, does not replace clinical judgment, and is not a substitute for institutional protocols or certified medical interpreters. No patient health information (PHI) should be entered into this application.