Allied Professionals Community of Practice

Hi Andrea,

We have not seen the phenomenon with Lux loop recorders.  We had a similar issue with a Linq; which interestingly enough,  procedure was done by a non-EP physician.  The technique was questionable.  Hope this helps.

Having implanted and removed ILRs from the early days through the present iteration of devices, my experience from referrals for problems over the years has shown that whenever a device herniates back through the implant incision, it's due to implant technique.  (The most challenging case I've ever seen was when an young woman's ILR was implanted subcutaneously in her breast and it subsequently migrated beneath her nipple.)

Common mistakes include significant incisional beveling (not making the incision perpendicular to the skin), not advancing the insertion tool far enough, not making certain the ENTIRE device is on the chest wall and not superficially angled back toward the incision, placing the device within breast tissue (female or male), and, surprisingly enough, not making the incision large enough to ensure the end of the device is indeed down on the chest wall and not angled up subcutaneously.

As far as wound closure is concerned, I was amazed to read staples are being used; they tend to hurt more than suture, particularly when removing them.  Sure, they help prevent the device from herniating back out, but proper technique would be the better solution.

When teaching my fellows, I would have them start out with a little larger incision (using an 11 blade rather than the tool that comes with the device) and then Metzenbaum scissors to dissect down to the muscular fascia before inserting the device delivery tool.  Once they were confident with their technique, the incision could be shorter in length as long as they could confirm they were down on fascia.  Once the device was deployed, a single deep dermal horizontal mattress suture with 2-0 Vicryl was used to close the tissue sufficient to take tension off the skin closure, which was done with 4-0 Monocryl in a running subcuticular manner.  Dermabond (skin glue) was used primarily as a waterproof barrier and dressing so the patient could shower in 24 hours.  This technique served me well with excellent cosmetic results and no complaints of pain or discomfort.

Hope this may be of help,

Lyle

Hi Lyle,

Thank you for your generous knowledge sharing; as I am beginning to do these procedures, it is invaluable to have an experienced clinician share "pearls of wisdom".  So  helpful!  #Teamwork   #WeAreHRS

We implant the Medtronic Linq and the Boston Lux device.  We currently have 223 patients with Lux monitors.  Most of our physicians prefer to staple the incision afterwards.  We have one physician that prefers surgical glue.  We have had only had one occurrence early on where a patient reported his device fell out that I am aware of.  Thanks for sharing your experience as this is something we will monitor.

Best regards,

We follow or have followed 1200 Linq and Lux devices.

I have seen one Linq dislodgement and one LUX dislodgement.

Both were early in the implant process, so I believe it was most likely implanter technique.

Sallie Gustafson, RN, CCDS

Sr Manager, Emory Cardiac Device Clinics

404.778.4942

Our clinic is almost exclusively Lux and we have not seen an issue with this. 

Regina M. Taylor, RN, CDRMS

Device Clinic Charge Nurse

EP Nurse Educator

HH The Heart Center

rmtaylor@theheartcenter.md

(256) 801 -6647