Allied Professionals Community of Practice

  • 1.  Lux vs Linq

    Posted 06-28-2022 23:27

    In the past year my institution has transitioned to implanting Lux as our primary Implantable cardiac monitor. We have since noted two devices which have become dislodged/fallen out of the patient from the incision site. I'm curious if others centers have seen this with Lux and could it be potentially related to the implant technique/design or just a coincidence as we did not see it with the Linq device. 

    Thanks!
    Andrea Robinson 



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    Andrea Robinson MSN, ACNP
    Nurse Practitioner
    Riverside Methodist Hospital, OhioHealth
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  • 2.  RE: Lux vs Linq

    Posted 06-29-2022 05:45

    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.

     

    Regards,

     

    Martha G. Ferrara, DNP FNP CCDS FHRS

    Assistant Director EP Services

    White Plains Hospital

    HRS AP Council Chairwoman

    MFerrara3@wphospital.org

    @MGMayanrn

     




    Original Message


  • 3.  RE: Lux vs Linq

    Posted 06-30-2022 17:40

     

    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

     




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  • 4.  RE: Lux vs Linq

    Posted 07-01-2022 11:38

    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

     

    Regards,

     

    Martha G. Ferrara, DNP FNP CCDS FHRS

    Assistant Director EP Services

    White Plains Hospital

    HRS AP Council Chairwoman

    MFerrara3@wphospital.org

    @MGMayanrn

     




    Original Message


  • 5.  RE: Lux vs Linq

    Posted 06-29-2022 07:55

    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,

     

    Michael Silva, RN, RCES
    Arrhythmia Clinic Supervisor, Cardiology
    msilva@wellspan.org
    Office 717-741-8672
    30 Monument Rd York, PA 17403

    Chat with me on Microsoft Teams

     

     

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  • 6.  RE: Lux vs Linq

    Posted 06-29-2022 13:35

    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

     




    Original Message


  • 7.  RE: Lux vs Linq

    Posted 06-29-2022 15:58

    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

     




    Original Message


  • 8.  RE: Lux vs Linq

    Posted 06-29-2022 17:46
     I have not seen this, and I am primarily  the one inserting them at our center. I tend to prefer Boston's platform for monitoring, so that is mostly what I implant.

    I have had the experience where the device gets hung up when trying to advance it past the skin. It usually requires reloading it inthe delivery tool- but I've not yet failed to get it placed. I'm not certian if it is related to patient factors or the tool. Possibly in thise pts the device is more superficial.  

    Do you commonly use suture to close? I usually use a 4.0 surelock. At times,  I feel it may be overkill- but it's how I was trained. 

    Your center likely has a higher volume, so it would be interesting to see if there is a trend.  




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  • 9.  RE: Lux vs Linq

    Posted 06-30-2022 17:39
    We still primarily implant Linq but are implanting some Lux here and there along with the Biotronic loop.  Our APP's implant Linq's exclusively but a couple of our physicians implant the other devices.  We have not had this issue with the Boston device- I see a few in follow-up in clinic with no issues so far.  similar to some of the other centers, our practice is to use absorbable sutures and most of our implanters use a dot of surgical glue externally.  We really don't see device erosions or infections here.

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    Rachel Schreier MSN, ACNP, APRN
    Nurse Practitioner
    Vanderbilt Heart and Vascular
    Nashville TN
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    Original Message


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