How to explant an insertable cardiac monitoring (ICM) device

Learn all about the ICM explantation process in this step-by-step video from our Insertable Cardiac Monitoring Essentials course. You'll cover the equipment needed, the possible complications, and what to do with the device once it has been removed.

Arrhythmias can be difficult to detect. Insertable cardiac monitors (ICMs) can spot rhythm problems when other devices can’t. In our Insertable Cardiac Monitoring Essentials course, you’ll learn about the indications for an ICM implant, the different types of ICMs available, and the techniques used to insert and explant these devices. You’ll also cover data download methods, troubleshooting, and how to make the most out of your ICM devices.

[00:05]
In this lesson, we're going to show you a typical ICM device explant procedure using Medtronic’s Reveal LINQ device as an example. Whichever device you're explanting, always be sure to read the manufacturer's recommendations for how the device should be removed. Before you start, ensure that you have all the necessary equipment ready for the device explant procedure.

Equipment for ICM explant procedure

[00:31]
Here we have an antiseptic for cleaning a patient's skin and a sterile surgical drape for placing over the area where we're going to be explanting the ICM device. We have a syringe and suitable needles for the administration of local anesthetic. And we have a scalpel and suitable instruments for the actual explant procedure. We also have some gauze swabs in case of any blood loss.

ICM explant preparation steps

[01:04]
Palpate the anterior chest wall to locate the ICM device, and then clean the skin over the device using an appropriate antiseptic solution. Identify where you're going to make your incision to remove the device and then administer local anesthetic in that area. We normally use lidocaine with adrenaline, also known as epinephrine, to provide good local anesthesia with a reduced risk of bleeding. Check that the local anesthetic is working, and, if so, make a small skin incision at one end of the device through which you intend to explant it.

ICM device removal

[02:09]
Pay careful attention to hemostasis throughout your procedure. Using blunt dissection, and with careful attention to hemostasis throughout, slowly and carefully work the ICM device loose. This can sometimes be tricky as the device may have become adherent to surrounding tissues. Once the device is freely mobile, it can then be extracted through the incision using the forceps. 

ICM device disposal

[03:00]
Put the explanted device safely to one side for the moment. Once you've completed the extraction procedure, the device should be cleaned using a solution of at least 1% sodium hypochlorite, followed by rinsing in water. The device should then be returned to the manufacturer for environmentally friendly disposal. The device must never be incinerated because the presence of a lithium battery means there is a risk of explosion. 

Post-procedure steps

[03:35]
Once hemostasis has been achieved, close the wound using surgical glue, surgical adhesive strips, or with a suture depending upon your preference. Finally, apply a suitable dressing over the wound. Remove the surgical drape and ensure that the patient is well. Before the patient leaves the department, answer any questions and ensure that they understand any subsequent follow-up arrangements.