Temporary ICD deactivation with a magnet
In the OOH setting you may encounter a situation where a patient with an ICD is requiring end of life care in the community.
Our local ICD clinics are engaged in anticipatory deactivation of ICDs in patients approaching the end of life who no longer want or would benefit from shock therapy. If the patient, relatives or carers are unsure if the ICD is deactivated you should contact the Bristol Royal Infirmary Cardiology SpR on-call to clarify (bleep number 6527).
We stock ICD magnets at the overnight bases (Christchurch, Marksbury Road and 168 Medical). The magnets are very strong. It is therefore not advisable to have any mobile phones/credit cards/other electronic devices/ICD/pacemaker or other implantable device within a 7 cm range of the magnet as lasting damage can occur. The magnets are stored in a plastic box with a warning sign on top. When transporting the magnets to a visit please place them in the glovebox of the car.
If your patient's ICD is active and you need to immediately deactivate the device shock function, please do the following:
- Apply the doughnut shaped magnet over the site of the ICD location.
- Tape the magnet firmly to the patient’s skin
Applying this magnet when the ICD is actively delivering shocks poses no risk to the attending healthcare professional. Please note, when the magnet is removed all shock therapies will immediately resume.
The ICD deactivation magnet can be left in position as an immediate deactivation bridge. If needed, the patients ICD team can arrange a home visit to perform a permeant device deactivation in working hours. After securing the ICD magnet please email the ICD team (ubh-tr.bhiarrhythmianurses@nhs.net) with the patient’s name, DOB, NHS number to request that they consider attendance.
Please advise the patient’s family that SevernSide will contact them at a later date to retrieve the magnet. Make sure the family are aware of the risks associated with the magnet. Please place a contact number/address for the family at the top of the notes and ask the shift manager to add this to the shift report for the operational team.
Operational team, please consider the following when following up from the shift report:
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supply a new magnet to the relevant treatment centre immediately
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ask a clinical colleague to check EMIS to see if the patient has been admitted to hospital or if they have died before contacting the family to arrange to retrieve the magnet
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consider contacting the ICD team to see if they have had follow up involvement
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consider contacting Sirona if they have had involvement to see if the magnet has been retrieved by them
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if the patient has passed away send a letter to the family with an offer to retrieve the magnet reminding them of the care that should be taken around the item