The patients with Intermittent Pulse Generator (IPG) battery inside the body should take following precautions during their lifetime:
There is a possibility of EMI – Electromagnetic Interference with following devices and equipments so their use should be avoided:
- Commercial electrical equipments e.g. Arc welders
- Induction furnaces, Resistant welders
- Communication equipments e.g. microwave transmitters, power amplifiers,
- High-power amateur transmitters
- High voltage power lines
- Theft detectors and screening devices
Other sources of EMI in the home or occupational environment unlikely to interfere with Neurostimulator operation include the following:
- Home appliances that are properly grounded and in good working order.
- Cellular phones – It is recommended that it should not be kept in the pocket of the shirt over the area of pacemaker.
Electrical or fire cremation should not be performed with the IPG in-situ. It may produce an explosion. IPG should be removed and safely disposed off. (Return all explanted components to Medtronic for analysis and safe disposal.)
Diathermy should not be used e.g. surgical diathermy, diathermy used for dental procedure etc. If it is absolutely necessary to use the diathermy then only bipolar diathermy should be used.
The neurostimulation system may affect the operation of other implanted devices, such as cardiac pacemakers and implantable defibrillators. Possible effects include sensing problems and inappropriate devices responses. If the patient requires concurrent implantable pacemaker and/or defibrillator therapy, careful programming of each system may be necessary to optimize the patient’s benefit from each device.
It can also interfere with ECG tracing. Repositioning the ECG leads away from the pacemaker can rectify this interference. External defibrillation may damage a Neurostimulator. If external defibrillation is necessary and the situation permits, follow these precautions to minimize current flowing through the neurostimulator and lead-extension system:
- Position defibrillation paddles as far from the neurostimulator as possible.
- Position defibrillation paddles perpendicular to the implanted neurostimulator-lead system.
- Use the lowest clinically appropriate energy output (watt seconds).
- Confirm neurostimulation system function following any external defibrillation.
- Proper shielding of the device should be done so as to exclude it from the field of radiation
The ultrasonic devices like Electrohydraulic Lithotriptor should not be used. If the use is mandatory; the beam should not be focused near the stimulator.
Patients with an implanted device should not be exposed to the electromagnetic fields produced by magnetic resonance imaging (MRI). Use of MRI may potentially change the neurostimulator settings, activate the device, or induce voltages in the neurostimulator and/or lead. An induced voltage through the neurostimulator or lead may cause uncomfortable, “jolting,” or “shocking” levels of stimulation. Additionally, MRI may dislodge or heat the lead. Any of the above effects may potentially injure the patient. Patients exposed to the electromagnetic fields generated from an MRI should be closely monitored, and programmed parameters verified upon cessation of MRI. However, recent study by Tronnier et al., 1999 on the effects of MRI on IPG has shown that there was no significant heat induction due to MRI.
Usually MRI is contraindicated in the patients with neurostimulators. However, in case there is a need for MRI, Medtronic has issued the following guidelines for performing MRI in patients with neurostimulator
Different devices interact differently with the neurostimulators. Details of each device and its interaction with various groups of neurostimulators can be found here.