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In this video, Lauren Sell, MSN, APRN, CPNP, discusses her presentation from Heart Rhythm 2024.

My name is Lauren Sell, and I'm a pediatric nurse practitioner at the Children's Hospital of Orange County. At Heart Rhythm 2024, I presented on best practices for wound care and follow-up. This topic is really important, as putting a device into any patient, regardless of whether it’s a pediatric or adult patient, is a very big deal. We're committing these patients to a device that is going to be with them potentially for the rest of their lives. So, it's very important for us to focus on the care that we are providing them in the immediate post-operative period and long-term period.

The biggest risk factor with getting a device is in the immediate post-operative period, when you are at a high risk for infection, a lead complication. So, we really want to make sure that we are following these patients appropriately to prevent major complications. At our center, we unfortunately did experience a couple of surgical site infections and had to explant 2 devices. That prompted us to really take a look at our post-op care and how we were providing this to our patients. 

We did an internal review with our infection prevention team, and we found a couple of tangible things that we could improve on to decrease our risk of infection. Some of those were located in the pre-operative area and the cath lab itself, but there were some from an allied professional/physician perspective that we could improve on, and that was mainly standardization of our post-operative care for these patients. 

We do have 2 implanting providers at our center, and at this time, they both have very different views on how we manage surgical wounds and any sort of complication that could arise and at what intervals do we follow these patients. So, we sat down and collaborated, looking at the most recent guidelines and recommendations from both PACES and the Heart Rhythm Society, and we came up with a new immediate post-operative plan on how we were going to follow these patients and what type of wound care we were actually going to provide. 

So, myself and one of our clinical nurse specialists in the ICU revamped our post-operative education materials to reflect that of the current recommendations and guidelines. Then, the physicians themselves collaborated on how they were going to standardize their operative technique, how they close the wounds, and how they dress the wounds following device placement. This is very important in the pediatric patient population, because these patients are going to go on to have multiple device procedures, and with each device procedure that they have, their increased risk of infection or complication continues to climb. So, we really need to be mindful and very meticulous, especially during that first device implant, that we're providing them with the appropriate care to prevent major complications like a lead complication or a wound complication that could lead to needing to explant the device.

The transcripts have been edited for clarity and length.