Tips for preventing hematoma and infection after pacemaker implantation

Background: The purpose of the study was to identify the clinical factors associated with hematoma formation after PM or ICD device implantation and how to prevent it. Methods: Fifty patients (group 1) were subjected to local measures such as electrocautery use and intra-pocket hydrogen peroxide (3%, diluted 50% with NaCl) application. Fifty other patients (group II) were implanted with the device during an era when cauterization was not available or not used, and no such solution was considered at that time. A hematoma was defined as palpable swelling with fluctuance over the device generator. Hematomas were categorized into 3 groups: Type 1 did not extend beyond 1 cm past the device margin, and type 2, hematoma, extended beyond 1 cm past the device margin. Clinically significant device-pocket hematoma (type 3) when hematoma needed evacuation. With this approach, device pocket evacuation was only performed in 4 cases. Good compression was adopted in all cases. In Group 1 there were four patients (8%) that had a mild hematoma and a grade 2 hematoma on one. Group 2: 9 (18%) had hematoma, and 5 (10 %) patients had hematoma grade 1. 2 patients had hematoma grade 2, and 2 patients had hematoma grade 3; the P value was <0.05. No infections had happened except in one in the grade 3 hematoma. So total types 2 or 3 were 5/100 patients (2.5%). So, the use of electrocautery and intra-pocket hydrogen peroxide was beneficial in preventing hematoma and infection.