PADIT-score and device infection in pacemaker or defibrillator surgery 93 and draping. The skin was prepared with antiseptic formulated with 0.5% chlorhexidine digluconate and 70% alcohol and sufficient time was given to allow the antiseptic preparation to dry. After the application of sterile drapes, the operating field was covered by an adhesive iodophor-impregnated incise drape, except in patients who were allergic to iodine. For transvenous lead implantation, the primary choice for venous access was the cephalic vein. For generator replacements and upgrade/revision procedures, we used a pulsed electron avalanche knife (PEAK) PlasmaBlade™ (Medtronic, Minneapolis, MN, USA). This is an electrocautery device which uses pulses of radiofrequency energy to cut and coagulate soft tissue without the thermal damage to surrounding tissues normally seen with traditional electrosurgery. Meticulous attention was paid to hemostasis before wound closure in several layers. The final skin closure was performed with an absorbable suture. A sterile dressing was applied to the wound for a minimum of 4 days. Pressure dressing was only applied in selected patients (e.g., oozing of wound). Patients were instructed to keep the wound dry for a minimum of 4 days. The peri-procedural measures are largely in line with the current EHRA consensus document (16). 2.5. Discharge and follow-up Patients undergoing a generator replacement only were discharged on the same day of the procedure after clinically significant pocket hematoma had been ruled out. Patients undergoing a de novo device implantation, upgrade, or revision were discharged the day after the procedure. On the day of discharge, these patients underwent a physical examination of their device pocket, a device interrogation, a chest X-ray (to rule out pneumothorax and lead dislodgement), and a bed-side echocardiogram (to rule out pericardial effusion). Two weeks after discharge the patients were seen at the outpatient clinic for wound inspection and device interrogation. Thereafter, device interrogation was performed every 6 months with or without remote monitoring. Every 3 months a CIED complication meeting was organized in which all CIED-related complications, including infections, are discussed by the operators. Furthermore, our center organizes a weekly regional multidisciplinary Endocarditis Heart Team in which patients with suspected endocarditis, including CIED-related infections, are discussed. Finally, our center is the only center in the region which performs transvenous lead extractions and is a 6
RkJQdWJsaXNoZXIy MTk4NDMw