1. Preparation
WHAT IS A CARDIAC ELECTROPHYSIOLOGY STUDY?
Electricity usually flows through the heart in a pattern that is ordered and regular. The hearts electrical system initiates contractions or beats of the heart muscle. In a healthy heart, the electrical conduction system produces a carefully coordinated contraction which enables the heart to function effectively as a pump and push blood around the body.
Disruption of one or more of the electrical pathways may result in a cardiac arrhythmia or unusual rhythm which will usually cause the heart to beat less effectively. Whilst some arrhythmias are life threatening, others can be relatively harmless. Symptoms of arrhythmia may include persistent palpitations (being aware of your heart beating), dizziness, chest pain, shortness of breath and fainting.
The precise nature and, if possible, cause of the abnormal heart rhythm need to be diagnosed to enable selection of the best treatment. As part of his or her investigation into possible cardiac arrhythmia, your doctor may recommend a test called Cardiac electrophysiology study (EPS). Whilst EPS is a fairly invasive test and involves catheters being placed in the heart, it allows your specialist to collect and analyse very precise data about your hearts electrical activity.
WHY IS IT DONE?
Non-invasive tests such as an electrocardiogram (ECG) or a holter monitor (which involves monitoring the hearts rhythm over a 24-48 hour period) can provide valuable information about the hearts electrical activity. However, in many cases the arrhythmia is intermittent and therefore not captured at the time of these tests, which only record activity during the time of attachment.
During an EPS study the specialist can actually provoke an arrhythmia which then enables extremely precise data to be collected about the abnormal electrical activity. It is also possible that the problem can be treated during the study. This may involve using a special catheter to ablate or remove a cluster of cells responsible for the abnormal rhythm. It may also be necessary to implant an artificial pacemaker to initiate and control the heart rhythm or a defibrillator which can interrupt any life threatening arrhythmias.
HOW DO I CHOOSE A SPECIALIST?
Your GP or cardiologist will be able to recommend and refer you to a cardiologist who has completed further specialist training in EPS.
You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.
The list of questions below may help you to better understand your care, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Cardiologists who participate in HCF’s Medicover no gap arrangement:
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
-
If your doctor recommends a pacemaker or defibrillator, will this be done at the same time or on a separate occasion?
-
Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products)
-
Blood thinners (Warfarin, heparin.)
-
Arthritis medication
-
Pain medication
-
Anti-inflammatory medication
-
Insulin
Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.
WHERE IS IT DONE?
An electrophysiology study is done in a special room called an EPS laboratory, located within a hospital. It is often attached to the cardiac ward or coronary care unit. The average length of stay is approximately 2 days.
HOW LONG IS THE PROCEDURE?
Although a simple cardiac electrophysiology test generally takes anywhere from 20 minutes to one hour, it may take longer if other procedures are required for treatment of the problem.
WHO IS INVOLVED?
The people involved in the procedure are:
-
The Electrophysiologist, your Specialist doctor
-
Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Nurses for the procedure and recovery
-
Technicians who assist with the machinery
HOW DO I PREPARE FOR AN ELECTROPHYSIOLOGY STUDY?
In most cases you will be required to fast for six to eight hours prior to the procedure.
Your doctor will have his/her own specific preparation requirements, including possibly stopping some of your medication. These instructions should be strictly followed or the procedure may not be able to go ahead, or be unsatisfactory and have to be repeated later.
WHAT DO I TAKE WITH ME TO THE HOSPITAL?
-
Do not bring any valuables with you
-
Leave all jewellery at home, a wedding ring is acceptable
-
Wear comfortable clothing
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Bring any relevant x-rays or scans
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
For your information, the average charges for claims paid for Cardiac Electrophysiology Study admissions for the financial year 09/10 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$6,169
|
$0
|
$6,021
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$704
|
$301
|
$361
|
$269
|
15.8%
|
$0
|
84.2%
|
|
Cardio-Thoracic Surgical Services
|
$1,885
|
$1,140
|
$745
|
$0
|
0.0%
|
$0
|
100.0%
|
|
Pathology Services
|
$150
|
$82
|
$57
|
$98
|
12.5%
|
$0
|
87.5%
|
|
Specialist Consultation
|
$315
|
$177
|
$128
|
$362
|
2.6%
|
$0
|
97.4%
|
|
Radiology Services
|
$403
|
$211
|
$187
|
$104
|
5.6%
|
$0
|
94.4%
|
|
2
Total Average Medical Services
|
$2,797
|
$1,602
|
$1,160
|
$334
|
10.4%
|
$0
|
89.6%
|
|
Hospital and Medical Services Average for Cardiac Electrophysiology Study Admissions
|
$8,966
|
$1,602
|
$7,181
|
$334
|
10.4%
|
$0
|
5
89.6%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 48 overnight admissions with an average length of stay of 1.7 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 38209 and 38212.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($2,797) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all cardiac electrophysiology study admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE HOSPITAL?
When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. In most cases a local anaesthetic is given which means that you will be awake throughout the procedure but will not feel anything. In rare cases a general anaesthetic is used if necessary.
An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.
In preparation, the nurse may shave or clip your groin area and ask you to shower using an antiseptic soap.
WHAT CAN I EXPECT DURING THE PROCEDURE?
Once you are in the EPS room, you will be given a sedative injection through a cannula (small plastic tube) into a vein in your arm or hand. Although this is not the same as having a general anaesthetic, many people will sleep or remain drowsy through the entire procedure.
Sometimes people are awake, although calm, and may even watch the procedure on the video screen (although they may not remember this afterwards). Local anaesthetic will be injected into the site of catheter insertion which is usually your right groin but occasionally veins in your neck.
Although you may feel some discomfort it is not a painful procedure. You will be covered in sterile drapes to ensure the insertion area remains clean.
At least 2 flexible narrow tubes called catheters will be inserted into the chosen vein(s). The catheters are inserted through either a tiny incision or via a needle-stick. The number of catheters needed for an electrophysiology study is dependent upon the type of arrhythmia and whether any treatment is to be given.
The catheters are carefully threaded to specific locations in your heart, using the guidance of an x-ray machine called a fluoroscope. The images appear on a monitor.
Electrodes at the tips of the catheters record various measurements that allow the electrophysiologist to analyse heart rhythm and electrical activity. Electrical impulses are then sent through the electrodes to stimulate or pace the heart muscle. In addition to gathering data, this process can be used to produce arrhythmia’s that can then be recorded and analysed. At this stage, medication to induce arrhythmia may also be used.
Depending on the findings, your specialist may decide to use radio-frequency ablation to treat the abnormal electrical pathway that is causing the arrhythmia. This option should have been discussed and your consent obtained prior to the procedure. Ablation is achieved by inserting a special catheter, guiding it to the area identified as causing the problem and using the tip of the catheter to transmit high frequency radio waves to destroy a minute area of tissue. Sometimes this method achieves a complete and permanent cure, in other instances you may have to continue taking anti-arrhythmia drugs indefinitely or occasionally, the ablation has to be repeated at a later date.
It is becoming more and more common for pacemakers and defibrillators to be inserted in the electrophysiology laboratory, and on occasion, this can be done at the time of the original study (providing your prior consent has been sought).
When the electrophysiology study and treatment is complete, the catheters are removed and pressure is applied to the insertion site or sites.
You will then be taken to the recovery area, cardiac ward or coronary care unit, depending on the nature of your study and the hospital in which you are being treated.
3. Aftercare
WHAT HAPPENS AFTER THE PROCEDURE?
You will be carefully monitored by nurses who will check the catheter insertion site, monitor your heart rhythm and basic vital signs such as blood pressure, pulse and breathing. You will need to remain flat and immobile, usually for four hours, so that a clot can form at the site of the catheter insertion.
Before discharge, you should be given specific instructions from either your specialist or the nurses looking after you concerning issues such as wound care, medication changes and level of activity/lifting. If you are discharged that day, you will not be able to drive home as you have received intravenous sedation, so you should arrange for someone to escort you home and, if possible, stay with you overnight. If this presents a problem for you please advise the hospital or your doctor prior to admission.
You will be given advice regarding your follow up care, and situations for which you should seek immediate help. These may include symptoms such as chest pain, and bleeding, discharge or excessive pain from the insertion site.
1. Preparation
WHAT IS A CARDIAC ELECTROPHYSIOLOGY STUDY?
Electricity usually flows through the heart in a pattern that is ordered and regular. The hearts electrical system initiates contractions or beats of the heart muscle. In a healthy heart, the electrical conduction system produces a carefully coordinated contraction which enables the heart to function effectively as a pump and push blood around the body.
Disruption of one or more of the electrical pathways may result in a cardiac arrhythmia or unusual rhythm which will usually cause the heart to beat less effectively. Whilst some arrhythmias are life threatening, others can be relatively harmless. Symptoms of arrhythmia may include persistent palpitations (being aware of your heart beating), dizziness, chest pain, shortness of breath and fainting.
The precise nature and, if possible, cause of the abnormal heart rhythm need to be diagnosed to enable selection of the best treatment. As part of his or her investigation into possible cardiac arrhythmia, your doctor may recommend a test called Cardiac electrophysiology study (EPS). Whilst EPS is a fairly invasive test and involves catheters being placed in the heart, it allows your specialist to collect and analyse very precise data about your hearts electrical activity.
WHY IS IT DONE?
Non-invasive tests such as an electrocardiogram (ECG) or a holter monitor (which involves monitoring the hearts rhythm over a 24-48 hour period) can provide valuable information about the hearts electrical activity. However, in many cases the arrhythmia is intermittent and therefore not captured at the time of these tests, which only record activity during the time of attachment.
During an EPS study the specialist can actually provoke an arrhythmia which then enables extremely precise data to be collected about the abnormal electrical activity. It is also possible that the problem can be treated during the study. This may involve using a special catheter to ablate or remove a cluster of cells responsible for the abnormal rhythm. It may also be necessary to implant an artificial pacemaker to initiate and control the heart rhythm or a defibrillator which can interrupt any life threatening arrhythmias.
HOW DO I CHOOSE A SPECIALIST?
Your GP or cardiologist will be able to recommend and refer you to a cardiologist who has completed further specialist training in EPS.
You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.
The list of questions below may help you to better understand your care, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Cardiologists who participate in HCF’s Medicover no gap arrangement:
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
-
If your doctor recommends a pacemaker or defibrillator, will this be done at the same time or on a separate occasion?
-
In addition to what the procedure involves, you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products)
-
Blood thinners (Warfarin, heparin.)
-
Arthritis medication
-
Pain medication
-
Anti-inflammatory medication
-
Insulin
Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.
WHERE IS IT DONE?
An electrophysiology study is done in a special room called an EPS laboratory, located within a hospital. It is often attached to the cardiac ward or coronary care unit. The average length of stay is approximately 2 days.
HOW LONG IS THE PROCEDURE?
Although a simple cardiac electrophysiology test generally takes anywhere from 20 minutes to one hour, it may take longer if other procedures are required for treatment of the problem.
WHO IS INVOLVED?
The people involved in the procedure are:
-
The Electrophysiologist, your Specialist doctor
-
Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Nurses for the procedure and recovery
-
Technicians who assist with the machinery
HOW DO I PREPARE FOR AN ELECTROPHYSIOLOGY STUDY?
In most cases you will be required to fast for six to eight hours prior to the procedure.
Your doctor will have his/her own specific preparation requirements, including possibly stopping some of your medication. These instructions should be strictly followed or the procedure may not be able to go ahead, or be unsatisfactory and have to be repeated later.
WHAT DO I TAKE WITH ME TO THE HOSPITAL?
-
Do not bring any valuables with you
-
Leave all jewellery at home, a wedding ring is acceptable
-
Wear comfortable clothing
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Bring any relevant x-rays or scans
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
For your information, the average charges for claims paid for Cardiac Electrophysiology Study admissions for the financial year 09/10 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$6,169
|
$0
|
$6,021
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$704
|
$301
|
$361
|
$269
|
15.8%
|
$0
|
84.2%
|
|
Cardio-Thoracic Surgical Services
|
$1,885
|
$1,140
|
$745
|
$0
|
0.0%
|
$0
|
100.0%
|
|
Pathology Services
|
$150
|
$82
|
$57
|
$98
|
12.5%
|
$0
|
87.5%
|
|
Specialist Consultation
|
$315
|
$177
|
$128
|
$362
|
2.6%
|
$0
|
97.4%
|
|
Radiology Services
|
$403
|
$211
|
$187
|
$104
|
5.6%
|
$0
|
94.4%
|
|
2
Total Average Medical Services
|
$2,797
|
$1,602
|
$1,160
|
$334
|
10.4%
|
$0
|
89.6%
|
|
Hospital and Medical Services Average for Cardiac Electrophysiology Study Admissions
|
$8,966
|
$1,602
|
$7,181
|
$334
|
10.4%
|
$0
|
5
89.6%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 48 overnight admissions with an average length of stay of 1.7 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 38209 and 38212.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($2,797) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all cardiac electrophysiology study admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE HOSPITAL?
When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. In most cases a local anaesthetic is given which means that you will be awake throughout the procedure but will not feel anything. In rare cases a general anaesthetic is used if necessary.
An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.
In preparation, the nurse may shave or clip your groin area and ask you to shower using an antiseptic soap.
WHAT CAN I EXPECT DURING THE PROCEDURE?
Once you are in the EPS room, you will be given a sedative injection through a cannula (small plastic tube) into a vein in your arm or hand. Although this is not the same as having a general anaesthetic, many people will sleep or remain drowsy through the entire procedure.
Sometimes people are awake, although calm, and may even watch the procedure on the video screen (although they may not remember this afterwards). Local anaesthetic will be injected into the site of catheter insertion which is usually your right groin but occasionally veins in your neck.
Although you may feel some discomfort it is not a painful procedure. You will be covered in sterile drapes to ensure the insertion area remains clean.
At least 2 flexible narrow tubes called catheters will be inserted into the chosen vein(s). The catheters are inserted through either a tiny incision or via a needle-stick. The number of catheters needed for an electrophysiology study is dependent upon the type of arrhythmia and whether any treatment is to be given.
The catheters are carefully threaded to specific locations in your heart, using the guidance of an x-ray machine called a fluoroscope. The images appear on a monitor.
Electrodes at the tips of the catheters record various measurements that allow the electrophysiologist to analyse heart rhythm and electrical activity. Electrical impulses are then sent through the electrodes to stimulate or pace the heart muscle. In addition to gathering data, this process can be used to produce arrhythmia’s that can then be recorded and analysed. At this stage, medications to induce arrhythmia may also be used.
Depending on the findings, your specialist may decide to use radio-frequency ablation to treat the abnormal electrical pathway that is causing the arrhythmia. This option should have been discussed and your consent obtained prior to the procedure. Ablation is achieved by inserting a special catheter, guiding it to the area identified as causing the problem and using the tip of the catheter to transmit high frequency radio waves to destroy a minute area of tissue. Sometimes this method achieves a complete and permanent cure, in other instances you may have to continue taking anti-arrhythmia drugs indefinitely or occasionally, the ablation has to be repeated at a later date.
It is becoming more and more common for pacemakers and defibrillators to be inserted in the electrophysiology laboratory, and on occasion, this can be done at the time of the original study (providing your prior consent has been sought).
When the electrophysiology study and treatment is complete, the catheters are removed and pressure is applied to the insertion site or sites.
You will then be taken to the recovery area, cardiac ward or coronary care unit, depending on the nature of your study and the hospital in which you are being treated.
3. Aftercare
WHAT HAPPENS AFTER THE PROCEDURE?
You will be carefully monitored by nurses who will check the catheter insertion site, monitor your heart rhythm and basic vital signs such as blood pressure, pulse and breathing. You will need to remain flat and immobile, usually for four hours, so that a clot can form at the site of the catheter insertion.
Before discharge, you should be given specific instructions from either your specialist or the nurses looking after you concerning issues such as wound care, medication changes and level of activity/lifting. If you are discharged that day, you will not be able to drive home as you have received intravenous sedation, so you should arrange for someone to escort you home and, if possible, stay with you overnight. If this presents a problem for you please advise the hospital or your doctor prior to admission.
You will be given advice regarding your follow up care, and situations for which you should seek immediate help. These may include symptoms such as chest pain, and bleeding, discharge or excessive pain from the insertion site.