PIG Meeting: 4th March 2021

Case study:

• 65yo patient for gynae surgery at another institution
• Patient arrived with a black arm band identifying her as having a cochlear implant and specifying diathermy may not be used.
• Conflicting advice/understanding from surgeon/nearby ENT surgeon/anaesthetist about what may/may not be used.
• Damage to the device or surrounding tissues is an extreme adverse outcome for these patients.

Discussion

•  Summary of various guidelines:
  • No monopolar diathermy for Head and Neck surgery due to risk of damage to the device and surrounding tissue through current induction. Monopoly diathermy use elsewhere in the body necessitates placing the grounding plate distant from the device site, to ensure current flow is not through the device.
  • Bipolar diathermy must be at least 1cm away from the entire Cochlear device.
  • MRI compatibility depends on the device type, time since implantation and MRI machine type/capabilities. All cochlears have an internal magnet. Some devices are MRI compatible, some need the magnet removed first and some are not MRI-compatible. External components usually need to be removed and pressure bandaging of the head may be required. Consultation between MRI staff and cochlear device company must occur. More info at https://www.oticonmedical.com/cochlear-implants/new-to-cochlear-implants/living- with-a-cochlear-implant
  • No ECT
  • Diagnostic and therapeutic US may pose a risk to the device and should not be used over the implant site.
• Similar issues exist for peripheral nerve stimulators, spinal cord stimulators and deep brain stimulators.
  • In addition the device should be switched off by patient, where possible.
  • Consideration of the disease process for which it was implanted (e.g. PD) and therefore the implications of switching off the device -> consult with the managing clinician.