Pocket Hematoma after Pacemaker Placement A rare, but can't-miss complication from pacemaker placement. Low incidence (1-9%) overall, but increased risk of infection, thromboembolism, & higher mortality. Pressure-induced necrosis Rightwards arrowskin breakdown → decreased blood flow → higher walled-off area at risk for infection. Staph is found in ~50% of these hematomas Elderly are most at risk! loose sub-q tissue, less muscle tone. Dual antiplatelet activity is a 6x risk compared to ASA alone. Heparin increases risk by 20-fold. Weirdly enough, warfarin & Factor X agent use has a LOWER risk. The biggest complication is abscess formation (pocket infection). Incisional dehiscence can also occur. Prevention includes OR-cardiology techniques and fibrin sealants, pocket compression vests etc. Tx: conservative is most common w/ compression dressing. Exploration is needed if hematoma expands more or if there if wound dehiscence or skin necrosis. NEVER attempt to drain it with a needle. Systemic antibiotics are indicated against skin/soft tissue flora if there is erythema, systemic signs (fever), and/or purulent drainage. Empiric or prophylactic ABX are not indicated in all pocket hematomas. Dr. Blake Briggs @blakebriggsMD #Pocket #Hematoma #clinical #Pacemaker #photo #cardiology
