Vagus nerve stimulation therapy: patient discharge information (Paediatric)

Your child has been discharged from Addenbrooke's Hospital following surgical implantation of a vagus nerve stimulator (VNS) on ……………. under the care of a consultant neurosurgeon. The following information may be of help after your discharge from hospital.

Will my child be in pain following their operation for VNS?

As you are aware, your child will have two wound sites following this operation, one on the left side of their neck and the other on the left side of their chest. Both wound sites contain soluble stitches with a dressing. These areas will be sore and uncomfortable but should not cause your child severe pain. Any ‘over the counter’ painkillers will be effective if you wish to treat the discomfort. Alternatively, you can ask your child’s doctor prior to discharge, your GP or local chemist for advice.

What should my child avoid doing to prevent any problems with the wound site?

Avoid lifting any heavy objects and be careful with strenuous exercise for the first couple of weeks.

Avoid an MRI for two weeks following surgery. If your child requires an MRI within this period, you must inform the team requesting this of the recent surgery and alternative method of imaging must be sought.

What should I expect with my child’s dressings?

The scar is covered by a dressing. This provides a layer of comfort and protection and can be removed three days after surgery. Do not worry if the dressing does come off before then as the incisions will still be protected by tissue glue. This skin glue will wash off at seven to ten days. The incisions can be gently washed (during a shower or bath) after three days. It is normal for a little discharge of reddish fluid to occur after an operation. If you feel the ooze is increasing, please contact a member of the epilepsy neurosurgery Team at Addenbrooke's Hospital (contact details can be found at the back of the leaflet).

What should I expect with my child’s wounds/ scars?

The skin around both operation areas will be bruised, reddish in colour and swollen for several weeks. The scars will appear very red and swollen initially but will, for most people, gradually fade in colour and size depending upon their healing process. In some cases, the chest scar may remain red, thick and become raised. It is normal to see or feel the neck electrode if your child moves their neck in a specific position. They will also feel the VNS generator under their chest scar, it is normal for the generator to appear as a bump under their scar. The generator may also move slightly under their skin.

What should I do about my child’s stitches?

The stitches are dissolvable and will have dissolved completely within six weeks of surgery. Occasionally these buried stitches may be slow to dissolve or become visible through the scar. If this occurs, they can be trimmed by the Practice Nurse at your child's GP practice.

What should I do if I think the wound area is infected?

Occasionally a wound may become infected, if this happens, your child may feel hot with or without a high temperature. One or both wounds may feel tight or hot, look red and may produce a discharge with an offensive smell. If this occurs, you should contact a member of the epilepsy neurosurgery team at Addenbrooke's Hospital. A course of oral antibiotics may be required, and the wound will be reassessed, cleaned and redressed. Very rarely will the VNS need to be removed due to infection.

When can my child return to school?

This will vary but most children will feel fine within a day or two of the operation and should be safe to return to school around one week after surgery. They will need to avoid boisterous play and contact sports for up to four weeks after surgery.

Can my child swim after surgery?

The scars will be protected with a layer of waterproof tissue glue. While it is safe for your child to have a shower three days after surgery, they should not go swimming for at least 4 weeks.

When will the VNS be switched on?

The VNS is generally pre-programmed in theatre to switch on two weeks after the device has been implanted. The current will increase every 2 weeks for up to 7 steps, you will also have telephone appointments with the Nurse to review how things are.

What should I do about my child’s epilepsy drugs?

Your child should continue taking their medication as usual. You should not stop any of their medication or reduce the dose.

What information will I be given on my child’s discharge from hospital?

When your child gets discharged, you will be given a discharge letter, which you should give to your GP or another doctor/health professional should your child experience any problems. You will be provided with a box of x2 magnets to use with the VNS for future use. You should be provided with a magnet leaflet for instructions of use.[DZ1]

[DZ1]Additional info

How do you switch the VNS on/change settings?

The VNS is switched on using a hand held iPad and wand – please see the pictures below. It is a simple and painless process. The occasional patient feels a tickle at the back of their throat and coughs a little. The magnet kit and information booklet will be fully explained to you and demonstrated, you have plenty of chance to ask questions.

What should I do if my child has a problem following my discharge from hospital or if I do not receive an outpatient appointment for them?

If you have a problem regarding your child, or would like to ask a question or wish to book or rebook a VNS outpatient appointment, please contact:

• Paediatric Epilepsy Nurse Specialist: 01223 586618 or Neurosurgical Nurse Team: Tel: 01223 256658/ 216663

For Appointments contact Tel: 01223 216410

If you need urgent advice out of hours, please contact the nurse in charge of the ward from where you were discharged or attend your local accident and emergency for advice.

Ward:……………………………………………………………………………………………