Vagal Nerve Stimulator (VNS) - Discharge Planning

What is a vagal nerve stimulation (VNS) device?

A vagal nerve stimulation (VNS) device is an implant to help control seizure activity.  The device has flexible wires and electrodes attached to a battery pack. The small battery pack, or , will be inserted into your child’s chest muscle during a surgical procedure.

How is the VNS placed?

The VNS is placed by making two incisions (cuts), one on the lower part of the neck and one over the left upper chest just below the collar bone. Small wires, called electrodes, are wrapped around the vagus nerve and  threaded down under the skin to the cut in the chest. The generator will stay in place through a “pocket” made from the chest muscle.  

What to Expect?

Your child may have some mild swelling and bruising following surgery. The swelling and bruising will improve over 1-2 weeks. Your child may have some discomfort. Take acetaminophen (Tylenol®) or ibuprofen (Advil®) to help with pain for a few days following surgery.

• New VNS placement - the system is tested during surgery but not activated (turned on). Devices will be programmed and activated at the post-operative visit.

• Battery Replacement – The battery will be replaced in surgery, activated, and programmed to the same settings.

What can I expect after the surgery?

The new VNS placement will have two incisions, one on the neck and one on the upper chest. The neck incision is closed with a skin glue that will stay on for 5-10 days. The chest incision is closed with stiches that start to dissolve in 2 - 3 weeks. At times, stitches that do not dissolve are used. These will be removed at the 2 week follow-up appointment. For battery changes, your child will only have a chest incision.

Wound care:

Remove the chest bandage 2 days after surgery.

Care of skin glue –The glue with fall off your child’s skin in 5-10 days.

• Do not scratch or pull it off.
• No additional bandages are needed.
• Do not apply ointments, lotions, creams or tape over the glue.
• Do not wash or scrub the incision or glue. If it gets wet, pat dry.

Dissolvable stitches – stitches will start to dissolve after . Your child’s skin can become itchy and turn brighter pink.

• Wash incision each day with mild soap and water and pat dry. Shower water can run over the incision, but do not allow water to directly hit the incision.
• Do not soak or submerge incision in water for 2 weeks.
• If a scab forms, do not pick or scratch it.
• Apply a warm wash cloth over skin for a few minutes to soften scabs and help with itching. Pat the incision dry when done
• Do not apply ointments, lotions, or creams.
• If clothing or the seatbelt causes irritation or friction, place a gauze-type bandage over the incision.  Leaving the incision open to air is best.

Activity:

• Do not swim in lakes or pools for 4  weeks
• No heavy lifting, excessive activity, or strenuous exercise for 4 weeks
• Do not make quick and sudden arm movements or put weight on that arm. This includes no backpacks, messenger bags, or purses on the side of the VNS for 2 weeks

Medicine:

• Anti-seizure medication – continue taking the same medications as before the surgery.
• Pain medicine – take acetaminophen (Tylenol®) or Ibuprofen (Advil®) for pain or discomfort at the surgical site.

Who do I call for incision concerns, seizures or device programming?

Call Children's Neurosurgery Clinic at 651-220-5230 if your child has:

• a fever is more than 101.5 F
• uncontrolled pain
• an incision that is red or hot to touch
• drainage/swelling around incisions
• any part of the device is exposed through the skin.

Call Minnesota Epilepsy Clinic (MEG) at 651-241-5290 if your child has:

• voice changes that sound weak or scratchy
• prickly feeling in their skin
• shortness of breath
• sore throat
• increased coughing or choking

Call MEG if there are questions about anti-seizure? medication, changes in seizure activity or VNS programming. If your child  needs to have any medical testing, such as a magnetic resonance imaging (MRI), contact MEG.

You must schedule a follow-up appointment with MEG 2 weeks after the procedure to check the incision and if needed, remove the stitches. The VNS will also be activated at this time.

Questions?

This information is not specific to your child, but provides general information. If you have any questions, please call your clinic.

Reviewed 4/2024

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