In a survey of pediatric patients, 9 (13.8%) of 65 with subcutaneously placed device-pocket transvenous sys- tems developed infection compared with none of the 82 who underwent retropectorally placed systems.90 Hematoma within the pocket that complicates CIED place- ment or invasive manipulation has been identified as a risk factor associated with device placement.19 Therefore, prevention of hematoma during the procedure is desirable, and several inter- ventions have been used, although there are no data to support their use. This can be achieved by meticulous cautery of bleeding sites and consideration of packing the pocket with antibiotic-soaked sponges to provide tamponade while leads are being placed. The application of topical thrombin may be helpful, particularly in anticoagulated patients. Irrigation of the pocket is useful to remove debris and may reveal persistent bleeding that could lead to a pocket hematoma. In addition, irrigation with an antimicrobial-containing solution for pocket cleansing has been used. Use of monofilament suture for closure of the subcuticular layer may avoid superficial postoperative cellulitis. A pressure dressing applied for 12 to 24 hours after skin closure and dressing may further decrease the risk of hematoma formation. In the immediate postoperative period, recent data indicate that low-molecular-weight heparin predisposes to hematoma formation and should be avoided.91 A hematoma should be evacuated only when there is increased tension on the skin. Needle aspiration should otherwise be avoided because of the risk of introducing skin flora into the pocket and subsequent development of infection. Routine ambulatory care follow-up after CIED place- ment to detect early infectious complications has been performed in many centers. Recent data from 1 investiga- tion92 failed to demonstrate the utility of early follow-up and advocated that instead, patients should be instructed to call their implanting physician for development of fever or incision findings of inflammation. 