Defebrilator

7/28/2019 Defebrilator

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ASSISTING THE PATIENT UNDERGOING THORACENTESIS

Equipment Direct current defibrillator with paddles or multifunctional defibrillator pads. Highly conductive multipurpose electrolyte gel.

PROCEDURE:Sl.

No

Nursing Action Rationale

Preparatory Phase

Monitored Patient

1. If ventricular fibrillation is witnessed,

precordial thump may be considered.

1 To minimize cerebral ischemia and

potentially

restart cardiac rhythm.

2 Immediately implement cardiopulmonary

resuscitation (CPR) until defibrillator is

available.

2 CPR is essential before and after

defibrillation to ensure blood supply to

the cerebral and coronary arteries.

Unmonitored patient

1 Expose anterior chest and move jewelry

and transdermal patches away from area.

1 Jewelry may interfere with electrical

current and cause serious burns.

2 Immediately implement CPR until

defibrillator is available. If response time

is greater or equal to five minutes,

perform two minutes of CPR prior to

defibrillation.

2 To provide oxygenated blood supply to

the cerebral and coronary arteries.

3 Apply multifunctional defibrillator pads orpaddles with conductive gel to patient's

bare chest.

3. Multipurpose electrolyte gel providesbetter conduction than paddles alone.

Do not allow gel to be spread across

the chest because this may cause

severe burns to the patient's chest and

may divert the current from traveling

to the heart.

4. Apply paddles or multifunctional pads. 4. The paddles/pads are placed so that


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the electrical current flows through as

much of the myocardium as possible.

b. In this method, the current directly

traverses the heart.

a. Anterolateral position: Apply one

paddle/pad to just the right of the

sternum below the clavicle and the

other paddle/pad to just the left of

the cardiac apex

b. Anteroposterior position: Apply

anterior pad over left apex and

posterior pad under the

infrascapular region.

5. Remove oxygen from immediate area. 5. Prevents danger of fire or explosion.

6. Turn on defibrillator to the prescribed

setting. The American Heart Association

recommends that initial defibrillation

should be 200 joules for biphasic or 360

joules for monophasic.

6. Biphasic is preferred over monophasic.

Means that the machine delivers

current that flows in one direction for a

specified duration then

reverses the current to flow in theother direction. Significantly lower

energy levels are required

with biphasic defibrillators.

7. For paddles:

a. Grasp the paddles only by the

insulated handles.

a. To prevent getting shocked.

b. Charge the paddles. Once paddles

are charged, give the command ALL

CLEAR. Look around quickly to

make sure everyone is clear from

the

b. If a person touches the bed, he may

get shocked when the patient is

defibrillated.


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patient and bed.

c. Push the discharge buttons located

on both of the handles of the

paddles while simultaneously

exerting 25 lb of pressure to each ofthe paddles.

c. If good skin contact is not maintained,

the electrical current may take the

path of least resistance and arc from

one paddle to the other.

8. For multifunctional pads: 8. Multifunctional pads provide hands-

free defibrillation

a. Press the charge button on

thedefibrillator machine. Once the

charge is reached, give the command

ALL CLEAR. Look around quickly

tomake sure everyone is clear from

thepatient and bed.

b. Push the shock button on the defibrillator machine.

9. Resume CPR immediately after

defibrillation.

9. To oxygenate the patient and restore

circulation

Follow-up Phase

1. After the patient is defibrillated and

rhythm is restored, antiarrhythmics areusually given to prevent recurrent

episodes.

1. Any resultant arrhythmia may require

appropriate drug intervention.

2. Continue with intensive monitoring and

care.

2. The patient may remain in an unstable

condition.


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Defebrilator