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dure for Defibrillation

This procedure is for use by nurses who have attained certification in the delegated act of
defibrillation.
Defibrillation is the application of a controlled electrical shock to terminate ventricular fibrillation
or pulseless ventricular tachycardia. The shock is delivered through the chest wall in an attempt
to completely depolarize the myocardium and provide an opportunity for the SA node to take
over (ACLS). The longer that the myocardium is in VF or VT, the more damage that is done, the
less chance there is of survival. The ONLY effective treatment is defibrillation. The probability of
successful defibrillation diminishes rapidly over time.
NOTE: nurses in the ICU are NOT certified to perform cardioversion; please refer to the cardioversion
procedure
For further information on delegated acts, please refer to the hospital policy:
Certification of Staff in the Performance of Delegated Controlled Acts

Procedure

1. Identify VF/pulseless VT on the monitor--check the patient,


check the leads and confirm pulselessness. If arrest was
witnessed, give precordial thump.

2. Lay pt flat and initiate CPR. Ask a colleague to get the crash
cart.

Rationale
Precordial thump may produce
enough energy to terminate VF if
given early in VF.

Bed surface must be made hard


for CPR to be effective.

NOTE: if pt is on a specialty bed, place the bed on "max inflate"


3.. Plug in the crash cart. Connect the gray cable with the silver
jack end on the defibrillator to the bedside monitor (silver round
outlet above the recorder) to obtain ECG information from the
monitor.

Connecting the crash cart to the


monitor means that you DO NOT
have to put more ECG
electrodes on the pt to obtain an
ECG signal.

4. Apply gel pads ( if using paddles) or pacing/defib


electrodes(Zoll pro-padz).

Pacing/defib electrodes have the


advantage of saving time if a pt
is in and out of a VF --don't have

If applying gel pads:

place one pad on upper chest below the right clavicle


place second pad below the left nipple at the midaxillary
line (see picture below)

If applying pacing/defib electrodes:

to waste time applying pads the


next time the pt goes into VF as
they are already on.

place the round pad on the anterior chest, in between the


left nipple and the sternum with the top of the pad level
with the top of the nipple (see package for placement)
--NOTE: if continuous 12 lead monitoring is being done, it
is recommended that the V leads be removed so that the
electrode can be properly placed
place the rectangular pad on the back behind the front pad
(see picture on the package)
press pads firmly to the edges to remove air pockets
remove the cable from the paddles and attach it to the
pacing/defib electrodes

The breast tissue has a higher


resistance and therefore should
be avoided. In theory since the
resistance is higher it will take
more energy to either convert the
rhythm or get capture.
Placement right over the nipple
tends to be rather painful and
should be avoided.
Arcing may occur if shock is
delivered near an ECG
electrode.

Place gel pads or electrodes at least 2 cm away from electrodes


and 10 cm away from a pacemaker generator
5. Prepare the machine for defibrillation:

turn the selector knob to "defib" setting(see below). The


energy level defaults to 120 joules.

The Zoll defibrillators are


biphasic; this means that the
machine delivers current that

flows in one direction for a


specified duration then reverses
the current to flow in the other
direction. Significantly lower
energy levels are required with
biphasic defibrillators.
6a) If using gel pads and paddles:

Apply the paddles to the chest on the gel pads, ensuring


that the paddles are not in contact with ECG electrodes or
wires.
Charge the defibrillator by pressing "charge" button on the
machine itself;alternatively, the person with the paddles
can press the "charge" button on the side of the
apex(right) paddle. A distinctive charge ready tone sounds
and "DEFIB 120J READY" message will be displayed
Hold the paddles firmly to the chest with 25-30 lbs of
pressure
ensure there is no contact with metal and that all
personnel are away from the bed
call "all clear--I'm shocking on 3--1, 2, 3 "
discharge the shock by simultaneously and firmly
depressing the red buttons on both paddles; hold the
buttons for 2 seconds .The shock should be delivered at
the end of exhalation

Firm pressure is required to


ensure good contact with the
chest.
Air filled lungs decrease
electrical conduction.
Keep the paddles on the chest
so that you are ready to give
another shock if necessary.

keep the paddles on the chest

6b) if using pacing/defib electrodes:

Charge the defibrillator by pressing "charge" button on the


machine. A distinctive charge ready tone sounds and
"DEFIB 120J READY" message will be displayed
ensure that all personnel are away from the bed
call "all clear--I'm shocking on 3--1, 2, 3 "
discharge the shock by pressing the "shock" button on the
machine

7. Immediately charge the defibrillator to 150 J by pressing the


up arrow on the display ; if VF still present, shock again as

150 is the next energy level on


the biphasic defibrillator.

above.

Rapid, stacked shocks decrease


thoracic impedance and improve
the chances of successful
conversion of VF.

8. Immediately charge the defibrillator to 200 J by pressing the


up arrow on the display; if VF still present, shock again as above.

200J is the next energy level with


a biphasic defibrillator.

9. If VF persists, start CPR and follow ACLS protocol. Continue to


monitor rhythm.

10. Document defibrillation on the cardiac arrest record.

11. Assess skin for burns.


12. Provide information and reassurance to patient and family .

References
1. American Heart Association. (2000)Guidelines 2000 for cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Part 6: advanced cardiovascular life support: 7D. The American Heart
in collaboration with the International Liaison Committee on Resuscitation.Circulation, August 22; 102(8
suppl).
2. Zoll defibrillator M series Operators manual
Developed By : Rachelle McCready, Clinical Educator, Critical Care, ICU-UC
Date: July 2004
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Disclaimer

Contact: Rachelle M
E-mail rachelle.mccready@lh