You are on page 1of 4

UNIVERSITY OF NORTH CAROLINA HOSPITALS Nursing Procedure Manual TITLE: PURPOSE: LEVEL: SUPPORTIVE DATA: AED Automated External

l Defibrillation To outline steps for use of the AED. Performed independently by an RN or LPN trained in the procedure. Early defibrillation is the most important link to improve survival for adult non-traumatic cardiac arrest. AEDs are used by staff who are not expected to interpret cardiac rhythms. The AED analyzes the EKG rhythm and advises shock or no shock. When no shock is advised, CPR is continued. The AED mode is not recommended for use on pediatric patients under age 1. CONTENT: STEPS: 1. 2. 3. 4. Dial 6-4111 to activate Code Blue. Start CPR while the AED/defibrillator is being brought to the room. Turn the central dial from OFF to 1 DEFIB (red). Adjust joules for pediatric patients. 3. Note: The AED automatically defaults to 120 joules. 4. For pediatric patients, it will be necessary to dial down the joules using the ENERGY SELECT arrow. Joule selection is based on weight; 2 joules/kg. 5. The preferred placement is anterior/posterior with the anterior pad just below the left breast to the left of the sternum and the posterior pad below the left scapula to the left of the
RL # 4

EQUIPMENT:

Zoll AED/Defibrillator Multifunction pads - Adult Lawson # 050216 - Pediatric Lawson # 050301 Hair clippers (optional)

KEY POINTS:

5.

Apply the multifunction pads to the patient as instructed on package. Roll from one pad edge to the other to avoid trapping air between the gel and the skin. remove transdermal medication

REVISED: August, 2006

UNC HOSPITALS, Nursing Procedure Manual

AED Automated External Defibrillation -

remove jewelry from neck and chest do not place over: implanted pacemaker implanted defibrillator dressings, including any Tegaderm, the Wound V.A.C. drape and the selfadhesive drapes (Ioban) used in the operating room CVADs

spine; sandwich the heart between the pads. An alternative placement is anterior/anterior with one pad below the right clavicle and the other pad below the left breast on the anterior axillary line. Dry the chest/back and/or clip hair as necessary. Excess hair may be removed using the pads themselves. Apply pads and pull off quickly, then apply new pads to chest. KEY POINTS: 6. It is recommended that pads (with the packaged sealed) remain connected to the cable at all times. 8. ANALYZE activates AED mode. Although messages displayed are audible, read all messages aloud. 9. No Shock Advised message is displayed if non-shockable rhythm is detected. Once ANALYZE is pressed, the Zoll AED/defibrillator will automatically announce Press Analyze every minute. However, follow the American Heart Association guidelines (effective 7/1/06) and perform CPR for 2 minutes before reanalyzing. 10. A continuous tone is emitted and the shock button becomes red when the AED/defibrillator is charged and ready to deliver a shock.

STEPS: 6. 7. 8. Connect pads to patient cable. Stop CPR; do not touch patient. Press 2 ANALYZE (red).

9.

No Shock Advised appears on the screen. Check the carotid or femoral pulse and continue CPR for two minutes if the patient is pulseless. After every two minutes of CPR, stop to ANALYZE and repeat pulse check. OR

10. Shock Advised appears on the screen.

11. Call out Clear Patient. Assure that no one is touching the patient or the bed. 12. Press 3 SHOCK (red). 12. Once ANALYZE is selected, the Zoll AED/defibrillator will automatically reanalyze after each shock for a total of 3 shocks. However, follow the American Heart Association guidelines (effective
RL # 4

REVISED: August, 2006

UNC HOSPITALS, Nursing Procedure Manual

AED Automated External Defibrillation -

7/1/06) and shock one time, then perform CPR for 2 minutes before re-analyzing. The AED/defibrillator charges to the preset energy level: first shock 120 joules second shock 150 joules third shock 200 joules subsequent shocks 200 joules STEPS: 13. Reassess the patient by checking the carotid pulse. If no pulse is felt, perform CPR for two minutes. KEY POINTS: 13. Once ANALYZE is pressed, the Zoll AED/defibrillator will automatically announce Press Analyze every one minute. However, follow the American Heart Association guidelines (effective 7/1/06) and perform CPR for 2 minutes before re-analyzing..

14. Repeat steps 8-12. 15. Discontinue Advisory as instructed by the Code Blue team. See Defibrillation procedure. 16. Print summary of event at the completion of the Code Blue, by pressing the Summary button and then choosing PRINT CHART. 17. Return the AED/defibrillator to its storage location and plug power cord into an AC power outlet. Verify that CHARGER light is on. 18. Check that sufficient recorder paper and external adhesive multifunction defib pads are available. 18. Keep 2 packages of multifunction pads, 2 packages of recorder paper and 6 single electrodes in the defib pocket. Attach one unopened package of pads to patient cable. Seal should remain unbroken. 16. The AED/defibrillator memory will store code information for 90 minutes, provided the AED/defibrillator is NOT turned off. PRINT CHART will print summary of rhythms, shocks and times.

19. Clean controls and cable with Vesphene.

REVISED: August, 2006

RL # 4

UNC HOSPITALS, Nursing Procedure Manual

AED Automated External Defibrillation -

DOCUMENTATION: Document on CPR record the time, the number of defibrillations, joules, vital signs, and patient response. Attach the Event Summary to the CPR record. APPROVAL: REVISED: May, 1998 November, 2001 December, 2004 February, 2006 August, 2006 By: Nursing Procedure Committee

REVISED: August, 2006

RL # 4