Cardioversion and Defibrillation

Michael Francis H. Cahandig, RN, MN

Edited by: MHFacundo
 Cardioversion is the process of restoring the
heart’s normal rhythm from an abnormal
rhythm. It is also referred to as the application
of direct-current or DC current for
cardioversion. Cardioversion is similar to
Cardioversion defibrillation but uses much lower levels of
and electricity.

Defibrillation
Defibrillation is the therapeutic use of
electricity to depolarize the
myocardium so coordinated
contractions can occur.
Cardioversion
 Involves the delivery of a “timed” electrical current to
terminate a tachydysrhythmia

The defibrillator is set to synchronize with the ECG on a cardiac

Cardioversion
monitor so that the electrical impulse discharges during
ventricular depolarization (QRS complex).

The amount of voltage used varies from 50 to 360 J, depending on

the following:
Defibrillator’s Type and duration of Size and hemodynamic
technology the dysrhythmia status of the patient
Steps in
Performing
Cardioversion
1. Prepare Explain Obtain
the Patient procedure consent
2. Prepare
the
Necessary
Equipment
3. Assist
in
Sedation
4. Place and Position
the Paddles
• Place one paddle directly
below the right collarbone.
• Place the other paddle to just
below the left nipple, near the
apex of the heart.
• If using pads, it can be placed
anterolateral position or
anteroposterior position
5. Followed ACLS
Guidelines
• Turn on defibrillator.
• Select the appropriate energy
level.
• Activate the synchronize mode
by pressing the button.
• Check to verify that the
machine is correctly sensing
the R wave.
6. Charge the
machine to
the ordered
energy level.
7. Before
discharging
the current,
call “clear”
three times.
8. Deliver
the shock.
9. Document
the Procedure
10. Do
Aftercare.
 1. Anticoagulation for a few weeks before
cardioversion may be indicated.

Precautions 2. Digoxin is usually withheld for 48 hours

and Nursing before cardioversion to ensure the
Responsibilities resumption of sinus rhythm with normal
conduction.
3. Patient is instructed not to eat or drink for
at least 4 hours before procedure.
 4. Gel-covered paddles or conductor pads are
positioned front and back (anteroposteriorly)
for cardioversion.
5. Moderate sedation IV as well as an
Precautions analgesic medication or anesthesia.
and Nursing
Responsibilities 6. Oxygen support (Face mask or via BVM)

7. Standby: Suction apparatus and set as well

as intubation set
Indications of a Adequate
Adequate
Successful Sinus rhythm peripheral
blood pressure
pulses
Cardioversion
Defibrillation
 Used in emergency situations as the treatment of choice for ventricular
fibrillation and pulseless VT.
Not used for patients who are conscious or have a pulse.
Defibrillation
Depolarizes a critical mass of myocardial cells all at once

When they repolarize, the sinus node usually recaptures its role as the
pacemaker
 Classification of
Defibrillators
Monophasic
• Delivers current in only one direction
and require increased energy loads

Biphasic
• Delivers the electrical charge to the
positive paddle, which then reverses
back to the originating paddle.
• Allows for lower, possibly
nonprogressive energy levels (eg,
150 J with each defibrillation) with
potentially less myocardial damage.
 Considerations

Epinephrine is administered after defibrillation.

Antiarrhythmic medications such as amiodarone, lidocaine, or

magnesium are administered if ventricular dysrhythmia persists.

This treatment with continuous CPR, medication administration,

and defibrillation continues until a stable rhythm resumes or until
it is determined that the patient cannot be revived.
Cardioversion
vs
Defibrillation
Joules in
Defibrillating a
Child
• Current AHA guidelines
recommend an initial
dose of 2 J/kg and
escalating to 4 J/kg if
the first one to two
shocks are
unsuccessful.
• Escalation beyond
4J/kg is not
recommended