ELECTROCONVULSIVE

THERAPY

PREPARED BY
RAJESH KUMAR
M.SC.NSG PREVIOUS
SHREE DIGAMBER
DEGREE CCOLLEGE OF
NURSING, BHARATPUR
INTRODUCTION
ECT was first introduced by Cerletti
and Bini in 1938.
DEFINITION:-
Electro-Convulsive Therapy is physical/
somatic therapy in which with the help of
two electrodes, current is passed through
the temporal regions in between the two
hemispheres of the brain, to produce a
grandmal type of seizure.
 Tonic phase lasting for 10 – 15 sec. and
Clonic phase lasting for 30 – 60 sec.
PARAMETERS OF CURRENT APPLIED:-
According to American Psychiatric
Association (1978) :-
Voltages – 70 - 120 volts
Duration – 0.7 – 1.5 sec.
MECHANISM OF ACTION OF ECT-:
Neuro-chemical theory:
Increasing the
catecholemine levels in the brain, accomplished by
blocking reuptake of these neurotransmitters by neurons.
Neuro-endocrine theory:
ECT release hypothalamic or
pituitary hormones or both, which results in its
antidepressant effects.
The electrical activity in the brain that ECT causes includes
increase in blood flow, oxygen levels, and use of glucose in
the brain.
TYPES OF E.C.T.:-
Direct E.C.T. :-
 Direct Method (ECT) is used directly on patients without
anaesthesia & muscle relaxation.
This technique causes a lot of anxiety to the patient.

Modified E.C.T. :-
Modified ECT is the use of anaesthesia (thiopentol sodium
5mg/kg), muscle relaxation (succinyl choline 1 mg/kg )and
oxygenation.
The use of anaesthesia is necessary to allay anxiety and achieve the
maximum effect.
NUMBER AND FREQUENCY OF ECT
TREATMENT :-
Frequency:-
3 times a week.

Total number:-
6-10 upto 25
APPLICATION OF ELECTRODES
• Bilateral placement:-Each electrode is placed 2.5 to
4cm above the midpoint, on a line joining the tragus of
the ear and the lateral canthus of the eye.
Cont…
• Unilateral placement
Electrodes are placed only on one side
of head, usually non dominant
hemisphere.(right side of the head in
right handed person).
INDICATIONS OF E.C.T. :-
1.Major depression.
2. Schizophrenia
3.Mania
4. Post partum dipression
5.Anorexia nervosa
6.Suicidal thoughts and suicidal attempts
CONTRA-INDICATIONS OF E.C.T.
• Increase I.C.P
• Cerebral aneurisms
• Cerebral hemorrhage
• Brain tumor
• Acute M. I
• Congestive cardiac failure
 Severe respiratory diseases
First trimester of pregnancy
Complications
• Life threatening complications are rare.
• Fractures
• Prolonged confusion
• Headache
• Nausea and Vomiting
• Body ache
• Tongue bite, injury to teeth and lips
Side Effects
Memory impairment
Confusion and restlessness.
Weakness and fatigue
Unsteady gate
ECT TEAM:-
Psychiatrist
Anesthesiologist
ECT nurses
Trained attendants
Recovery room nurse
Treatment Facilities
A pleasant, comfortable waiting room.
ECT room with following equipments
 ECT Machine and electrodes
 Suction apparatus
 Face mask
 Oxygen cylinder
 Tongue depressors
 Ambu bag etc.
 Nursing Management
1.Pre ECT Care
Emotional support and education.
TAKE Written consent .
N.B.M. 6 hrs before ECT.
Remove dentures, glasses, jewellery, watch, bangles and metal
pin & oil from hair.
Encourage patient to empty bladder & bowel before ECT.
Give premedication to the patient. e.g. Inj Atropine
Make sure that suction, ET intubations & oxygen Should be
ready in case of emergencies.
Take a patient on a stretcher to the waiting room.
NURSING CARE DURING E.C.T. :-
Place the patient on the ECT table in supine position.
 Assist in administering the anesthetic agent.
Patent airway should be ensured and ventilatory support should be
started.
Mouth gag should be inserted to prevent possible tongue bite.
The site of electrode placement should be cleaned with normal
saline or 25 % bicarbonate solution, or a conducting gel applied.
Monitor voltage, intensity and duration of electrical stimulus given.
Monitor seizure activity.
100 % oxygen should be provided.
During seizure monitor vital signs, ECG, oxygen saturation, etc.
Record the findings and medicines given in the patient's chart.
AFTER ECT CARE :-
Placed patient in one side or rolling cot. (Prevent fall from bed
and prevent aspiration).
Observe and record vital sign.
Assess for confusion and restlessness.
Orient the patient about time, place and person.
Give medication for minor comfort such as headache and nausea.
Provide opportunities to the patient to express his feeling about
treatment.
Take safety precaution to prevent injury.
Documents patient response before and after the treatment
(ECT).
 
THANK YOU