Guide to using devices in surgical operating rooms

Definition:

Defibrillation is the process of delivering an electric shock to the surface of the heart to suppress an irritated focus in either the atrium or ventricle. It is most effective when administered within 15–20 seconds of the onset of arrhythmia (irregular heartbeat).

This procedure stabilizes the irritated focus, allowing the sinoatrial (SA) node to restore the heart’s natural rhythm.

The energy of the shock is measured in joules (J) and is typically administered as follows:

• First dose: 200 J
• Second dose: 200–300 J
• Third dose: 360 J

Device Description and Operation:

A defibrillator functions both as a monitor and a shock-delivering device.

Steps to Operate the Device:

1. Set the shock energy as per the protocol mentioned above.

2. Select the mode of defibrillation:

• Synchronized (Sync Mode): Delivers the shock in sync with the R wave on the ECG.
• Used for:
• Atrial fibrillation
• Atrial flutter
• Non-Synchronized Mode: Used only for Ventricular Fibrillation (VF), where there is no R wave.

3. Apply a sufficient amount of conductive gel on both paddles and the patient’s skin to prevent burns.

4. Correct placement of paddles:

• The sternum paddle (labeled Sternum) is placed on the right upper chest below the clavicle (collarbone).
• The apex paddle (labeled Apex) is placed at the heart's apex, below the left nipple.

Purpose of Using the Defibrillator:

• To correct irregular heartbeats (arrhythmias).
• To restart the heart in cases of sudden or complete cardiac arrest.

How the Defibrillator Works:

• The device delivers an electric shock through two paddles placed on the patient’s chest.
• This shock forces the heart muscle cells to contract momentarily.
• The electrical charge is stored in a high-voltage capacitor, which takes a few seconds to charge.
• Once charged, an alarm sounds, signaling that the device is ready to deliver the shock.
• The capacitor then releases the stored energy into the patient's body through the paddles, resetting the heart’s electrical activity.

Nursing care  with  defibrillator

Safety and Security Procedures

1. Device Safety Measures:

• Complete electrical isolation between the input and output circuits.
• Each paddle should have a discharge button to release residual energy.
• The device should have both audible and visual alarms to indicate when it is charged.
• The device should include automatic internal discharge to prevent accidental shocks.

2. Patient Safety Measures:

• Apply a sufficient amount of conductive gel to prevent skin burns.
• Firmly press the paddles onto the chest to prevent movement, ensuring that the gel does not create a gap between them, which could cause an ineffective discharge.
• Ensure the patient is not connected to any other electrical medical device during defibrillation.

3. User Safety Measures:

• Clean the paddles thoroughly after use to remove gel residue.
• Do not touch the patient while delivering the shock.
• Never discharge the shock into the air or on adhesive electrode pads.

Steps for Performing Defibrillation

1. Expose the patient's chest.

2. Begin CPR (Cardiopulmonary Resuscitation) immediately.

3. Apply conductive gel on both paddles and the patient’s skin to prevent burns.

4. Set the shock energy level according to the doctor’s instructions.

5. Correct paddle placement:

o   Sternum Paddle: On the upper right chest, below the clavicle (sternum).

o   Apex Paddle: Over the apex of the heart, below the left nipple (apex).

6. Press the charge button.

7. Lift the paddles after delivering the shock.