Cardiac Electrical Therapies By Omar AL-Rawajfah, PhD, RN
Outlines What are cardiac electrical therapies Ablation Defibrillation Cardioversion What are the nursing considerations for each type of therapy
Ablation A medical procedure that involves using a radioactive catheter to induces tissue destruction to eliminate source of recurrent arrhythmias Multiple catheters (mapping, ablation, and defibrillation) are inserted through the groins bilaterally up to the right atrium
Ablation Ablation catheter A Circular Mapping Catheter RF Catheter Ablation System
Medications: Ablation: Pre-Operative Preparation Anticoagulants: INR at least 2 for 3 weeks before the procedure Antiarrhythmic agents are withdrawn at least two weeks before the procedure NPO: at least 6 hours before the procedure Routine lab test: KFT, PTT, PT, X-ray, ECG Cardiac studies: Echo, MRI
Ablation: During the Procedure Medications: Sedations Local anesthesia The team often comprises physicians, a physician assistant, RNs, a nurse anesthetist, and an engineer Fluoroscopy imaging Induced arrhythmia Burring sensation
Ablation: After the Procedure Vital signs are monitored Vascular access site is closely monitored by direct visualization for hematoma formation or active bleeding, Anticoagulation medications are resumed Fluid intake Discharge instruction should include how to measure pulse and BP and medication instructions
Defibrillation Defibrillation consists of delivering a therapeutic dose of electrical energy to the heart with a device called a defibrillator Defibrillation is a nonsynchronized (untimed) delivery of energy during any phase of the cardiac cycle This depolarizes a critical mass of the heart muscle, terminates the dysrhythmia and allows normal sinus rhythm to be reestablished by the body's natural pacemaker, in the SA node of the heart.
Indications Pulseless ventricular tachycardia (VT) Ventricular fibrillation (VF) Contraindications awake, responsive patients any arrhythmias in a patient with a pulse Indication & Contraindications of Defibrillation
Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period (or relative refractory period) of the cardiac cycle, which could induce ventricular fibrillation Cardioversion Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle.
Indication of Cardioversion Atrial fibrillation Atrial flutter Ventricular tachycardia Paroxysmal SVT
Contraindication of Cardioversion Dysrhythmias due to enhanced automaticity such as in digitalis toxicity and catecholamineinduced arrhythmia Cardioversion is not only ineffective but is also associated with a higher incidence of postshock ventricular tachycardia/ventricular fibrillation (VT/VF).
Cardioversion: Preparations Elective cardioversion Digitalis is usually discontinued 24-36 hours prior cardioversion Baseline observations - BP pulse and ECG for post procedure comparison Labe tests: KFT, PT, PTT Ensure patient IV access. The patient is connected to the monitoring function of the defibrillator baseline rhythm recorded, Lead selected for recording, Lead II. Sedation is given: short acting general anaesthetics
Cardioversion: Preparations Emergency cardioversion History Short acting general anaesthetics. The patient will require recovery nursing care Gel pad interface or defibrillator pads are applied to the chest The correct positions are to the right of the upper sternum for the sternal pad and paddle and between the left midclavicular line and the left mid axillary line for the apical pad and paddle.
Cardioversion: Preparations Emergency cardioversion Place defibrillator paddles over the gel or defibrillator pads apply 10-12kg of weight; charge machine to the joule level selected by the medical officer. Commencement at 50-150j increasing to 300-360j Ensure bed is clear; no one is in contact. Press the discharge buttons and maintain pressure on the paddles for one second following electrical discharge.
Cardioversion: Post care The procedure will be terminated either by a successful reversion to sinus rhythm or when the medical officer determines that cardioversion will not revert the rhythm. Ensure the patients airway is patent. Patient nursed in the left lateral position until fully conscious. Oxygen administration c/- hudson mask. BP record immediately post procedure at 5 minute intervals for 15 minutes then 15 minute intervals for 2 hours. A 12 lead ECG is recorded within _ an hour of the procedure.
Types Defibrillators Manual external defibrillator Manual internal defibrillator Automated external defibrillator (AED) Implantable cardioverterdefibrillator (ICD)
Manual external defibrillator
Manual internal defibrillator
An automated Manual external defibrillators defibrillator require (AED) extensive is much simpler training to prior operate. to use
Types of AEDs: Fully automated AED Semiautomated AED Advantages of AEDs: Speed of operation Safer, more effective delivery More efficient monitoring
Implantable Defibrillator types
Electrodes
Biphasic versus Monophasic 150 to 200 J 200, 300, 360 J Biphasic: more effective with less energy Monophasic: less effective with more energy
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