ASSISTING THE PATIENT UNDERGOING THORACENTESIS

Equipment
Direct current defibrillator with paddles or multifunctional defibrillator pads. Highly conductive multipurpose electrolyte gel.

PROCEDURE:
Sl. No Nursing Action Preparatory Phase Monitored Patient 1. If ventricular fibrillation is witnessed, precordial thump may be considered. 1 To minimize cerebral ischemia and potentially restart cardiac rhythm. CPR is essential before and after defibrillation to ensure blood supply to the cerebral and coronary arteries. Rationale

Immediately implement cardiopulmonary 2 resuscitation (CPR) until defibrillator is available. Unmonitored patient

Expose anterior chest and move jewelry and transdermal patches away from area.

Jewelry may interfere with electrical current and cause serious burns.

Immediately implement CPR until defibrillator is available. If response time is greater or equal to five minutes, perform two minutes of CPR prior to defibrillation.

To provide oxygenated blood supply to the cerebral and coronary arteries.

Apply multifunctional defibrillator pads or 3. paddles with conductive gel to patient's bare chest.

4.

Apply paddles or multifunctional pads.

4.

Multipurpose electrolyte gel provides better conduction than paddles alone. Do not allow gel to be spread across the chest because this may cause severe burns to the patient's chest and may divert the current from traveling to the heart. The paddles/pads are placed so that

the electrical current flows through as much of the myocardium as possible.

a.

Anterolateral position: Apply one paddle/pad to just the right of the sternum below the clavicle and the other paddle/pad to just the left of the cardiac apex Anteroposterior position: Apply anterior pad over left apex and posterior pad under the infrascapular region. b. In this method, the current directly traverses the heart.

b.

5. 6.

Remove oxygen from immediate area. Turn on defibrillator to the prescribed setting. The American Heart Association recommends that initial defibrillation should be 200 joules for biphasic or 360 joules for monophasic.

5. 6.

Prevents danger of fire or explosion. Biphasic is preferred over monophasic. Means that the machine delivers current that flows in one direction for a specified duration then reverses the current to flow in the other direction. Significantly lower energy levels are required with biphasic defibrillators.

7.

For paddles:

a. b.

Grasp the paddles only by the a. insulated handles. Charge the paddles. Once paddles b. are charged, give the command ALL CLEAR. Look around quickly to make sure everyone is clear from the

To prevent getting shocked. If a person touches the bed, he may get shocked when the patient is defibrillated.

patient and bed. c. Push the discharge buttons located on both of the handles of the paddles while simultaneously exerting 25 lb of pressure to each of the paddles. c. If good skin contact is not maintained, the electrical current may take the path of least resistance and arc from one paddle to the other.

8.

For multifunctional pads: a. Press the charge button on thedefibrillator machine. Once the charge is reached, give the command ALL CLEAR. Look around quickly tomake sure everyone is clear from thepatient and bed.

8.

Multifunctional pads provide handsfree defibrillation

b. 9.

Push the shock button on the defibrillator machine. 9. To oxygenate the patient and restore circulation

Resume CPR immediately after defibrillation. Follow-up Phase

1.

2.

After the patient is defibrillated and rhythm is restored, antiarrhythmics are usually given to prevent recurrent episodes. Continue with intensive monitoring and care.

1.

Any resultant arrhythmia may require appropriate drug intervention.

2.

The patient may remain in an unstable condition.