Download Cardiac Electrical Therapies

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
RF Catheter Ablation System
A Circular Mapping Catheter
Ablation: Pre-Operative
Preparation
• Medications:
– 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– Antiarrhythmic agents are withdrawn at least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.
Indication & Contraindications of
Defibrillation
• Indications
– Pulseless
ventricular
tachycardia (VT)
– Ventricular
fibrillation (VF)
• Contraindications
– awake, responsive
patients
– any arrhythmias in
a patient with a
pulse
Cardioversion
• Synchronized electrical
cardioversion uses a therapeutic
dose of electric current to the
heart at a specific moment in the
cardiac cycle.
• 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
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
Manual
An automated
defibrillators
external
defibrillator
require
(AED) extensive
is much
training
prior
to
simpler to operate.
use
Types of AEDs:
•Fully automated AED
•Semiautomated AED
Advantages of AEDs:
•Speed of operation
•Safer, more effective delivery
•More efficient monitoring
Defibrillator types
• Implantable
Electrodes
Biphasic versus Monophasic
150 to 200 J
Biphasic: more
effective with less
energy
200, 300, 360 J
Monophasic: less
effective with more
energy
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