Cardiology In Critical Care

Defibrillation Skills Check List

NAME _____________________________ POSITION ____________UNIT_________

EVALUATOR _______________________ POSITION ____________DATE ________

***Critical Performance Elements

yes no
COMPETENCY STATEMENT: Provides care for the patient requiring defibrillation.    
1. Identifies the indications for defibrillation. Performs initial assessment IAW AHA standards.    
2. Assembles the necessary equipment for defibrillation.    
3. Prepares patient and paddles with proper conductive medium.    

1. Turns power "ON" defibrillator. Defaults to 200 joules.

a. Set "lead select" to "paddles" for quick look.

b. *** If other than 200 joules is desired, presses "ENERGY SELECT" and selects the energy desired.

c. *** Presses "CHARGE" on defibrillator front panel or on the Apex paddle. Wait until the indicator stops flashing to indicate fully charged.

d. Checks that defibrillator is in nonsynchronized mode.

   
5. Turns on ECG recorder for continuous printout.    
6. Applies 25lbs/square inch pressure to paddles.    
7. *** States "all clear"" and visually checks that all personnel are clear of contact with bed, patient and equipment.    
8. *** Checks rhythm immediately before discharge.    
9. Depresses both buttons simultaneously and maintains pressure until electrical current delivered.    
10. *** Assesses for conversion of cardiac rhythm.    
11. If unquestionable VF/VT remains, immediately repeats steps 1 through 8 @ 300 joules avoiding any delays. If there is any question about the rhythm, check for pulse.    
12. After 2nd defibrillation, if unquestionable VF/VT remains, immediately repeats steps 1 through 8 @ 360 joules avoiding any delays. If there is any doubt about the rhythm, check for pulse.    
13. If 3rd defibrillation is unsuccessful, continues BCLS and initiates ACLS protocols. Assesses patient status and precipitating factors to prevent further decompensation of patient.    
14. Cleans defibrillator and paddles, discards supplies, and washes hands.    
15. Documents procedure in patient record or cardiac arrest flowsheet.    
16. Verbalizes post-defibrillation nursing care.    
*** = Must performs these critical elements for successful completion.
NOTE: Joules should be adjusted to 2joules/Kg for children. Also please remember to convert to pediatric paddles for children.    

Reference: Advanced Cardiac Life Support, 1994 American Heart Association.

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