Cardiology In Critical Care

Cardioversion Skills Check List

NAME ____________________________ POSITION ___________ UNIT __________

EVALUATOR ______________________ POSITION ___________ DATE _________

***Critical Performance Elements YES NO
COMPETENCY STATEMENT: To provide care for the patient requiring synchronized cardioversion.    
1. Identifies the indications for synchronized cardioversion.    
2. Identifies patient, explains procedure, ensures written consent has been obtained if not emergency situation. (If time permits evaluated recent serum electrolytes, digitalis level, and ABG results.    
3. Ensures IV line established if not emergency. (Prepares any medications ordered, checks on conscious sedation requirements).    
4. Obtains baseline VS and rhythm strip, to include EKG if time allows.    
5. Prepares equipment for cardioversion: (Ensure emergency cart & suction available)
  1. Turns "ON" monitor/defibrillator.
  2. *** Attaches ECG leads to patient, choosing lead, which optimizes QRS, complex amplitude.
  3. Applies conductive gel pads to patient’s chest in appropriate position.
  4. *** Presses "SYNC" and confirms placement of marker over QRS complex. If not, adjusts sizeup or down, changes to another lead or repositions ECG electrodes.
  5. *** Presses "ENERGY SELECT" to choose the energy to be delivered.
  6. *** Presses "CHARGE" and waits for completion.
  7. Turns on ECG recorder.
    
6. Applies 25lbs/square-inch pressure to paddles placed appropriately on patient’s chest.    
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 holds pressure until discharge occurs with next detected QRS complex.    
10. *** Assesses pulse and identifies rhythm.    
11.*** If unsuccessful, press "SYNC" again as device automatically returns to asynchronous mode after each synchronized discharge. Repeat steps 4 through 9.    
12. To remove unwanted charge, press ENERGY SELECT.    
13. Cleans paddles and equipment, discards supplies and washes hands.    
14. Documents procedures in patient record or cardiac arrest flowsheet.    
15. Verbalizes need to obtain 12-lead ECG after cardioversion, to monitor patient for complications and provide continued patient education.    

*** = Must perform these critical elements for successful completion.

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

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This page last updated 07/25/10