CHHS16/073

Canberra Hospital and Health Services Clinical ProcedureElective Direct Current (DC) Cardioversion - Adults Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Equipment and Procedure......................................................................................3

Implementation........................................................................................................................ 5

Related Policies, Procedures, Guidelines and Legislation.........................................................5

References................................................................................................................................ 5

Search Terms............................................................................................................................ 5

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS16/073

Purpose

To provide nursing and medical staff at Canberra Hospital and Health Services (CHHS) with clear guidelines on the safe and effective management of adult patients undergoing elective direct current (DC) Cardioversion.

DC Cardioversion is a procedure that optimises patients cardiac output and reduces complications associated with atrial fibrillation/flutter by electrically reverting the heart rhythm to sinus rhythm.

Scope

Alerts

It is essential that the patient: has cardiac monitoring commenced before the procedure then continuously until four

(4) hour post procedure is fasted for six (6) hours prior to procedure has received therapeutic anticoagulation for at least four (4) weeks.

If the patient is fitted with a permanent pacemaker the device will require checking buy a cardiac technician prior to and post cardioversion.

If the patient is fitted with an implantable defibrillator this is used to cardio vert the patient requiring a cardiac technician to be present.

An Advanced Trainee, anaesthetist or anaesthetic registrar and Advanced Cardiac Life Support (ACLS) competent Registered Nurse (RN) must be present during the procedure.

Strict hand hygiene should be adhered to at all times when performing all clinical procedures as per CHHS Healthcare Associated Infections Procedure

Contraindications to DC Cardioversion include: Digoxin toxicity, severe hypokalaemia and patients at high risk for stroke.

Scope

This document pertains to all patients who require elective DC Cardioversion conducted at CHHS.

This procedure applies to the following professionals at CHHS: Coronary Care Unit (CCU) – Cardiologist, Cardiology Advance Trainee (AT), Anaesthetist

or anaesthetic registrar CCU RN ACLS competent.

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CHHS16/073

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Section 1 – Equipment and Procedure

Equipment Cardiac monitor Haemodynamic monitoring equipment Zoll biphasic defibrillator (Medical Emergency Team (MET) trolley) Defibrillator pads 1 litre normal saline Intravenous giving set Hudson mask and oxygen tubing Guedels airway Bag and mask ventilator Suction equipment

Procedure Medical Officer is responsible for explaining the procedure to the patient, obtaining informed consent and admitting the patient.

The RN prepares the patient by: ensuring consent has been signed ensuring patient has been fasting since midnight dressing the patient in a hospital gown ensuring the emergency equipment at the bedside is operational and that the bed area

remains free from clutter recording a baseline set of observations on the CHHS observation chart performing a 12 lead ECG inserting an intravenous (IV) cannula or ensuring patient has an IV cannula inserted as

per Peripheral Intravenous Cannulation CHHS15/116 collecting bloods for urea electrolytes and creatinine, full blood count and INR (if on

Warfarin, target INR for elective procedure greater than 2 international units) and send to pathology

reviewing and reporting pathology results to the anaesthetist and AT cardiology registrar

prime IV giving set with 1 litre of normal saline shaving the left side chest and back for defibrillator pad placement and ensure that the

area is free from electrodes, wires and nitrate patches attaching the patient to Zoll defibrillator monitor as instructed by the AT cardiology

registrar attaching the patient to the central monitor ensuring that the SYNCHRONIZE button is selected on the defibrillator notifying - the anaesthetist and AT cardiology registrar that all is ready.

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CHHS16/073

The dedicated staff members involved in the procedure will confirm the following in accordance with Canberra Hospital Correct Patient, Correct Site, and Correct Procedure Protocol as per CHHS Patient Identification and Procedure Matching Policy (Time Out): informed consent has been obtained the patient's identity – this is to be checked against the patient identification band and

through positive identification e.g. verbal the procedure to be performed and sedation agent to be given the procedure side/site is marked if applicable that all relevant documentation and imaging data are available.

In CCU the AT cardiology registrar: checks that the pads are in correct position and have good skin contact ensures synchronize button is activated on the defibrillator awaits Anaesthetist verbal order for when it is safe to proceed orders the defibrillator mode and correct energy level to the person operating the

defibrillator charges the defibrillator. Registered nurse or medical staff operating the defibrillator loudly calls “stand clear” and checks there are no staff in contact with the bed or patient. when staff are all clear, charge is delivered the shock can be delivered up to three times with increasing joules as per the AT.

The medical officer providing patient sedation: attends sedation as per CHHS Procedural Sedation procedure gives verbal order when it is safe to proceed with defibrillation.

During cardioversion the RN responsibilities include: continuous monitoring of patient’s hemodynamic status ensuring vital signs are documented 3 minutely during procedure.

Post procedure Registered Nurse responsibilities include: monitoring and recording vital signs 3 minutely until patient can maintain a wakeful

state ensuring a clear airway can be maintained and is haemodynamically stable attend an ECG following reversion to sinus rhythm remove the defibrillator pads whilst patient is still sedated if patient is admitted electively they can be discharged by a medical officer 2 hours post

procedure

Prior to discharge ensure patient is alert, orientated and haemodynamically stable. Inform patient of medication requirements post procedure, supply any follow up appointments and provide discharge letter. Advise patient not to drive for 24 hours.

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Implementation

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CHHS16/073

This procedure will be made available on the ACT Health Policy Register. Staff will be notified in team meetings and ward in-services. Information will be incorporated into existing education and training programs. New staff will be informed of this procedure in their orientation to the ward.

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Related Policies, Procedures, Guidelines and Legislation

Procedural Sedation TCH07:005 Peripheral Intravenous Cannulation Adults and Children (Not neonates) CHHS15/116 Pathology Requests and Specimens TCH11:012 Consent and Treatment Policy CHHS16/026 Patient Identification and Procedure Matching Policy CHHS14/051 Medication Handling Policy 4.11, 5.6, 5.7, 5.8, 5.9.5, 5.9.6, 5.9.7, 5.10. CHHS15/086 Vital Signs and Early Warning Scores Procedure CHHS14/048 Healthcare Associated Infections Procedure 2.1,2.2.1 CHHS15/072 Code Blue Response Procedure-Adults, Paediatrics, Neonates Procedure CHHS14/045

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References

Dr Susan Slade, BScApp (Physio), Grad Dip Manip Ther, M Musc Ther, PhD (from Joanna Briggs)

Deakin CD, Nolan JP, Sunde K, Koster RW. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation. 2010; 81:1293-1304.

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Search Terms

Direct Current Cardio Version (DCCV), Atrial Fibrillation, Atrial Flutter, Cardioversion

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CHHS16/073

Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register