ELECTROCONVULSIVE THERAPY AND ITS NURSING MANAGEMENT, ECT

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure.

1. ELECTROCONVULSIVE THERAPY AND ITS NURSING MANAGEMENT PRESENTED BY PANKAJ SINGH RANA NURSE PRACTITIONER

2. Electroconvulsive Therapy :- Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure.

3. History- In 1785, the therapeutic use of seizure induction was documented in the London Medical Journal. Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J Meduna .

4. Contd.. Italian Professor of neuropsychiatry Ugo cerletti , and his colleague Lucio Bini in 1937, experimented ECT for the first time on a person. Through the 1940s and 1950s, the use of ECT became widespread.

5. Definition Electroconvulsive therapy ( ECT ), formerly known as electroshock , is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect.

6. Indications The indication for ECT are- Major severe depression. Severe catatonia. Severe psychosis. Schizophrenia. Mania.

7. Mechanism of action the exact mechanism of action of ECT remains elusive. One hypothesis states that ECT possibly affects the catecholamine pathway between the diencephalon and limbic system also involving hypothalamus.

8. Technique- The technique used for ECT administration are of two type- Direct ECT. Modified ECT

9. Electrodes- according to placement of electrodes ECT is of 2 types- Unilateral. Bilateral

10. Drugs used in ECT Atropine 0.6mg Administration of anesthetic agent like propofol 0.75-2-5 mg/kg or thiopentone 2-5mg/kg. ( propofol because it keep gag refelex intact and thio is ultra short acting sedative) Muscle relaxant succinylcholine 0.5-1.5 mg/kg. ( Succinylcholine because it is short acting (15 min max. Before giving we should check the potassium level)

11. Contra indication- Absolute- increase ICP. Relative- Recent MI. Severe Hypertension. CVA. Retinal detachment.

12. Side effects- Effects on memory- The acute effects of ECT can include amnesia. Side effects of general anaesthesia. Confusion. Other.

13. Nursing Care in ECT Providing educational and emotional support. Pre-treatment planning and assessment. Preparing and monitoring the patient during the actual procedure. Post-treatment care and evaluation.

14. Providing Educational and emotional support Explain the procedure to the patient informed consent Respond to patient’s concerns and feelings. Educate the patient concerning the procedure Initiate education interventions based on knowledge deficits.

15. Pre-treatment Nursing care Complete the pre-treatment check list. The patient’s identity is checked and the patient wears an identity bracelet. Ensure safekeeping of the patient’s valuables. NPO for minimum 4 hours before treatment to prevent possible aspiration during anaesthesia.

16. Contd.. The patient’s hair should be clean and dry to allow for electrode contact. Hairpins, bracelets, body piercing should be removed to avoid burns. The patient should be encouraged to pass urine before the treatment to avoid incontinence during the procedure

17. Nursing Care during ECT Procedure Transfer the patient on a trolley from the waiting room to the ECT room on a well padded bed Apply ECG electrodes, BP cuff, and pulse oximetry sensor. Give a short acting anaesthetic agent and succinylcholine Prepare EEG electrodes.

18. Contd.. Prepare scalp and apply electrodes (unilateral vs. Bilateral). Support the shoulder and arms of the patient. Restraint the thigh with the help of a sheet. Hyperextension of the head with support to the chin. Administer oxygen

19. Contd.. Apply jelly to the electrodes Make the observations of the convulsions. The presence of initial tonic stage which lasts for 10-15 seconds followed by clonic stage which lasts for 25-30 sec. Do suction immediately Restore respiration by giving O2 if necessary.

20. Post-ECT Care Observe and record the vital parameters Place the patient on side lying position, clean the secretions Transfer the patient from recovery room .

21. Contd.. Allow the patient to sleep for 30 min to one hour. Reassure the client and reorient to the ward. Allow the patient to have tea or any drinks. Record the procedure.