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Sandhana

1. Defibrillator & infusion pump PRESENTED By Sandhana m sabu 4 th semester B. Sc nursing Govt. College of nursing kottayam

2. Defibrillator Definition A defibrillator is a medical device used to restore normal heart rhythm by delivering an electric shock to the heart in case of life threatening cardiac arrhythmias such as ventricular fibrillation or pulseless ventricular tachycardia

3. INDICATIONS Ventricular fibrillation Pulseless ventricular tachycardia It may also be used in certain cases of unstable tachycardia or atrial fibrillation with rapid ventricular response

4. CONTRAINDICATION Patients who are conscious or have a pulse
Non shockable rhythm – asystole, pulseless electrical activity
Multifocal atrial tachycardia
Dysrhythmia due to enhanced automaticity such as digitalis toxicity.

5. History of defibrillation Defibrillation was invented in by Prevost and Batelli, two Italian physiologists. They discovered that electric shocks could convert ventricular fibrillation to sinus rhythm in dogs. The first case of a human life saved by defibrillation was reported by Beck in 1947.

6. Parts of defibrillator

7. DEFIBRILLATOR ELECTRODES Metal Disc 5 x 10 cm
Types
a. Spoon shaped electrode
b. Paddle type electrode
c. Pad type electrode

8. Electrode position STERNO APICAL POSITION

ANTERIOR POSTERIOR POSITION

BI-AXILLARY POSITION

9. Types of waveform Monophasic waveform :A monophasic waveform delivers electrical shocks in a single direction from one electrode to another. Biphasic waveform: Biphasic shock, the current travels in two phases. In the first phase, the current runs from the first electrode to the second electrode via the patient’s heart .

10. Types of defibrillator Manual external defibrillator Manual internal defibrillator Automated defibrillator Implantable cardioverter defibrillator Wearable cardioverter defibrillator

11. Manual external defibrillator First diagnose the cardiac rhythm and then manually determine the voltage and timing for the electrical shock

12. Manual Internal defibrillator Delivers the shock through paddles directly on the heart.
Used in OT-Open heart surgery

13. Automated external defibrillator Defibrillator having rhythm detection capacity and the ability to advise the operator to deliver a shock using hands free defibrillator pads.
Untrained or briefly trained laypersons.
Fully automated or semi automated

14. Implantable cardioverter defibrillator ICD is primarily used to treat people who have a high risk of sudden cardiac death (SCD) due to certain heart conditions.
It is often recommended for people who have already experienced a life-threatening arrhythmia or have a condition that puts them at high risk of one.

15. Common conditions that may lead to the need for an ICD include:
- Coronary artery disease
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
- Long QT syndrome

16. Wearable cardioverter defibrillator A wearable cardiac defibrillator is a device that is worn externally on the body to detect and treat abnormal heart rhythms, known as arrhythmias. It is typically used by patients who are at risk of sudden cardiac arrest, but who are not currently candidates for an implantable cardioverter defibrillator (ICD).

17. PROCEDURE Confirm cardiac arrest-check for signs of life
CPR should be ongoing Turn the defibrillator on
Stop chest compression confirm VT from the ECG
Turn the defibrillator on
Squeeze generous amount of jelly on the defibrillator paddles
The designated person select the appropriate on the defibrillator. 150-200 J for biphasic defibrillators and 150-360 J for monophasic defibrillators.

18. Press ‘charge’ button to charge the capacitor
While the defibrillator is charging, warn all rescuers other than the individual performing the chest compressions to ‘stand clear’ and remove any oxygen delivery device as appropriate Once the defibrillator is charged, tell the rescuer doing the chest compressions to “stand clear”.
When clear, discharge the current by pressing both paddle of discharge buttons simultaneously. Give shock.
Examine the patient’s ECG to see whether defibrillation has altered the patient’s condition and restored the normal rhythm.

19. Continue CPR for 2 min.
If desired outcome is not restored, defibrillate again following same procedure Perform the 3 counter shocks in rapid succession.
If the patient still has no pulse after 3 initial defibrillations,
Resume CPR
Give supplemental oxygen
Begin administering epinephrine and switch to non shockable algorithm. If further defibrillation is unnecessary, discharge the machine by turning off. Once machine is discharged, clean the paddles and making sure to remove conductive jelly. Any jelly remains the paddle will corrode the metal paddles.

20. Assess patient level of status.
Obtain baseline data/ ABG levels and 12 lead ECG
Provide supplemental oxygen, ventilation Document the procedure.

21. AUTOMATED EXTERNAL DEFIBRILLATOR PATIENT PREPARATION
Assess the patient to determine if he lacks a pulse
Call for help
Perform resuscitation until the defibrillation and other emergency equipment arrive.
As soon as the AED arrives, expose the patient’s chest. PROCEDURE
Turned on or opened AED.

22. AED will instruct the user to
Connect the electrodes (pads) to the patient.
If more than I rescuer is present, continue CPR
Follow the voice directions
Avoid touching the patient to avoid false readings by the unit.
The AED examine the electrical output from heart and determine the patient is in shockable rhythm or not

23. When device determined that shock is warranted, it will charge its internal capacitor in preparation to deliver the schok When charged, the device instructs the us ensure no one is touching the victim or trolley and callout “stand clear”
Then to press a red button to deliver the shock
Continue as directed by voice/ visual prompts

24. Complications Skin burns from the defibrillator paddles are the most common complication of defibrillation.
Other risks include injury to the heart muscle, abnormal heart rhythms, and blood clots.
Myocardial necrosis and myocardial dysfunction
Pulmonary edema

25. Nursing management Monitor cardiovascular status.
Monitor respiratory status
Monitor neurologic status
Initiate IV antiarrhythmic therapy
Monitor for burns
Documentation
Patient/ family education

26. Infusion pumps

27. Infusion pumps DEFINITION • An infusion pump is an external medical device that delivers fluids, such as nutrients and medications, into a patient’s body in controlled amounts.
• Infusion pumps are capable of delivering fluids in large or small amounts, and are used to deliver nutrients or medications – such as or other hormones, antibiotics, chemotherapy drugs, and pain relievers.

28. Indications Administration of intravenous fluids to maintain hydration and electrolyte balance For prevention of fluid overload
Administer specific amount of pharmacologic agent

29. Types of infusion pumps According to principle of working 1.Gravity infusion pump 2.Volumetric pump 3. Patient controlled analgesia pump 4.Syringe pump

30. Types of infusion pumps According to usage 1.Ambulatory /Portable infusion pump 2. Stationary infusion lump 3. Insulin pump 4. Enteral infusion pump 5.Elastomeric Pump 6. Multi- channel infusion pump

31. 7. Multi-channel syringe infusion pump 8.Smart pumps

32. Gravity infusion Device

33. Volumetric pump

34. Patient controlled analgesia pump

35. Syringe infusion pump

36. Ambulatory /portable infusion pump

37. Stationary infusion pump

38. Insulin infusion pump

39. Enteral infusion pump

40. Elastometric infusion pump

41. MuLti - channel infusion pump

42. Multi-channel syringe infusion pump

43. FACTORS TO CONSIDER WHile USING INFUSION PUMPS • Quality of vasculature
• Age of the patient
• IV set
• Medication

44. Features of infusion pump Air filter - Battery backup Flow rate control - Wireless connectivity Volume control Drug library History and logging Alarm & alerts Bolus and intermittent infusion

45. Steps of using infusion pumps • The following are the usual steps /process of using infusion pumps
• Ensure that the machine is plugged properly into suitable electrical socket
• Switch on the machine
• Prepare the materials needed
• Check for expiry date • Flush the primary/secondary to IV pump
• Set rate and volume
• Connect the line to the patient

46. • Start infusion
• Check safety (machine & keep the line untangled)
• Document amount of fluid given

47. PROBLEMS ENCOUNTERED Software problems
Alarm errors
Inadequate user interface
Battery failure
Fire, sparks, charging or shocks

48. WHEN PLUMBING ALARM will SOUND ALARM IN INFUSION WILL SOUND UNDER THE FOLLOWING CONDITIONS:
1.No Flow
2.Clamped tubing
3.High pressure occlusion
4.Device occluded
5.Device infiltrated
6.Volume has been delivered to the patient
7.Previous volume setting has not been deleted from programming

49. Cautions Do no use on aesthetic patients
Do not operate in high pressure oxygen rooms
Do not operate in rooms where chemicals are stored
Do not keep in strong sunlight o any strong light
Do not operate in areas where air pressure decrease or increase spontaneously
Do not expose it to dust, or in presence of corrosive gas in atmosphere

50. Conclusion In conclusion both defibrillators and infusion pump play crucial role in Healthcare settings although in different ways while defibrillator are vital for addressing life cardiac arrhythmias, infusion pumps are essential for delivery precise medication doses to patient despite their differences both devices are importance of Medical Technology in saving life and improving patients outcomes

51. Thank you