Hands-Free Defibrillation: What to Do Before the Code Team Arrives

When sudden cardiac arrest occurs, the patient’s chances of survival drop by up to 10% for every minute that defibrillation is delayed. If cardiopulmonary resuscitation (CPR) and defibrillation are not initiated within a few minutes, the chance of survival is slim. So when cardiac arrest occurs in the hospital, every second counts.

In the past, when a patient became unresponsive or was in a life-threatening situation, a nurse would call a code and wait for a code team to arrive. No matter how quickly the code team responded, precious minutes were lost. Now hands-free defibrillation can save time—and lives.

How It Works

Using hands-free defibrillation, the nurse can intervene immediately, even before the code team arrives. The procedure is referred to as hands-free because a nurse doesn’t need to hold the paddles in place to deliver the shock. Instead, the nurse can follow these simple steps:

  • Attach disposable, adhesive electrode pads to the patient. Place one pad on the patient’s anterior chest, directly beneath the right clavicle and another under the fifth intercostal space on the left anterior chest. Or the pads may be positioned to sandwich the heart on the front and back of the patient. 
  • Plug one end of the cable into the defibrillator and the other end into the pads.
  • Set the defibrillator to automated external defibrillation (AED) mode.
  • Let the AED shock the patient, hands-free (The defibrillator analyzes the rhythm, determines the shock needed and delivers it automatically).

If preferred, the nurse can perform hands-free defibrillation in the manual mode. With this option, the nurse controls the rhythms and timing. Here’s how it works:

  • Apply the pads and attach the cable as you would for AED mode.
  • Select the energy level, according to hospital policy (The American Heart Association recommends 200 joules for adults and at least 2 joules/kg for children).
  • Release the charge to deliver the shock.

If the AED mode is used before the code team arrives, they may switch to the manual mode for greater control. Some teams may switch over to paddles, but that’s not required. The self-adhesive pads can deliver as many as 50 shocks before they must be changed and can be left in position for up to 24 hours.

Done Fast, Done Right

Hands-free defibrillation not only prevents a delay while waiting for the code team but also ensures that defibrillation is done correctly, especially when novice nurses or nurses who are not comfortable using paddles are involved. It’s also safer for the user and ensures better electrocardiogram (ECG) rhythm monitoring while allowing the nurse to remain in control of defibrillation if used in the manual mode. Training is usually provided in basic life support classes.

For more information about different defibrillation methods, check out Mosby’s online course ACLS for Healthcare Providers or call 1-866-416-6697.

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